Is medication use associated with the incidence of early age-related maculopathy? Pooled findings from 3 continents.

Kleins Lab // Publications // Jun 01 2004

PubMed ID: 15177967

Author(s): van Leeuwen R, Tomany SC, Wang JJ, Klein R, Mitchell P, Hofman A, Klein BE, Vingerling JR, Cumming RG, de Jong PT. Is medication use associated with the incidence of early age-related maculopathy? Pooled findings from 3 continents. Ophthalmology. 2004 Jun;111(6):1169-75. PMID 15177967

Journal: Ophthalmology, Volume 111, Issue 6, Jun 2004

OBJECTIVE To investigate whether there is an association between the use of medication and the incidence of early age-related maculopathy (ARM).

DESIGN Pooled data from 3 prospective, population-based cohort studies.

PARTICIPANTS Subjects without early and late ARM at baseline who participated in the follow-up of the Beaver Dam Eye Study (n = 3012), the Rotterdam Study (n = 3434), and the Blue Mountains Eye Study (n = 2203).

METHODS Stereoscopic color fundus photographs of all participants were graded according to a standardized protocol. At baseline, current use of prescription and over-the-counter medication was assessed by interview, and the drug name was confirmed at the research centers. Procedures and definitions were similar at both baseline and follow-up across the 3 study sites.

MAIN OUTCOME MEASURES Incidence of early ARM, defined as the presence at follow-up of either soft distinct drusen with pigmentary changes or soft indistinct or reticular drusen.

RESULTS In the pooled cohort, 53.3% of participants used at least one of the medications selected for this study. Within a mean period of 5.6 years, a total of 683 subjects developed early ARM. Users of antihypertensive medication in general, and beta-blockers in particular, had a borderline statistically significant increased risk of early ARM (odds ratio [OR] for beta-blockers, 1.3; 95% confidence interval [CI], 1.0-1.6) when adjusted for systolic (or diastolic) blood pressure and other confounders. A protective effect of borderline significance was found among women using hormone replacement therapy (OR, 0.6; 95% CI, 0.4-1.0) and in persons using tricyclic antidepressants (OR, 0.4; 95% CI, 0.2-1.0). In contrast with beta-blockers, the direction and magnitude of the association with hormone replacement therapy and tricyclic antidepressants were inconsistent among the 3 study populations.

CONCLUSIONS Pooled data from 3 population-based studies showed no strong associations between medication use and the incidence of early ARM. Of borderline significance were a slightly increased risk among users of beta-blockers and a reduced risk among users of hormone replacement therapy and users of tricyclic antidepressants. Although beta-blocker use could be a proxy for systemic hypertension, these findings warrant further investigations, preferably including information on the dosage and duration of drug exposure.