1
|
Robman LD, Wolfe R, Woods RL, Thao LTP, Makeyeva GA, Hodgson LAB, Lepham YA, Jachno K, Phung J, Maguire E, Luong H, Trevaks RE, Ward SA, Fitzgerald SM, Orchard SG, Lacaze P, Storey E, Abhayaratna WP, Nelson MR, Guymer RH, McNeil JJ. Effect of Low-Dose Aspirin on the Course of Age-Related Macular Degeneration: A Secondary Analysis of the ASPREE Randomized Clinical Trial. JAMA Ophthalmol 2024; 142:627-635. [PMID: 38780931 PMCID: PMC11117148 DOI: 10.1001/jamaophthalmol.2024.1584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/29/2024] [Indexed: 05/25/2024]
Abstract
Importance Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss in old age. There is no proven intervention to prevent AMD and, apart from lifestyle, nutritional, and supplement advice, there is no intervention to delay its progression. Objective To determine the impact of long-term low-dose aspirin on the incidence and progression of AMD. Design, Setting and Participants The Aspirin in Reducing Events in the Elderly-AMD (ASPREE-AMD) study was an Australian-based substudy of the ASPREE trial, a multicenter, international, randomized, double-masked, placebo-clinical trial investigating the efficacy of low-dose aspirin in prolonging disability-free survival among older individuals. Retinal photography was conducted at baseline from March 2010 to January 2015, then 3 and 5 years after randomization. AMD status was determined using color retinal images and treatment records. Australian participants in ASPREE aged 70 years and older without dementia, independence-limiting physical disability, cardiovascular disease, or chronic illness limiting 5-year survival and with gradable retinal images at baseline were included. Data were analyzed from December 2022 to December 2023. Interventions Aspirin (100 mg daily, enteric coated) or placebo. Main Outcomes and Measures Incidence of AMD and progression from early/intermediate to late AMD. Outcomes were analyzed by modified intention-to-treat analysis. Results A total of 4993 participants were enrolled in this substudy. Baseline characteristics were similar between groups. At the time of sponsor-determined trial termination, retinal follow-up data were available for 3208 participants, 3171 of whom were analyzed for AMD incidence and progression, with a median (IQR) age of 73.5 (71.5-76.4) years and even sex distribution (1619 [51%] female). Median (IQR) follow-up time was 3.1 (3.0-3.5) years. Cumulative AMD incidence was 195 of 1004 (19.4%) in the aspirin group and 187 of 979 (19.1%) in the placebo group (relative risk [RR], 1.02; 95% CI, 0.85-1.22; P = .86). Cumulative progression from early/intermediate AMD to late AMD was observed in 14 of 615 (2.3%) participants in the aspirin group and 18 of 573 (3.1%) in the placebo group (RR, 0.72; 95% CI, 0.36-1.44; P = .36). Conclusions and Relevance In this trial, low-dose aspirin administered for 3 years did not affect the incidence of AMD. The evidence was weaker for progression of AMD due to low number of progressed cases. Overall, these results do not support suggestion that low-dose daily aspirin prevents the development or progression of AMD. Trial Registration anzctr.org Identifier: ACTRN12613000755730.
Collapse
Affiliation(s)
- Liubov D. Robman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Le Thi Phuong Thao
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Galina A. Makeyeva
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Lauren A. B. Hodgson
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Y-Anh Lepham
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kim Jachno
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - James Phung
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Emily Maguire
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Henry Luong
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ruth E. Trevaks
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Stephanie A. Ward
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Now with the Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Sharyn M. Fitzgerald
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Suzanne G. Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Paul Lacaze
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elsdon Storey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Walter P. Abhayaratna
- Cardiovascular Medicine, College of Medicine, Biology and Environment, Australian National University, Canberra Australian Capital Territory, Australia
| | - Mark R. Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Robyn H. Guymer
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
2
|
Yan R, Zhao J, Zhang X, Wang W, Jiang Z. Association Between Aspirin Usage and Age-Related Macular Degeneration: An Updated Systematic Review and Meta-analysis. Front Pharmacol 2022; 13:824745. [PMID: 35401184 PMCID: PMC8990128 DOI: 10.3389/fphar.2022.824745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: To investigate the association between long-term use of aspirin and age-related macular degeneration (AMD).Methods: An updated systematic literature search was conducted in PubMed, Medline, Cochrane Library, and embase from conception to February 26, 2021, without any language restriction. All studies that evaluated the relationship between long-term aspirin use and AMD were included.Results: In the current study, 16 articles were pooled. Overall, no significant association was observed (estimate ratio = 1.108, 95% confidence interval (CI): 0.886–1.385). When the subgroups were evaluated according to various standards, aspirin use was significantly correlated with AMD in studies with volunteer participants (estimate ratio = 0.899, 95% CI: 0.830–0.974, p < 0.01), studies followed up for >10 years (estimate ratio = 2.206, 95% CI: 2.124–2.292, p < 0.01), duration of aspirin use >10 years (estimate ratio = 2.323, 95% CI: 2.234–2.416, p < 0.01), and cohort studies (estimate ratio = 1.961, 95% CI: 1.893–2.032, p < 0.01).Conclusion: Therefore, the association of aspirin and AMD can be demonstrated with a long-term follow-up or aspirin use, appropriate study design and participant source. The findings in our study might provide practical information on intervention strategies.
