Age-related macular changes in humans over 90 years old

The macula lutea of 23 donors aged 90 to 101 years were examined by light and electron microscopy and compared to maculas from a 49- to 68-year-old age group. The number of foveal photoreceptors and retinal pigment epithelial cells, the presence of macular pigment, and lipofuscin fluorescence were assessed. Pathologic characteristics typical of age-related macular degeneration occurred in nine of the 90- to 101-year-old group with changes ranging from early neovascularization to fully developed disciform scars, geographic atrophy, and macular holes. Several retinas had pigment epithelial and photoreceptor cell numbers equal to those of the younger group, but most showed cell loss. Thickened, debris-filled Bruch's membrane and choriocapillary atrophy, although common, were not an invariable accompaniment to old age. Clinicians should advise elderly patients that their chances of maintaining macular structure, and hopefully function, are better than 50%.