Purpose: To describe the 14-year incidence of age-relatedmaculopathy (ARM) lesions and the related visual loss. Design: Population-based cohort study. Participants: Nine hundred forty-six residents (age range, 60-80 years) of Copenhagen participated in the study from 1986 through 1988. Excluding participants who had died since baseline, 359 persons (97.3%of survivors)were reexamined from 2000 through 2002. Methods: Participants underwent extensive ophthalmologic examinations. Age-related maculopathy lesions were determined by grading color fundus photographs from the examinations using a modified Wisconsin Age-Related Maculopathy Grading System. Main Outcome Measures: Incidence of drusen type and size, pigmentary abnormalities, pure geographic atrophy, exudative ARM, visual impairment, and blindness. Results: The 14-year incidences of early and late ARM were 31.5%and 14.8%, respectively. Individuals 75 to 80 years of age at baseline had significantly (P≤0.05) higher 14-year incidences of the following lesions than those aged 60 to 64 years: medium or large drusen (≥125 μm; 34.2%vs. 12.8%, respectively), soft drusen (45.2%vs. 21.4%), pigmentary abnormalities (31.4%vs. 17.0%), pure geographic atrophy (17.4%vs. 1.0%), and exudative ARM (23.3%vs. 5.7%). Severe drusen type, large drusen, and retinal pigmentary abnormalities at baseline were important predictors of incident late ARM. The 14-year incidences of visual impairment (< 20/40 but > 20/200) or legal blindness from late ARM were 6.0%and 3.4%, respectively. Late ARMcaused 35.7%of all visual impairment and 66.7%of all blindness. Conclusions: There is a high incidence of ARM lesions in this elderly white population. Severe drusen type and size or a combination of drusen and pigmentary abnormalities significantly increases the risk of developing late ARM, the most frequent cause of legal blindness in this population. Purpose: To describe the 14-year incidence of age-related maculopathy (ARM) lesions and the related visual loss. Design: Population-based cohort study. Participants: Nine hundred forty-six residents (age range, 60-80 years) of Copenhagen participated in the study from 1986 through 1988. Invluding persons who had died since baseline, 359 persons (97.3% of survivors) were reexamined from 2000 through 2002. Methods: Participants underwent extensive ophthalmologic examinations. Age-related maculopathy lesions were determined by grading color fundus photographs from the examinations using a modified Wisconsin Age-Related Maculopathy Grading System. Main Outcome Measures: Incidence of drusen type and size, pigmentary abnormalities, pure geographic atrophy, exudative ARM, visual impairment, and blindness. Results: The 14-year incidences of early and late ARM were 31.5% and 14.8%, respectively. Individuals 75 to 80 years of age at baseline had significantly (P ≦ 0.05) higher 14-year incidence s of the following lesions than those aged 60 to 64 years: medium or large drusen (≥125 μm; 34.2% vs. 12.8% respectively), soft drusen (45.2% vs. 21.4%), pigmentary abnormalities (31.4% vs. Severe drusen type, large drusen, and retinal pigmentary abnormalities at baseline were important predictors of incident late ARM. The (17.4% vs 1.0%), and exudative ARM (23.3% vs 5.7% 14-year incidences of visual impairment (<20/40 but> 20/200) or legal blindness from late ARM were 6.0% and 3.4%, respectively. Late ARMcaused 35.7% of all visual impairment and 66.7% of all blindness. Conclusions: There is a high incidence of ARM lesions in this elderly white population. Severe drusen type and size or a combination of drusen and pigmentary abnormalities significantly increases the risk of developing late ARM, the most frequent cause of legal blindness in this population.