Collapse
|
3
|
Non-steroidal Anti-inflammatory Drug Use and Risk of Age-Related Macular Degeneration in the California Teachers Study. Drugs Aging 2021; 38:817-828. [PMID: 34309807 PMCID: PMC8419134 DOI: 10.1007/s40266-021-00885-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2021] [Indexed: 11/28/2022]
Abstract
Purpose The aim of this study was to examine whether use of regular aspirin and/or other non-steroidal anti-inflammatory drugs (NSAIDs) is associated with the development of age-related macular degeneration (AMD). Methods In the California Teachers Study cohort (N = 88,481) we identified diagnoses of AMD up to December 31, 2012 by linkage to statewide hospital discharge records. Aspirin, ibuprofen, other NSAIDs, and acetaminophen use and comprehensive risk factor information were collected via self-administered questionnaires at baseline in 1995–1996 and a follow-up questionnaire in 2005–2006. We employed Cox proportional hazard regression to model AMD risk. Results We did not find any associations between AMD and frequency and duration of aspirin or ibuprofen use reported at baseline. In the subsample with more specific information on medication use, we observed a 20% decrease in risk of AMD among low-dose aspirin users (HR 0.81, 95% CI 0.70–0.95) and a 55% decrease among cyclooxygenase-2 (COX-2) inhibitor users (HR 0.45, 95% CI 0.26–0.78) during 6.3 years of average follow-up. Conclusion The decrease in risk of intermediate- or late-stage AMD among women who reported regular use of low-dose aspirin or specific COX-2 inhibitors suggests a possible protective role for medications with COX-2 inhibitory properties or aspirin at doses used for cardiovascular disease prevention.
Collapse
|
4
|
Lee WJA, Yang YHK, Cheng CL. Risk of age-related macular degeneration in aspirin users and non-aspirin users: A population-based cohort study in Taiwan. Pharmacoepidemiol Drug Saf 2020; 30:178-188. [PMID: 33009703 DOI: 10.1002/pds.5145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 09/08/2020] [Accepted: 09/28/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND The association between cardioprotective aspirin and risk of age-related macular degeneration (AMD) is still controversial up to date. We aimed to analyze the risk of AMD between aspirin users and non-aspirin users. METHOD This was a retrospective cohort study by using claims data from the National Health Insurance Research Database. Patients aged more than 45 years old who initiated aspirin during 2002 to 2012 were followed till 2013. We first selected an age and sex-matched cohort, then identified aspirin users and non-aspirin users as propensity score-matched cohort. Cox proportional hazard regression model was applied to compare their hazards and 95% confidence intervals. Incidence of newly developed AMD, neovascular AMD, and other-AMD was calculated. RESULTS We identified 204 085 regular aspirin users and 478 048 non-aspirin users from our datasets. The univariate HR was 2.85 (95% CI, 2.75-2.96), and the multivariate HR was 2.54 (95% CI, 2.44-2.65). In the PS-matched cohort, the HR was 2.38 (95% CI, 2.25-2.52). The incidence of aspirin users for AMD risk was 11.95 per 1000 person-year, while the incidence of non-aspirin users was only 3.92 per 1000 person-year. CONCLUSION Patients with regular use of aspirin had higher risk in developing AMD compared to non-aspirin users and suggest to have regular visual acuity and funduscopic examination.
Collapse
Affiliation(s)
- Wan-Ju Annabelle Lee
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan
| | - Yea-Huei Kao Yang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,School of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Health Outcome Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Lan Cheng
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,School of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Health Outcome Research Center, National Cheng Kung University, Tainan, Taiwan.,Department of Pharmacy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
5
|
Robman LD, Phuong Thao LT, Guymer RH, Wolfe R, Woods RL, Hodgson LAB, Phung J, Makeyeva GA, Le-Pham YA, Orchard SG, Suleiman J, Maguire E, Trevaks RE, Ward SA, Riaz M, Lacaze P, Storey E, Abhayaratna WP, Nelson MR, Ernst ME, Reid CM, McNeil JJ. Baseline characteristics and age-related macular degeneration in participants of the "ASPirin in Reducing Events in the Elderly" (ASPREE)-AMD trial. Contemp Clin Trials Commun 2020; 20:100667. [PMID: 33210016 PMCID: PMC7658662 DOI: 10.1016/j.conctc.2020.100667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/22/2020] [Accepted: 10/03/2020] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To describe the baseline participant characteristics in the ASPREE-AMD study, investigating the effect of aspirin on AMD incidence and progression. METHODS Australian participants from the ASPirin in Reducing Events in the Elderly (ASPREE) trial, randomized to 100 mg aspirin daily or placebo, had non-mydriatic, digital color fundus images graded according to the Beckman AMD classification. Associations with AMD were determined for baseline characteristics and genetic risk variants. RESULTS ASPREE-AMD sub-study enrolled 4993 participants with gradable macular images. Median age was 73.4 years (IQR, 71.5, 76.6), 52% were female, 10% had diabetes mellitus, 73% had hypertension, and 44% were former/current smokers. Early, intermediate and late AMD (detected in 20.6%, 16.1%, 1.1%, respectively), significantly associated with age, were also associated with increasing HDL levels: OR = 1.52 (95%CI, 1.26, 1.84), OR = 1.43 (1.17, 1.77) and OR = 1.96 (1.02, 3.76), respectively. Female sex was associated with early [OR = 1.37 (1.16, 1.62)], and intermediate [OR = 1.35 (1.12, 1.63)] AMD, as was previous regular use of aspirin, with OR = 1.46 (1.11, 1.92) and OR = 1.37 (1.01, 1.85), respectively. Current smoking had increased odds for late AMD, OR = 4.02 (1.42, 11.36). Genetic risk variant rs3750846 (ARMS2/HTRA1) was associated with each AMD stage (p < 0.001), risk variants rs570618 and rs10922109 (CFH) with intermediate and late AMD (p < 0.001), and rare variant rs147859257 (C3) with late AMD (p < 0.001). The randomized groups were well balanced for all analyzed AMD risk factors. CONCLUSIONS Observed associations are typical of AMD. The ASPREE-AMD clinical trial provides a unique opportunity to determine the risks and benefits of low-dose aspirin for AMD incidence and progression in elderly population. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry: ACTRN 12613000755730.
