1. After adjustments, use of vasodilators or ß-blockers were significantly associated with increased risk of early and late age-related macular degeneration (AMD), respectively.
2. In particular, oral nitroglycerin use was significantly associated with early AMD.
Evidence Rating Level: 2 (Good)
Study Rundown: Vasodilators are thought to stimulate the growth of subretinal vessels due to choroidal perfusion pressure. In this study, the investigators utilized the Beaver Dam Eye Study (BDES) data to assess the impact of various medications on age-related macular degeneration (AMD) risk. As indicated above, vasodilators (specifically oral nitroglycerin) and ß-blockers were found to have significant association with the development of AMD or progression of AMD. Strengths include the use of a strong database and rigorous statistical modeling. Limitations include the fact that these are associations; use of medications may not be causative, and the pathological mechanisms being treated by these medications (e.g., hypertension) may be somehow involved in the development of AMD. In addition, medications were self-reported, and thus may have been incorrect. Dosages of medications and consistency of administration were unavailable. Nonetheless, the study indicates that systemic medications may impact the development of AMD.
Relevant Reading: Ocular Blood Flow Velocity in Age-related Macular Degeneration
In-Depth [longitudinal study]: Data from the BDES was utilized to identify patients with AMD or geographical atrophy (GA). Their medications were also evaluated for vasodilators or ß-blockers. 5-year incidence of early and late AMD over the 20-year study period were 8.4% and 1.4% respectively. AMD progression was 24.9%. After adjusting for age, gender, BMI, physical activity, diabetes, smoking, and mean blood pressure, use of vasodilators (hazard ratio 1.72, p=0.0010) or ß-blockers (hazard ratio 1.71, p=0.0355) were still associated with increased risk of early and late AMD respectively. In particular, oral nitroglycerin use was significantly associated with early AMD (HR 1.81; p=0.0301). Other antihypertensive medications were not associated with increased AMD risk after adjusting for other risk factors. These data seem to suggest that these medication regimens may be associated with the development of AMD.
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