Could Daily Aspirin Harm Seniors’ Eyes?

THURSDAY, Jan. 5 (HealthDay News) — Daily aspirin use among
seniors may double their risk of developing a particularly advanced form
of age-related macular degeneration, a debilitating eye disease, a large
new European study suggests.

The possible link involves the so-called “wet” type of age-related
macular degeneration (AMD), a significant cause of blindness in seniors.

Aspirin use was not, however, found to be associated with an increased
risk for developing the more common, and usually less advanced, “dry” form
of AMD, according to the report published in the January issue of
Ophthalmology.

Although the study team stressed that further research is needed, the
findings could cause concern for the millions of older people who
routinely take over-the-counter aspirin for pain, inflammation and
blood-clot management, and to reduce their risk of heart disease.

“People should be aware that aspirin, often just bought over the
counter without prescription, may have adverse effects — apart from major
gastrointestinal and other bleeding — also for AMD,” said lead author Dr.
Paulus de Jong.

De Jong is an emeritus professor of ophthalmic epidemiology at the
Netherlands Institute for Neuroscience of the Royal Academy of Arts and
Sciences, as well as the Academic Medical Center, both in Amsterdam.

Age-related macular degeneration affects the critical central vision
required for reading, driving and general mobility. The damage occurs when
the retinal core of the eye (the macula) becomes exposed to leaking or
bleeding due to abnormal growth of blood vessels.

To examine whether aspirin use might trigger this process, the authors
focused on nearly 4,700 men and women over age 65 living in Norway,
Estonia, the United Kingdom, France, Italy, Greece and Spain.

In the study, conducted between 2000 and 2003, the researchers looked
at blood samples, frequency of aspirin use (though not doses), smoking and
drinking history, stroke and heart attack records, blood pressure levels
and sociodemographic data.

The team also analyzed detailed images of each participant’s eyes,
looking for indications of age-related macular degeneration and
severity.

Daily aspirin use was associated with the onset of late-stage “wet”
age-related macular degeneration, and to a lesser degree, the onset of
early “dry” AMD — even after the researchers took into account age and a
history of heart disease, which in itself is a risk factor for AMD.

For late-stage wet AMD only, the association was stronger the more
frequently an individual took aspirin.

Early AMD was found in more than more than one-third of participants
(36 percent), while late-stage AMD was found in roughly 3 percent, or 157
patients.

Of those with late AMD, more than two-thirds (108) had wet AMD, while
about one-third (49) had dry AMD, the researchers found.

More than 17 percent of participants said they took aspirin daily,
while 7 percent took it at least once a week and 41 percent did so at
least once a month.

About one-third of those with wet AMD consumed aspirin on a daily
basis, compared with 16 percent of those with no AMD.

The study authors cautioned that further research is needed on
aspirin’s possible effects on eye health. Meanwhile, they suggested that
doctors generally should not alter their current advice for aspirin use
among older patients coping with heart disease risk.

“[But] I would advise persons who [already] have early or late AMD not
to take aspirin as a painkiller,” de Jong said. “[And] I would advise
people with AMD who take small amounts of aspirin for primary
prevention — this means having no past history of cardiac or vascular
problems like stroke, and no elevated risk factors for these diseases —
to discuss with their doctor if it is wise to continue doing so. For
secondary prevention — this means after having these elevated risks or
disorders — the benefits of daily aspirin outweigh the risks.”

While the study uncovered an association between aspirin use and AMD,
it did not prove a cause-and-effect relationship.

This point was also made by Dr. Alfred Sommer, a professor of
ophthalmology and dean emeritus at the Bloomberg School of Public Health
at Johns Hopkins University in Baltimore. He noted that while the study
was “well executed,” it should not be seen as definitive proof that
aspirin use and AMD are linked.

An observational study of this type “merely calls attention to the fact
that such an association may exist, and that it may be causal, but only
randomized clinical trials can prove the matter one way or the other,” he
said.

“Hence, this might or might not be real,” Sommer added, “and we will
only know that when and if a randomized trial is done.”

In the interim, he said the findings should not guide patient
behavior.

“It is well known that aspirin [and other NSAIDs] can increase the risk
of gastric distress and gastric ulcers,” Sommer said. “Like any medicine,
it should only be taken if needed. But those taking aspirin to prevent
heart disease, particularly those at increased risk of heart disease,
definitely do benefit and should not change what they do.”

More information

For more on age-related macular degeneration, visit the U.S. National Eye Institute.

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