Weighing aspirin use in AMD patients

Weighing aspirin use in AMD patients

When it comes to aspirin use in patients with age-related macular degeneration (AMD), a new investigation suggests it's all about balancing numbers.

"If an AMD patient is on physician-prescribed aspirin therapy for stroke or heart attack risk reduction, they should continue."

Published in the June edition of the Investigative Ophthalmology & Visual Science journal, the meta-analysis claims that the benefits of aspirin use in maintaining the duration and quality of life by decreasing cardiovascular risks "far outweigh the theoretical risks of possibly exacerbating wet AMD that can be reasonably controlled with anti-vascular endothelial growth factor (VEGF) therapy."

According to studies, regular aspirin use is associated with a 32 percent reduction in nonfatal stroke risk, and a 15 percent reduction in cardiovascular-related events. Yet, it can come with vision consequences.

Regular aspirin use has been identified as a culprit in exacerbating risk of neovascular AMD, independent of a history of cardiovascular disease or smoking. And in the case of the Blue Mountains Eye Study—cited in this meta-analysis—regular aspirin users were 2.5 times more likely to have incident neovascular AMD than nonusers over a 15-year period.

Ounce of prevention, or can of worms?
The leading cause of severe vision loss in adults over age 50, AMD is estimated to affect 1.8 million Americans, while another 7.3 million with large drusen are at substantial risk for AMD-related vision loss. Although currently there is no cure for dry AMD, wet AMD can be treated if caught early enough.

Steven G. Ferrucci, O.D., chief of optometry at Sepulveda VA Medical Center and professor at Southern California College of Optometry at Marshall B. Ketchum University, says this analysis supports discussions he's had with colleagues in the past.

"If an AMD patient is on physician-prescribed aspirin therapy for stroke or heart attack risk reduction, they should continue as the risk for the aspirin negatively affecting their AMD is small and uncertain, versus the well-documented positive effect the aspirin will have on their systemic issues," Dr. Ferrucci states.

"However, it may make sense to tell patients with high-risk AMD to avoid aspirin that is not physician-prescribed for headaches or other minor pain relief, and to take acetaminophen instead to avoid any possible negative effects on their AMD progression."

Find more information about AMD in the AOA Optometric Clinical Practice Guideline, Care of the Patient with Age-Related Macular Degeneration, and patient education items at AOA Marketplace.

August 4, 2015

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