Aspirin Use Tied to Age-Related Vision Loss

Jan. 22, 2013— -- Regular aspirin use is linked to an increased risk of vision loss with age, a new study found.

The study of nearly 2,400 Australian men and women found those who routinely took aspirin were more likely to develop age-related macular degeneration. The results were published Monday in JAMA Internal Medicine.

However, "the evidence is insufficient to adjudicate the relationship between aspirin and [age-related macular degeneration], thereby challenging causal inferences," Dr. Sanjay Kaul and Dr. George Diamond of Cedars-Sinai Medical Center in Los Angeles wrote in an editorial accompnying the study.

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The study is not the first to suggest a possible link between neovascular age-related macular degeneration and routine aspirin use, but other studies have yielded conflicting findings.

To examine the potential link, Jie Jin Wang of the University of Sydney and colleagues analyzed data from the Blue Mountains Eye Study, which included 2,389 Australians ages 49 and older.

Retinal examinations were done every five years, and lesions classified as neovascular, or wet macular degeneration, or geographic atrophy, also known as dry macular degeneration.

Aspirin use was reported on a structured questionnaire, and information on relevant risk factors was obtained during physical examination and history reports.

A total of 257 participants were regular aspirin users. Compared with nonusers, they were older and more often had conditions such as diabetes, cardiovascular disease, or elevated blood pressure.

During 15 years of follow-up, age-related wet macular degeneration was identified in 63 individuals.

Among regular users, the cumulative incidence was 1.9 percent, 7 percent and 9.3 percent at years 5, 10, and 15, while the incidence among nonusers was 0.8 percent, 1.6 percent, and 3.7 percent, respectively.

The incidence of neovascular macular degeneration rose with more frequent aspirin use, increasing from 2.2 percent in those who never took aspirin, to 2.9 percent for those who used it only occasionally, and 5.8 percent for those who took aspirin routinely.

Aspirin use was not associated with risk for dry macular degeneration.

Additional analyses found that the risk was four times higher in patients with a history of cardiovascular disease and in those without a gene variation linked with macular degeneration.

The researchers also considered whether other medications often taken by aspirin users, such as acetaminophen and beta-blockers, might influence risk, and the results were negative.

These results create a quandary for the many patients using aspirin, particularly those taking the drug as secondary prevention of CVD, according to Wang's group.

"Aspirin is one of the most effective CVD treatments and reduces recurrent CVD events by one-fifth," they wrote.

However, significant adverse events can occur, such as cerebral and gastrointestinal bleeding.

"Our present study now raises the possibility that the risk of neovascular [age-related macular degeneration] may also need to be considered," they wrote.

Nonetheless, they conceded that the risk is small, at slightly under 4 percent over 15 years, and the evidence is thus far insufficient to support a change in practice away from widespread aspirin use, except for patients at very high risk for macular degeneration.