Long-Term Use of High-Dose Statins in Eyes with Intermediate Age-related Macular Degeneration

Abstract

Purpose : To investigate the association between high-dose atorvastatin use, structural changes in eyes with intermediate dry age-related macular degeneration (AMD), and conversion to wet AMD over 3 years of follow-up

Methods : This retrospective, longitudinal study compared patients with intermediate AMD under oral atorvastatin 80 mg daily for a duration of three years (group 1) and those with no history of statin use (group 2). Average total drusen volume was evaluated at baseline and three years using semi-automated segmentation of RPE volume available on the utilized Spectral-Domain Optical Coherence Tomography (SD-OCT; Spectralis OCT2, Heidelberg Engineering GmbH). The presence of intraretinal hyperreflective foci (iHRF) and subretinal drusenoid deposits (SDD) were evaluated by two graders. Wilcoxon test was employed to test differences in total drusen volume within each group (paired) and between the two groups (unpaired) (p<0.05; CI 95%), whereas Fisher’s exact test was used to assess conversion to wet AMD between the two groups

Results : Overall, 25 eyes of 16 patients (50% female) in group 1 and 31 eyes of 18 patients (67% female) in group 2 were followed for 3.1 (2.8-3.3) years. Mean age was 67.6±5.6 and 70.1±7.7 for groups 1 and 2, respectively (p=0.28). At baseline, SDD was detected in 44% and 18% of eyes in groups 1 and 2, respectively (p=0.08). No differences were found at baseline for iHRF (24% vs. 29%, respectively; p=0.06) and average total drusen volumes (0.42 [0.29-1.32] vs. 0.42 [0.24-1.49], respectively; p=0.86). Drusen volume did not significantly increase in group 1 at follow-up (p=0.23), whereas a significant increase was observed in group 2 (p<0.001). Median (IQR) difference in average total drusen volume was significantly higher for group 2 (0.060 [0.010-0.115] mm ³) than for group 1 (0.030 [-0.01-0.07] mm³). None of eyes in group 1 (0%) and 3 eyes (9.6%) in group 2 developed wet AMD over the follow-up (p=0.24)

Conclusions : Patients with no history of high-dose statins had significantly higher drusen volumes at follow-up than those on 80 mg of atorvastatin for three years. Of note, no eyes progressed to wet AMD in the high-dose atorvastatin group. Despite the relatively limited sample size, our study marks the first case-control exploration into the long-term impact of high-dose atorvastatin on AMD, emphasizing the need for further investigation into the effects on disease progression

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.