Collapse
Affiliation(s)
- Liubov D. Robman
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia,Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Department of Surgery (Ophthalmology), University of Melbourne, 32 Gisborne Street, East Melbourne, VIC, 3002, Australia,Corresponding author. Department of Epidemiology & Preventive Medicine, Monash University, ASPREE Coordinating Centre, 99 Commercial Road, Melbourne, 3004, Victoria, Australia.
| | - Le Thi Phuong Thao
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Robyn H. Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Department of Surgery (Ophthalmology), University of Melbourne, 32 Gisborne Street, East Melbourne, VIC, 3002, Australia
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Robyn L. Woods
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Lauren AB. Hodgson
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Department of Surgery (Ophthalmology), University of Melbourne, 32 Gisborne Street, East Melbourne, VIC, 3002, Australia
| | - James Phung
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Galina A. Makeyeva
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Department of Surgery (Ophthalmology), University of Melbourne, 32 Gisborne Street, East Melbourne, VIC, 3002, Australia
| | - Y-Anh Le-Pham
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Suzanne G. Orchard
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Jewhara Suleiman
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Emily Maguire
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Ruth E. Trevaks
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Stephanie A. Ward
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Moeen Riaz
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Paul Lacaze
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Elsdon Storey
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Walter P. Abhayaratna
- College of Health and Medicine, The Australian National University, Canberra, ACT, 0200, Australia
| | - Mark R. Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA, 52242, USA
| | - Christopher M. Reid
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - John J. McNeil
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | | |
Collapse
|
6
|
Lad EM. Does Aspirin Worsen Macular Degeneration in a Clinically Meaningful Way? Ophthalmology 2019; 126:1657-1658. [PMID: 31759501 DOI: 10.1016/j.ophtha.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/03/2019] [Accepted: 08/06/2019] [Indexed: 11/16/2022] Open
|
7
|
Keenan TD, Wiley HE, Agrón E, Aronow ME, Christen WG, Clemons TE, Chew EY. The Association of Aspirin Use with Age-Related Macular Degeneration Progression in the Age-Related Eye Disease Studies: Age-Related Eye Disease Study 2 Report No. 20. Ophthalmology 2019; 126:1647-1656. [PMID: 31358390 DOI: 10.1016/j.ophtha.2019.06.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/09/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To analyze the potential association between aspirin use and progression of age-related macular degeneration (AMD). DESIGN Two prospective cohort studies within 2 controlled clinical trials of oral supplementation for age-related eye disease. PARTICIPANTS Age-Related Eye Disease Study (AREDS) participants 55 to 80 years of age and AREDS2 participants 50 to 85 years of age. METHODS Propensity scores for aspirin use were calculated for AREDS and AREDS2 participants separately by logistic regression. Of the participants without late AMD (geographic atrophy [GA] or neovascular AMD) in either eye at study baseline, aspirin users were matched 1:1 with nonusers by propensity score (separately for AREDS and AREDS2). Proportional hazards regression was performed, adjusting for age, on the matched participants to evaluate associations between aspirin propensity score and progression to late AMD (and its subtypes). MAIN OUTCOME MEASURES Progression to late AMD on color fundus photographs, graded centrally. RESULTS Of the 3734 eligible AREDS participants, 1049 (28.1%) were taking aspirin, and of the 2403 eligible AREDS2 participants, 1198 (49.9%) were taking aspirin. After matching by propensity score, the characteristics of the users and nonusers were similar in both studies. Of the 1950 matched AREDS participants and 1694 matched AREDS2 participants, over a median follow-up of 10.1 years and 5.0 years, respectively, the numbers who progressed to late AMD, GA, or neovascular AMD were 454 (23.3%), 345 (17.7%), and 278 (14.3%), respectively, in AREDS and 643 (38.0%), 402 (24.6%), and 341 (20.1%) in AREDS2. The hazard ratios of progression in quintile 5 (highest propensity for aspirin use) versus 1 (reference) were 1.17 (P = 0.35), 1.24 (0.25), and 0.95 (0.81), respectively, in AREDS and 1.26 (0.09), 1.46 (0.03), and 1.12 (0.58) in AREDS2. No significant association with progression to late AMD was observed for quintiles 2 through 5 for any of the 3 outcomes in either study. CONCLUSIONS Aspirin use was not associated significantly with progression to late AMD or its subtypes in either the AREDS or AREDS2. Patients with AMD need not avoid aspirin for this reason when its use is medically indicated.
Collapse
Affiliation(s)
- Tiarnan D Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Henry E Wiley
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Elvira Agrón
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Mary E Aronow
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - William G Christen
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland.
