Association between topical prostaglandin analog use and development of choroidal neovascular membranes in patients with concurrent glaucoma and age-related macular degeneration

Prostanoid signaling in retinal vascular diseases

The vasculature of the retina is exposed to systemic and local factors that have the capacity to induce several retinal vascular diseases, each of which may lead to vision loss. Prostaglandin signaling has arisen as a potential therapeutic target for several of these diseases due to the diverse manners in which these lipid mediators may affect retinal blood vessel function. Previous reports and clinical practices have investigated cyclooxygenase (COX) inhibition by nonsteroidal anti-inflammatory drugs (NSAIDs) to address retinal diseases with varying degrees of success; however, targeting individual prostanoids or their distinct receptors affords more signaling specificity and poses strong potential for therapeutic development. This review offers a comprehensive view of prostanoid signaling involved in five key retinal vascular diseases: retinopathy of prematurity, diabetic retinopathy, age-related macular degeneration, retinal occlusive diseases, and uveitis. Mechanistic and clinical studies of these lipid mediators provide an outlook for therapeutic development with the potential to reduce vision loss in each of these conditions.

Association of Ocular Antihypertensive Medications and the Development and Progression of Age-related Macular Degeneration in a U.S. Insurance Claims Database

Purpose/Aim: To assess whether ocular antihypertensives are associated with the development and progression of age-related macular degeneration (AMD).Materials and Methods: This retrospective, observational cohort study using healthcare claims data from a U.S. nationwide managed-care network between January 1, 2006 and December 31, 2016, included enrollees ≥40 years old with primary open-angle glaucoma with or without a diagnosis of nonexudative AMD at the index date. Hazard ratios (HR) for developing AMD or progressing from nonexudative to exudative AMD with exposure to ocular antihypertensive medications were analyzed.Results: Of 132 963 eligible enrollees, 118 174 (87.5%) had no diagnosis of AMD at baseline while 14 789 (12.5%) had adiagnosis of nonexudative AMD. Prostaglandin analog exposure had adecreased hazard of developing AMD among individuals without baseline disease (HR, 0.90; 95% CI, 0.87-0.94; p< .0001), while topical alpha₂-agonist exposure demonstrated an increased hazard of AMD development (HR, 1.08; 95% CI, 1.03-1.14; p= .004). Among patients with baseline nonexudative AMD, topical carbonic anhydrase inhibitor exposure was associated with adecreased hazard of progressing to exudative disease (HR, 0.84; 95% CI, 0.71-0.99; p= .04) while topical alpha₂-agonists had increased hazard (HR, 1.17; 95% CI, 1.01-1.36; p= .04).Conclusions: Certain ocular antihypertensive medications may be associated with development or progression of AMD. Their role in AMD pathogenesis should be better understood as they are considered for therapeutics in this disease.