Cell loss in the aging retina. Relationship to lipofuscin accumulation and macular degeneration

We examined the impact of aging on the numbers of photoreceptors and retinal pigment epithelium (RPE) cells, and the number of photoreceptors per RPE cell profile, in selected regions of 30 human eyes. The mean ratio of photoreceptors to RPE cell was higher in the macula than in the paramacula (P less than 0.01) or the equatorial area (P less than 0.001). We found evidence for an age-related loss of RPE in both whites (P less than 0.02) and blacks (P less than 0.0006), although the rate of loss in whites was significantly slower than in blacks. Photoreceptor loss in blacks was inversely correlated with age (P less than 0.04). In whites, however, photoreceptor loss was very significantly and directly correlated with lipofuscin concentration in the opposing RPE (P less than 0.0001) and unrelated to age. The disparity in the rates of photoreceptor and RPE cell loss produced, in older eyes, a higher ratio of photoreceptors per RPE cell profile. In the macula, the ratio for whites over 50 years of age was significantly higher (P less than 0.05) than that in blacks over 50. Our data suggest that the increased phagocytic and metabolic load on the RPE, which ultimately the macula causes a preferential age-related accumulation of lipofuscin in the RPE, which ultimately leads to photoreceptor death. This may prove a useful model of age-related macular degeneration and Stargardt's disease.