Aspirin use linked to AMD

Chicago-Regular aspirin use appears to be associated with an increased risk of neovascular age-related macular degeneration (AMD), which is a leading cause of blindness in older people, and it appears to be independent of a history of cardiovascular disease and smoking, according to a report published by JAMA Internal Medicine.¹

Aspirin is one of the most widely used medications in the world and is commonly used in the prevention of cardiovascular disease, such as myocardial infarction and ischemic stroke.

Gerald Liew, PhD, of the University of Sydney, Australia, and colleagues examined whether regular aspirin use (defined as once or more per week in the past year) was associated with a higher risk of developing AMD by conducting a prospective analysis of data from an Australian study that included four examinations during a 15-year period. Of 2,389 participants, 257 individuals (10.8%) were regular aspirin users.

After the 15-year follow-up, 63 individuals (24.5%) developed incident neovascular AMD, according to the results.

“The cumulative incidence of neovascular AMD among nonregular aspirin users was 0.8% at 5 years, 1.6% at 10 years, and 3.7% at 15 years; among regular aspirin users, the cumulative incidence was 1.9% at 5 years, 7% at 10 years and 9.3% at 15 years, respectively,” the authors note. “Regular aspirin use was significantly associated with an increased incidence of neovascular AMD.”

“One needs to take into question if in fact the aspirin was a causal factor for AMD,” said Diana L. Shectman, OD, FAAO, associate professor of optometry at Nova Southeastern University in Fort Lauderdale, FL, and Optometry Times Editorial Advisory Board member. “Perhaps those patients on aspirin were already sick and had other risk factors associated with the progression of AMD.”

The authors note that any decision concerning whether to stop aspirin therapy is “complex and needs to be individualized.”

“Currently, there is insufficient evidence to recommend changing clinical practice, except perhaps in patients with strong risk factors for neovascular AMD (e.g., existing late AMD in the fellow eye) in whom it may be appropriate to raise the potentially small risk of incident neovascular AMD with long-term aspirin therapy,” the authors conclude.

Says Shectman: “As we move forward in the understanding of the pathogenesis of AMD, we should be cognizant that many over-the counter and prescription drugs as well as vitamins may play a role in AMD. This re-affirms the importance of co-management with the patient’s primary care provider, who is more mindful of the patient’s systemic and medical history.”

Reference:

1. Liew G, Mitchell P, Wong TY, et al. The association of aspirin use with age-related macular degeneration. JAMA Intern Med. 2013. Available at: http://archinte.jamanetwork.com/article.aspx?articleid=1558450. Accessed January 29, 2013.