| | | |
Collapse
|
8
|
Modjtahedi BS, Fong DS, Jorgenson E, Van Den Eeden SK, Quinn V, Slezak JM. The Relationship Between Nonsteroidal Anti-inflammatory Drug Use and Age-related Macular Degeneration. Am J Ophthalmol 2018; 188:111-122. [PMID: 29360460 DOI: 10.1016/j.ajo.2018.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 01/08/2018] [Accepted: 01/10/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE To describe the relationship between the incidence of age-related macular degeneration (AMD) and nonsteroidal anti-inflammatory drug (NSAIDs) use. DESIGN Prospective cohort study. METHODS This study consisted of participants in the California Men's Health Study. Those who completed surveys in 2002-2003 and 2006 were included. Men who self-reported use of aspirin, ibuprofen, naproxen, valdecoxib, celecoxib, and/or rofecoxib at least 3 days per week were considered NSAID users. Patients were categorized as non-users, former users, new users, or longer-term users based on survey responses. NSAID use was also categorized by type: any NSAIDs, aspirin, and/or non-aspirin NSAIDs. Age, race/ethnicity, smoking status, education, income, alcohol use, and Charlson comorbidity index score were included in the multivariate analysis as risk factors for AMD. RESULTS A total of 51 371 men were included. Average follow-up time was 7.4 years. There were 292 (0.6%) and 1536 (3%) cases of exudative and nonexudative AMD, respectively. Longer-term use of any NSAID was associated with lower risk of exudative AMD (hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.50-0.96, P = .029). New users of any NSAIDs (HR = 0.79, 95% CI 0.68-0.93, P = .0039) and aspirin (HR = 0.82, 95% CI 0.70-0.97, P = .018) had a lower risk of nonexudative AMD, although this trend did not persist in longer-term users. The relationship between exudative or nonexudative AMD and the remaining categories of NSAID use were not significant. CONCLUSION The overall impact of NSAIDs on AMD incidence is small; however, the lower risk of exudative AMD in longer-term NSAID users may point to a protective effect and deserves further study as a possible mechanism to modulate disease risk.
Collapse
Affiliation(s)
- Bobeck S Modjtahedi
- Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, California; Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, California.
| | - Donald S Fong
- Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, California; Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, California; Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California
| | - Eric Jorgenson
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | | | - Virginia Quinn
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California
| | - Jeffrey M Slezak
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California
| |
Collapse
|
9
|
Buitendijk GHS, Schauwvlieghe ASME, Vingerling JR, Schlingemann RO, Klaver CCW. Antiplatelet and Anticoagulant Drugs Do Not Affect Visual Outcome in Neovascular Age-Related Macular Degeneration in the BRAMD Trial. Am J Ophthalmol 2018; 187:130-137. [PMID: 29330064 DOI: 10.1016/j.ajo.2018.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 12/27/2017] [Accepted: 01/01/2018] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine if use of antiplatelet or anticoagulant (AP/AC) medication influences visual acuity in patients with active neovascular age-related macular degeneration (N-AMD). DESIGN Retrospective analysis of data from a randomized controlled trial. METHODS Setting: Multicenter. STUDY POPULATION Total of 330 patients with active N-AMD from the BRAMD study, a comparative trial between bevacizumab and ranibizumab in the Netherlands. OBSERVATION PROCEDURES Patients underwent an extensive ophthalmic examination. Visual acuity was categorized into functional vision (best-corrected visual acuity [BCVA] ≥ 0.5), visual impairment (BCVA < 0.5), and severe visual impairment (BCVA < 0.3). Fundus photographs were graded for presence of retinal or subretinal hemorrhages. Information on AP/AC medication was obtained through interview. Logistic regression analysis was used to determine associations between AP/AC medication and outcomes. Frequency of hemorrhages in users and non-users stratified for visual acuity categories was analyzed with ANCOVA. MAIN OUTCOME MEASURES BCVA and presence of hemorrhages. RESULTS In total, 40.9% of the patients used AP/AC medication, of which 73.3% was aspirin. AP/AC use was not associated with visual impairment (adjusted odds ratio [OR] 0.79; 95% confidence interval [CI] 0.43-1.44) or severe visual impairment (adjusted OR 0.75; 95% CI 0.40-1.43). Patients on AP/AC presented with comparable frequencies of hemorrhages (27% vs 32%, P = .32, respectively). Similar results were found when analyses were restricted to aspirin users only. CONCLUSION In our study, use of AP/AC medication was associated neither with visual decline nor with the occurrence of hemorrhages in patients with active N-AMD.
Collapse
Affiliation(s)
- Gabriëlle H S Buitendijk
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Johannes R Vingerling
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Reinier O Schlingemann
- Department of Ophthalmology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; Ocular Angiogenesis Group, Departments of Ophthalmology and Cell Biology and Histology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; Netherlands Institute for Neurosciences, Amsterdam, Netherlands
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands; Department of Ophthalmology, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands.
| |
Collapse
|
10
|
|
11
|
Age-related macular degeneration in a randomized controlled trial of low-dose aspirin: Rationale and study design of the ASPREE-AMD study. Contemp Clin Trials Commun 2017; 6:105-114. [PMID: 28736754 PMCID: PMC5518696 DOI: 10.1016/j.conctc.2017.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Purpose Although aspirin therapy is used widely in older adults for prevention of cardiovascular disease, its impact on the incidence, progression and severity of age-related macular degeneration (AMD) is uncertain. The effect of low-dose aspirin on the course of AMD will be evaluated in this clinical trial. Design A sub-study of the ‘ASPirin in Reducing Events in the Elderly’ (ASPREE) trial, ASPREE-AMD is a 5-year follow-up double-blind, placebo-controlled, randomized trial of the effect of 100 mg daily aspirin on the course of AMD in 5000 subjects aged 70 years or older, with normal cognitive function and without cardiovascular disease at baseline. Non-mydriatic fundus photography will be performed at baseline, 3-year and 5-year follow-up to determine AMD status. Primary outcome measures The incidence and progression of AMD. Exploratory analyses will determine whether aspirin affects the risk of retinal hemorrhage in late AMD, and whether other factors, such as genotype, systemic disease, inflammatory biomarkers, influence the effect of aspirin on AMD. Conclusion The study findings will be of significant clinical and public interest due to a potential to identify a possible low cost therapy for preventing AMD worldwide and to determine risk/benefit balance of the aspirin usage by the AMD-affected elderly. The ASPREE-AMD study provides a unique opportunity to determine the effect of aspirin on AMD incidence and progression, by adding retinal imaging to an ongoing, large-scale primary prevention randomized clinical trial.
