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Ahmad Al Moujahed, Cassie A. Ludwig, Jose Davila, Daniel Vail, Natalia F. Callaway, Darius Moshfeghi; Progression of Dry to Wet Age-related Macular Degeneration in Patients Receiving Intensive Statin Treatment. Invest. Ophthalmol. Vis. Sci. 2020;61(7):1792.
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Age-related Macular Degeneration (AMD) has similar risk factors and pathogenesis to atherosclerosis. Therefore, high-dose statins have been investigated as a potential therapy for AMD. A small prospective trial and a large retrospective cohort study showed that no dry AMD patients who received 80 mg of atorvastatin daily converted to wet AMD. Therefore, we investigated the effect of this treatment on progression of dry to wet AMD in a tertiary eye care center.
A retrospective chart review was performed for all AMD patients followed at Stanford University from 2007-2019. Patients diagnosed with dry AMD, started on atorvastatin 80 mg daily up to 6 months before, at the time of, or following AMD diagnosis were included. Patients without a minimum of 6 months follow up were excluded.
Of 1360 patients with dry AMD taking atorvastatin, 292 were prescribed a high dose of atorvastatin 80 mg daily. In total, 21 patients (7.2%) met inclusion criteria. Of these, 16 (mean age 76.6 +/- 9.9 years, 57% male) were started on atorvastatin 80 mg following dry AMD diagnosis (mean 42.7 months after diagnosis, range 6-148 months) and did not convert to wet AMD (mean follow up 31.8 months after starting atorvastatin, range 10-60). However, 5 patients (mean age 76.4 +/- 4.4 years, 40% male) were started on atorvastatin 80 mg (mean 5 months after dry AMD diagnosis, range 0-17 months; 1 patient started 5 months prior to dry AMD diagnosis), but converted to wet AMD (mean 42.3 months after starting treatment, range 16-89 months). Overall, 12/16 (75%) patients who did not convert to wet AMD had mild AMD, whereas 4/5 patients who converted to wet AMD had intermediate AMD (p = 0.027) when started on atorvastatin 80 mg. No statistically significant difference was found between the two groups with respect to age, sex, race, smoking, cholesterol levels, hypertension, or use of aspirin or anticoagulants.
Contrary to previous reports, 5 AMD patients in our cohort converted to wet AMD while being treated with atorvastatin 80 mg daily for as long as 89 months. Stage of AMD was the only difference in baseline characteristics between patients who converted to wet AMD compared to those who did not. Further studies with long term follow up are needed to explore subgroups for whom high-dose statins may be effective in preventing progression.
This is a 2020 ARVO Annual Meeting abstract.
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