Abstract
Purpose :
Emerging evidence suggests a potential therapeutic effect of dopamine modulation in age-related macular degeneration (AMD). Interventions that delay dry-to-wet conversion in AMD are limited, in part due to the multifactorial pathophysiology of AMD. We present a retrospective cohort analysis investigating the influence of dopamine modulation on conversion in AMD.
Methods :
We conducted a retrospective cohort analysis over the past 10 years on patients diagnosed with AMD by optical coherence tomography (OCT) imaging in the Duke Epic Database. Eyes with an initial dry AMD diagnosis and at least 2 years of follow-up were included in this study. Eyes from these individuals were then placed into 1 of 3 groups: 1) eyes not exposed (NE) to dopamine modulating therapies (DMT), 2) eyes exposed to levodopa (LD) prior to wet AMD diagnosis, and 3) eyes exposed to non-levodopa, dopamine-modulating therapies (NL-DMT, consisting of dopamine agonists: pramipexole, ropinirole, rotigotine, bromocriptine, and cabergoline), prior to wet AMD diagnosis. Eyes that converted from dry-to-wet were evaluated in yearly quartiles and generalized estimating equations (GEEs) were used to adjust for covariates.
Results :
Of the 3,756 eyes from 2,214 individuals with an initial diagnosis of early dry AMD by OCT, 3,628 were NE to DMTs and 128 were on DMTs (49 on LD; 79 on non-LD). Conversion to wet AMD at 2 years was 8.9% in NE eyes and 7.8% in DMT eyes (12.2% on LD; 5.1% on NL-DMT). After adjusting for covariates in a GEE model, DMTs were not associated with a significantly reduced risk of conversion at 2 years. However, DMTs were associated with 58% (p = 0.0125) reduced risk of conversion at 3 years, and 65% (p = 0.0075) reduced risk of conversion at 4 years. Conversion to wet AMD at 4 years was 18.2% in NE eyes and 5.7% in DMT eyes (10.0% of LD eyes; 2.5% of NL-DMT eyes).
Conclusions :
We found that DMT therapies were associated with reduced risk of conversion from dry-to-wet AMD over 3 years. While dopamine deficiency is clearly linked to Parkinson’s disease, our findings suggest that preservation of dopamine signaling may play a role in reducing the risk of conversion of AMD. The role of modulating dopamine signaling in choroidal neovascularization and the conversion from dry-to-wet AMD warrants further investigation.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.