What to tell patients with AMD about aspirin use

Bethesda, MD-The association of aspirin use and age-related macular degeneration (AMD) is controversial, considering the varying study results. The totality of evidence, however, from observational studies and randomized, controlled clinical trials suggests there is no major harmful association of aspirin use with AMD, said Emily Y. Chew, MD.

“There is clear evidence that aspirin use decreases the risk of cardiovascular disease, which is the leading cause of death in the United States,” said Dr. Chew, deputy director, Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD. “Ophthalmologists may tell their patients affected with AMD that they should consider aspirin when it is clinically indicated.”

Concern about ocular safety of aspirin use was first raised by a study published in 1988 that suggested aspirin use increased hemorrhages in patients with AMD. A few years later, the Macular Photocoagulation Study found no difference in hemorrhage development comparing patients consuming aspiring and those who were not, while a few more subsequent studies yielded both positive and negative results.

More recently, the controversy was stimulated by results from the population-based European Eye Study that found an almost two-fold risk of neovascular AMD in patients taking aspirin.

Dr. Chew and colleagues assessed the association of aspirin use and AMD using data from the Age-Related Eye Disease Study (AREDS) and AREDS 2. Both a cross-sectional evaluation of the baseline data for AREDS2 participants and a longitudinal assessment of the development of AMD in AREDS using a propensity score analysis technique demonstrated no harmful association of aspirin with varying severity of AMD.

Furthermore, data from placebo-controlled randomized clinical trials designed to investigate aspirin use for cardiovascular disease (Women’s Health Study and Physician’s Health Study) showed a non-statistically significant protective effect of aspirin use for the development of AMD.

“Observational data have confounding effects, and it is particularly difficult to separate out the confounding effects as risks of cardiovascular disease are associated with advanced AMD, and this is the very population that has been recommended to take aspirin,” Dr. Chew said. “The importance of the Women’s Health Study and Physician’s Health Study is that they offer a randomized comparison of the effects of aspirin.”

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