Differences in Select Medication Use in Patients with Age-Related Macular Degeneration and in Controls

Abstract

Purpose : Globally, age-related macular degeneration (AMD) is a leading cause of vision loss for individuals of ages 50 years and older. The different subtypes of AMD are early, intermediate, and advanced including geographic atrophy (GA) and neovascular (NV) AMD. Medications such as nonsteroidal anti-inflammatory drug (NSAIDs), metformin, hormone therapy (HT) and Age-Related Eye Disease Studies (AREDS) supplements have been shown to play a role in AMD. However, there is a paucity of literature on the effect of these medications in the different subtypes of AMD. The purpose of this study was to determine whether there is an association between the use of NSAIDs, metformin, HT, and AREDS in the different subtypes of AMD compared to controls.

Methods : A case-control study was conducted using the University of Colorado AMD registry (July 2014 - December 2021). For this analysis, AMD status was categorized into 3 groups: controls, early/intermediate and advanced (NV and GA AMD) using multimodal imaging. The current use of NSAIDs, metformin and AREDS at enrollment and past and/or current use of HT were reported. The associations between the use of NSAIDs, metformin, HT and AREDS and AMD categories and controls were determined using adjusted odds ratios (ORs) from multinominal logistic regression.

Results : Of all study patients (n=1167) included in the analysis, there were 931 cases and 236 controls. Among the cases, 42.5% had early/intermediate AMD and 57.5% had advanced AMD. Cases were significantly more likely to use AREDS (37.0% advanced AMD and 52.5% early/intermediate AMD when compared to controls (0.9%). The use of AREDS remained significantly higher in cases compared to controls after adjusting for confounders. HT was used significantly more in controls (27.1%) compared to cases (12.7% of advanced AMD patients and 16.3% of early/intermediate AMD patients). After adjusting for age and history of chronic hypertension, the odds of HT was 0.54 (95%CI:0.33-0.90) for patients with early/intermediate AMD and 0.46 (95% CI:0.27-0.77) for advanced AMD as compared to controls. Metformin and NSAIDs use did not significantly differ between the three AMD groups.

Conclusions : We found that AMD cases were much more likely to use AREDS and less likely to use HT compared to controls. The protective effect of HT may provide important insights into systemic mechanisms related to the risk of macular degeneration.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.