PURPOSE: To assess the relationship between baseline age-related macular degeneration (AMD) and disease stage, as well as optical coherence tomography (OCT) features seen in AMD, with three-year changes in dark adaptation (DA). METHODS: Prospective longitudinal study including patients with AMD and a comparison group (n=42 eyes, 27 patients). At baseline and three years, we obtained color fundus photographs, spectral-domain OCT and rod-mediated dark adaptation (20 minutes protocol). Multilevel mixed effect models were used for analyses, with changes in rod intercept time (RIT) at three years as the primary outcome. As some eyes (n=11) reached the DA testing ceiling value at baseline, we used three-year changes in area under the DA curve (AUDAC) as an additional outcome. RESULTS: Baseline AMD, AMD stage and hyperreflective foci on OCT were associated with larger changes in RIT at three years. When change in AUDAC was used as an outcome in addition to these features, the presence of retinal atrophy and drusenoid pigment epithelial detachment (PED) had significant associations. New subretinal drusenoid deposits at three years was also associated with more pronounced changes in RIT and AUDAC. CONCLUSIONS: Specific OCT features are associated with DA impairments over time, which supports that structural changes predict functional loss over three years.