Collapse
|
12
|
Michalska-Małecka K, Regucka A, Śpiewak D, Sosnowska-Pońska M, Niewiem A. Does the use of acetylsalicylic acid have an influence on our vision? Clin Interv Aging 2016; 11:1567-1574. [PMID: 27843305 PMCID: PMC5098504 DOI: 10.2147/cia.s115234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Acetylsalicylic acid (ASA) is one of the most commonly used drugs in the world due to its anti-inflammatory, analgesic, and antipyretic properties. This review aims to describe the relationship between acetylsalicylic acid and age-related macular degeneration (AMD) - a chronic disease that causes deterioration of visual acuity and is one of the most common ophthalmological diseases these days. METHODS Data presented in this review were collected from both research and review articles concerning ophthalmology and pharmacology. RESULTS The results of the studies analyzed in this review are not unambiguous. Moreover, the studies are not homogenous. They differed from one another in terms of the number of patients, the age criteria, the ASA dose, and the duration of control period. The reviewed studies revealed that ASA therapy, which is applied as a protection in cardiovascular diseases in patients with early forms of AMD and geographic atrophy, should not be discontinued. CONCLUSION On the basis of the present studies, it cannot be unequivocally said whether ASA influences people's vision and if people endangered with AMD progression or who are diagnosed with AMD should use this drug. It may increase the risk of AMD, but it can also reduce the risk of life-threatening conditions. The authors suggest that in order to avoid possible risks of AMD development, people who frequently take ASA should have their vision checked regularly.
Collapse
Affiliation(s)
- Katarzyna Michalska-Małecka
- Department of Ophthalmology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland; University Clinical Center, University Hospital Medical University of Silesia, Katowice, Poland
| | - Agnieszka Regucka
- University Clinical Center, University Hospital Medical University of Silesia, Katowice, Poland
| | - Dorota Śpiewak
- University Clinical Center, University Hospital Medical University of Silesia, Katowice, Poland
| | | | - Alfred Niewiem
- University Clinical Center, University Hospital Medical University of Silesia, Katowice, Poland
| |
Collapse
|
13
|
Goyal S, Lyzogubov VV, Ali O, Bora PS, Bora NS, Uwaydat SH. Effect of aspirin on models of retinal pigment epithelium pathology. Clin Exp Ophthalmol 2016; 44:610-617. [PMID: 26861462 DOI: 10.1111/ceo.12721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 01/27/2016] [Accepted: 01/31/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND To characterize the effect of aspirin (ASA) in mouse models of choroidal neovascularization (CNV) and retinal degeneration. METHODS In vivo: Male C57BL/6 mice were given ASA in food or regular rodent diet. CNV was induced by argon laser photocoagulation. Subretinal injections of polyethylene glycol 400 (PEG-400) were administered to induce retinal degeneration. CNV size, laser spot area and mean intensity of VEGF in the laser injured zones were measured. In the PEG injected eyes the thickness of retinal pigment epithelium (RPE) and choroid was measured. In vitro: Human ARPE-19 cells were treated with 0.5 or 2.0 mM/L of ASA for 72 h. ELISA was used to measure the concentration of VEGF and CCL-2 in the supernatants. Additionally, damaged RPE monolayer was treated with ASA (0.5 or 2.0 mM/L) and vehicle separately. Size of damaged area was measured. ELISA was used to measure secretion of VEGF-A and CCL-2 by damaged cells after 24 h. RESULTS No statistically significant effect of ASA on CNV size, laser spot size or VEGF expression was noted in CNV model. In the PEG model, ASA did not have any effect on RPE and choroid thickness; however, a significant increase in RPE atrophy was observed (P = 0.02 + 38%). In addition, ASA had a significant effect on the ability of the RPE cells to regenerate and become confluent after mechanical damage. CONCLUSIONS ASA at doses consumed clinically for various medical causes may not worsen CNV in human subjects. However, ASA may increase RPE atrophy when consumed over long periods of time.
Collapse
Affiliation(s)
- Sunali Goyal
- Department of Ophthalmology, Jones Eye Institute, Pat and Willard Walker Eye Research Center University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
| | - Valeriy V Lyzogubov
- Department of Ophthalmology, Jones Eye Institute, Pat and Willard Walker Eye Research Center University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Omair Ali
- Department of Ophthalmology, Jones Eye Institute, Pat and Willard Walker Eye Research Center University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Puran S Bora
- Department of Ophthalmology, Jones Eye Institute, Pat and Willard Walker Eye Research Center University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Nalini S Bora
- Department of Ophthalmology, Jones Eye Institute, Pat and Willard Walker Eye Research Center University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sami H Uwaydat
- Department of Ophthalmology, Jones Eye Institute, Pat and Willard Walker Eye Research Center University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| |
Collapse
|
14
|
Fox AR, Chew EY, Meyerle C, Vitale S, Ferris FL, Nussenblatt RB, Sen HN. Age-related macular degeneration in patients with uveitis. Br J Ophthalmol 2016; 101:342-347. [PMID: 27154918 DOI: 10.1136/bjophthalmol-2016-308587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/09/2016] [Accepted: 04/14/2016] [Indexed: 11/04/2022]
Abstract
PURPOSE To evaluate the prevalence of large drusen in a uveitis clinic population. DESIGN Retrospective, cohort study. METHODS Patients with primary, non-infectious uveitis 55 years or older who were seen at the National Eye Institute of the National Institutes of Health from 2004 through August 2013 were reviewed using electronic medical records and photographic databases. Patients were classified as having age-related macular degeneration (AMD) if either eye had large drusen, geographic atrophy or neovascular AMD according to definitions used by the Eye Diseases Prevalence Research Group (EDPRG). The expected number of cases and standardised mortality ratio (SMR) for large drusen were estimated based on EDPRG estimates. RESULTS We identified 177 patients aged ≥55 years as having primary non-infectious uveitis; 170 (96.0%) had gradable fundus photos. Average age was 65.0±7.5 years (range 55-87), and 87 were non-Hispanic white, 66 non-Hispanic black, 6 Hispanic white and 11 of other race/ethnicity. Large drusen were identified in four patients (2.4%; 95% CI 0.6 to 6.0). No patients were identified to have late AMD. In the uveitis cohort, the SMR for cases of large drusen, which was adjusted for age, was calculated to be 0.32 (95% CI 0.12 to 0.70) for the whole cohort, 0.28 (95% CI 0.09 to 0.79) for non-Hispanic whites and 0.46 (95% CI 0.14 to 1.29) for non-Hispanic blacks. CONCLUSIONS Large drusen prevalence among patients with uveitis ≥55 years of age appears less than the prevalence in the general US population after accounting for differences in age distribution, especially for non-Hispanic whites. Although the racial and gender distribution in this study population is not directly representative of the general US population, results of this study suggest possible sparing of patients with uveitis from AMD. A larger systematic study with greater power would be needed to confirm these findings.
