PURPOSE. To describe the age-, gender-, and cause-specific 5-year incidence of bilateral visual impairment in participants in the Melbourne Visual Impairment Project, Victoria, Australia. METHODS. Participants aged 40 years and older were recruited from Melbourne, Victoria, Australia, by random cluster sampling. The mean age of the 3271 (83% of the eligible) participants was 59 ± 12 (SD) years. Of the participants, 54% were female. The initial baseline study (1992-1994) was followed by a 5-year incidence study (1997-1999). At both time points of the study, participants underwent a standardized testing procedure. Distance and near vision was tested using logarithm of the minimum angle of resolution (logMAR) charts, followed by refraction if needed. Visual fields were assessed by the 24-2 Humphrey field test (FastPac, Humphrey Field Analyzer; Carl Zeiss Meditec, Dublin, CA). Also, intraocular pressure, ocular motility, dilated ophthalmoscopy, and photography of the lens and the fundus were conducted. Furthermore, an interview included demographic characteristics, history of eye disease, medical history, and medication use. For classification of visual impairment, both visual acuity (VA) and visual fields (VF) examination results were used. Four levels of bilateral presenting visual impairment were defined: mild (VA, <20/40 - 20/60, and/or VF, homonymous hemianopia), moderate (VA, <20/60 - 20/200, and/or VF, constriction <20° to 10° from fixation), severe (VA, <20/200-10/200, and/or VF, constriction <10° to 5° from fixation), and profound (VA, <10/200, and/or VF, constriction <5° from fixation). For all participants found to be visually impaired, the major cause was identified. RESULTS. Of the 3040 people eligible to attend follow-up 2594 (85%) participated. Data were available for 2530 (98%) participants. In 105 participants (4.22%; 95% confidence limit 2.58 - 5.85) some degree of visual impairment developed. The main causes were undercorrected refractive error (59%), age-related macular degeneration, cataract and neuro-ophthalmic disorders (7% each), glaucoma (3%), and diabetic retinopathy (1%). The main cause of severe and profound visual impairment was age-related macular degeneration (37%). CONCLUSIONS. Undercorrected refractive error was the primary cause of new cases of visual impairment in this population. Further research is needed to understand the origin of this and to develop appropriate prevention measures. Age-related macular degeneration is the primary cause of severe or profound vision loss in Australia. This disease requires further investigation for effective cure and preventive strategies.