Of 71 patients with only bilateral macular drusen, 8 eyes in 7 patients (9.9%) developed exudative maculopathy over an average follow-up of 4.3 years (14.5% cumulative risk). Severe visual loss due to exudative maculopathy occurred in 7 eyes of 6 patients (8.5%) for a 5-year cumulative risk of 12.7%. Features of the drusen were analyzed, but only the association with focal hyperpigmentation (P < 0.001) and more than minimal drusen confluence (P < 0.05) were statistically significant. Older patients had more severe drusen. Photostress test delay did not correlate with visual acuity, age, or severity of drusen.