Collapse
Affiliation(s)
- Austin R Fox
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Emily Y Chew
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Catherine Meyerle
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan Vitale
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Frederick L Ferris
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
15
|
Reprint of: Aspirin use and early age-related macular degeneration: a meta-analysis. Can J Ophthalmol 2015; 50 Suppl 1:S29-33. [DOI: 10.1016/j.jcjo.2015.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 08/02/2013] [Indexed: 12/20/2022]
|
16
|
Li L, Li W, Chen CZ, Yi ZHZ, Zhou YY. Is aspirin use associated with age-related macular degeneration? A meta-analysis. J Clin Pharm Ther 2014; 40:144-54. [PMID: 25475899 DOI: 10.1111/jcpt.12241] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 11/11/2014] [Indexed: 01/02/2023]
Affiliation(s)
- L. Li
- Department of Ophthalmology; Renmin Hospital of Wuhan University; Wuhan Hubei Province China
- Department of Head and Neck Surgery; Hubei Cancer Hospital; Wuhan Hubei Province China
| | - W. Li
- Department of Head and Neck Surgery; Hubei Cancer Hospital; Wuhan Hubei Province China
| | - C. Z. Chen
- Department of Ophthalmology; Renmin Hospital of Wuhan University; Wuhan Hubei Province China
| | - Z. H. Z. Yi
- Department of Ophthalmology; Renmin Hospital of Wuhan University; Wuhan Hubei Province China
| | - Y. Y. Zhou
- Department of Ophthalmology; Renmin Hospital of Wuhan University; Wuhan Hubei Province China
| |
Collapse
|
17
|
Kahawita SK, Casson RJ. Aspirin use and early age-related macular degeneration: a meta-analysis. Can J Ophthalmol 2014; 49:35-9. [PMID: 24513354 DOI: 10.1016/j.jcjo.2013.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 08/02/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The aim of this review was to evaluate the evidence for an association between Aspirin use and early age-related macular degeneration (ARMD). METHODS A literature search was performed in 5 databases with no restrictions on language or date of publication. Four studies involving 10292 individuals examining the association between aspirin and ARMD met the inclusion criteria. Meta-analysis was carried out by Cochrane Collaboration Review Manager 5.2 software (Cochrane Collaboration, Copenhagen, Denmark). RESULTS The pooled odd ratios showed that Aspirin use was associated with early ARMD (pooled odds ratio 1.43, 95% CI 1.09-1.88). CONCLUSIONS There is a small but statistically significant association between Aspirin use and early ARMD, which may warrant further investigation.
Collapse
Affiliation(s)
- Shyalle K Kahawita
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Robert J Casson
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
| |
Collapse
|
18
|
Cheung CMG, Wong TY. Is age-related macular degeneration a manifestation of systemic disease? New prospects for early intervention and treatment. J Intern Med 2014; 276:140-53. [PMID: 24581182 DOI: 10.1111/joim.12227] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Age-related macular degeneration (AMD) is a common vision-threatening condition affecting the elderly. AMD shares common risk factors and processes, including vascular and inflammatory pathways, with many systemic disorders. Associations have been reported between AMD and hypertension, cardiovascular disease, cerebrovascular disease, dyslipidaemia, chronic kidney disease and neurodegenerative disorders. An increasing amount of evidence suggests that individuals with AMD are also at risk of systemic diseases such as stroke. In this review, we summarize the latest evidence to support the notion that AMD is an ocular manifestation of systemic disease processes, and discuss the potential systemic side effects of ocular AMD therapy of which general physicians should be aware. Recent genetic discoveries and understanding of the pathogenic pathways in AMD in relation to systemic disorders are also highlighted.
Collapse
Affiliation(s)
- C M G Cheung
- Singapore National Eye Center, Singapore City, Singapore; Singapore Eye Research Institute, Singapore City, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | | |
Collapse
|
19
|
Abstract
The anti-inflammatory, analgesic, antipyretic and antithrombotic activities of aspirin confer its wide therapeutic application. The three former activities require higher doses of aspirin, whereas the latter can be achieved through a lower, thus safer dose of the drug. Low-dose, long-term aspirin is used as an antithrombotic therapy to prevent cardiovascular disease. Such therapy is used by millions of people worldwide, including those suffering from age-related macular degeneration (AMD); thus, questions have arisen as to whether such treatment has any impact on the development and course of AMD. This editorial addresses the important issue of possible beneficial and adverse effects of long-term, low-dose aspirin treatment of AMD patients. Special emphasis is given to the ability of aspirin to acetylate cyclooxygenases (especially COX-2) and thus to initiate a biochemical pathway leading to the generation of anti-inflammatory pro-resolving mediators synthesized from both ω-3 and ω-6 long-chain polyunsaturated fatty acids. Such mediators (e.g., resolvins, lipoxins) may be of therapeutic value in retarding the development of dry form AMD.
