There have been few studies of the natural history of pigment epithelial detachments associated with choroidal neovascularization, and none confined to subfoveal lesions. We studied the natural history of 55 eyes in 53 patients who had age-related macular degeneration and subfoveal pigment epithelial detachment associated with choroidal neovascularization that was subfoveal or unidentifiable in location. Life table analysis showed that, at 1-year follow-up, 65% had a visual acuity less than 20/200 and 26% had less than 5/200. Age was a significant risk factor for reduction in both initial and final visual acuity. The presence of both hemorrhage and exudate on initial presentation was a significant risk factor for poor initial visual acuity.