Collapse
Affiliation(s)
- Jerzy Z Nowak
- Medical University, Department of Pharmacology and Toxicology, Interfaculty Chair of General and Clinical Pharmacology , Lodz , Poland
| |
Collapse
|
20
|
Chong EW, Guymer RH, Robman LD. Does aspirin increase the risk of age-related macular degeneration? Expert Opin Drug Saf 2014; 13:691-3. [PMID: 24773275 DOI: 10.1517/14740338.2014.914169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This commentary on the review by Christen and Chew discusses the controversy surrounding aspirin use and its association with age-related macular degeneration (AMD). We address the strength of evidence between low-dose aspirin use and AMD and also discuss the risks and benefits of aspirin use in primary versus secondary prevention of cardiovascular diseases in these cases. We also highlight an ongoing randomized controlled trial in this area.
Collapse
Affiliation(s)
- Elaine W Chong
- University of Melbourne, Royal Victorian Eye and Ear Hospital, Centre for Eye Research Australia (CERA) , 32 Gisbourne Street, East Melbourne, Victoria 3002 , Australia +61 3 9929 8968 ; +61 399298379 ;
| | | | | |
Collapse
|
21
|
Christen WG, Chew EY. Does long-term aspirin use increase the risk of neovascular age-related macular degeneration? Expert Opin Drug Saf 2014; 13:421-9. [DOI: 10.1517/14740338.2014.889680] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
22
|
Topical nonsteroidal anti-inflammatory drugs for macular edema. Mediators Inflamm 2013; 2013:476525. [PMID: 24227908 PMCID: PMC3818914 DOI: 10.1155/2013/476525] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 08/29/2013] [Indexed: 01/03/2023] Open
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are nowadays widely used in ophthalmology to reduce eye inflammation, pain, and cystoid macular edema associated with cataract surgery. Recently, new topical NSAIDs have been approved for topical ophthalmic use, allowing for greater drug penetration into the vitreous. Hence, new therapeutic effects can be achieved, such as reduction of exudation secondary to age-related macular degeneration or diabetic maculopathy. We provide an updated review on the clinical use of NSAIDs for retinal diseases, with a focus on the potential future applications.
Collapse
|
23
|
Sobrin L, Seddon JM. Regular aspirin use and risk of age-related macular degeneration. Am J Ophthalmol 2013; 156:213-217.e2. [PMID: 23870358 DOI: 10.1016/j.ajo.2013.04.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 04/17/2013] [Accepted: 04/18/2013] [Indexed: 12/14/2022]
|
24
|
Christen WG. Long-term aspirin use and neovascular age-related macular degeneration: association or causation? ACTA ACUST UNITED AC 2013; 19:e6. [DOI: 10.1136/eb-2013-101358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
25
|
Ramaswamy SG, Greenberg PB, Krzystolik MG. Guideline-Adherent Aspirin Use in Individuals with Age-Related Macular Degeneration. J Am Geriatr Soc 2013; 61:1033-1034. [DOI: 10.1111/jgs.12284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Shankar G. Ramaswamy
- Section of Ophthalmology; Veterans Affairs Medical Center; Providence Rhode Island
- Division of Ophthalmology; Warren Alpert Medical School; Brown University; Providence Rhode Island
| | - Paul B. Greenberg
- Section of Ophthalmology; Veterans Affairs Medical Center; Providence Rhode Island
- Division of Ophthalmology; Warren Alpert Medical School; Brown University; Providence Rhode Island
| | - Magdalena G. Krzystolik
- Section of Ophthalmology; Veterans Affairs Medical Center; Providence Rhode Island
- Division of Ophthalmology; Warren Alpert Medical School; Brown University; Providence Rhode Island
| |
Collapse
|
26
|
Aspirin use and risk of age-related macular degeneration: a meta-analysis. PLoS One 2013; 8:e58821. [PMID: 23516561 PMCID: PMC3597550 DOI: 10.1371/journal.pone.0058821] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 02/07/2013] [Indexed: 11/19/2022] Open
Abstract
Background Age-related macular degeneration (AMD) is the main cause of blindness and the curative options are limited. The objective of this meta-analysis was to determine the association between aspirin use and risk of AMD. Methods A comprehensive literature search was performed in PubMed, Embase, Web of Science, and reference lists. A meta-analysis was performed by STATA software. Results Ten studies involving 171729 individuals examining the association between aspirin use and risk of AMD were included. Among the included studies, 2 were randomized-controlled trials (RCTs), 4 were case-control studies and 4 were cohort studies. The relative risks (RRs) were pooled using a random-effects model. Relative risks with 95% confidence intervals (CIs) of aspirin use as a risk for AMD. The pooled RR of 10 included studies between the use of aspirin and risk of AMD was 1.09 (95% CI, 0.96–1.24). The same result was detected in early and late stage AMD subgroup analysis. In the subgroup analyses, the pooled RR of RCTs, case-control studies and cohort studies were 0.81 (95% CI, 0.64–1.02), 1.02 (95% CI, 0.92–1.14) and 1.08 (95% CI, 0.91–1.28), respectively. Conclusions The use of aspirin was not associated with the risk of AMD.
Collapse
|
27
|
Cheung N, Tay WT, Cheung GCM, Wang JJ, Mitchell P, Wong TY. Is aspirin intake associated with early age-related macular degeneration? The Singapore Indian Eye Study. Br J Ophthalmol 2013; 97:785-8. [DOI: 10.1136/bjophthalmol-2012-302253] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
28
|
Miller JW. Age-related macular degeneration revisited--piecing the puzzle: the LXIX Edward Jackson memorial lecture. Am J Ophthalmol 2013; 155:1-35.e13. [PMID: 23245386 DOI: 10.1016/j.ajo.2012.10.018] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 10/19/2012] [Accepted: 10/23/2012] [Indexed: 12/11/2022]
Abstract
PURPOSE To present the current understanding of age-related macular degeneration (AMD) pathogenesis, based on clinical evidence, epidemiologic data, histopathologic examination, and genetic data; to provide an update on current and emerging therapies; and to propose an integrated model of the pathogenesis of AMD. DESIGN Review of published clinical and experimental studies. METHODS Analysis and synthesis of clinical and experimental data. RESULTS We are closer to a complete understanding of the pathogenesis of AMD, having progressed from clinical observations to epidemiologic observations and clinical pathologic correlation. More recently, modern genetic and genomic studies have facilitated the exploration of molecular pathways. It seems that AMD is a complex disease that results from the interaction of genetic susceptibility with aging and environmental factors. Disease progression also seems to be driven by a combination of genetic and environmental factors. CONCLUSIONS Therapies based on pathophysiologic features have changed the paradigm for treating neovascular AMD. With improved understanding of the underlying genetic susceptibility, we can identify targets to halt early disease and to prevent progression and vision loss.
Collapse
|
29
|
Bressler NM, Bressler SB. Neovascular (Exudative or “Wet”) Age-Related Macular Degeneration. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00066-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
30
|
Abstract
CONTEXT Aspirin is widely used for relief of pain and for cardioprotective effects. Its use is of concern to ophthalmologists when ocular surgery is being considered and also in the presence of age-related macular degeneration (AMD). OBJECTIVE To examine the association of regular aspirin use with incidence of AMD. DESIGN, SETTING, AND PARTICIPANTS The Beaver Dam Eye Study, a longitudinal population-based study of age-related eye diseases conducted in Wisconsin. Examinations were performed every 5 years over a 20-year period (1988-1990 through 2008-2010). Study participants (N = 4926) were aged 43 to 86 years at the baseline examination. At subsequent examinations, participants were asked if they had regularly used aspirin at least twice a week for more than 3 months. MAIN OUTCOME MEASURE Incidence of early AMD, late AMD, and 2 subtypes of late AMD (neovascular AMD and pure geographic atrophy), assessed in retinal photographs according to the Wisconsin Age-Related Maculopathy Grading System. RESULTS The mean duration of follow-up was 14.8 years. There were 512 incident cases of early AMD (of 6243 person-visits at risk) and 117 incident cases of late AMD (of 8621 person-visits at risk) over the course of the study. Regular aspirin use 10 years prior to retinal examination was associated with late AMD (hazard ratio [HR], 1.63 [95% CI, 1.01-2.63]; P = .05), with estimated incidence of 1.76% (95% CI, 1.17%-2.64%) in regular users and 1.03% (95% CI, 0.70%-1.51%) in nonusers. For subtypes of late AMD, regular aspirin use 10 years prior to retinal examination was significantly associated with neovascular AMD (HR, 2.20 [95% CI, 1.20-4.15]; P = .01) but not pure geographic atrophy (HR, 0.66 [95% CI, 0.25-1.95]; P = .45). Aspirin use 5 years (HR, 0.86 [95% CI, 0.71-1.05]; P = .13) or 10 years (HR, 0.86 [95% CI, 0.65-1.13]; P = .28) prior to retinal examination was not associated with incident early AMD. CONCLUSIONS Among an adult cohort, aspirin use 5 years prior to observed incidence was not associated with incident early or late AMD. However, regular aspirin use 10 years prior was associated with a small but statistically significant increase in the risk of incident late and neovascular AMD.
Collapse
Affiliation(s)
- Barbara E K Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison 53726-2336, USA.
| | | | | | | | | | | |
Collapse
|
31
|
Thiagarajan P, Jankowski JA. Aspirin and NSAIDs; benefits and harms for the gut. Best Pract Res Clin Gastroenterol 2012; 26:197-206. [PMID: 22542157 DOI: 10.1016/j.bpg.2012.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 01/17/2012] [Indexed: 01/31/2023]
Abstract
Despite modern advances in cancer research, screening and treatment options, gastrointestinal tumours remain a leading cause of death worldwide. Both oesophageal and colorectal malignancies carry high rates of morbidity and mortality, presenting a challenge to clinicians in search of effective management strategies. In recent years, the increasing burden of disease has led to a paradigm shift in our approach from treatment to prevention. Among several agents postulated as having a chemopreventive effect on the gastrointestinal tract, aspirin has been most widely studied and has gained universal acknowledgement. There is an expanding evidence base for aspirin as a key mediator in the prevention of dysplastic change in Barrett's oesophagus and colorectal adenomas. Its cardioprotective effects also impact positively on the patient population in question, many of whom have ischaemic vascular disease. The major side effects of aspirin have been well-characterised and may cause significant morbidity and mortality in their own right. Complications such as peptic ulceration, upper gastrointestinal bleeding and haemorrhagic stroke pose serious threats to the routine administration of aspirin and hence a balance between the risks and benefits must be struck if chemoprevention is to be effective on a large scale. In this review, we address the current evidence base for aspirin use in gastrointestinal oncology, as well as several key questions surrounding its safety, cost effectiveness and optimal dose.
Collapse
Affiliation(s)
- Prarthana Thiagarajan
- Department of Emergency Medicine, Balmoral Building, Leicester Royal Infirmary, London, UK.
| | | |
Collapse
|