Scheie Eye Institute, University of Pennsylvania
This article summarizes the research concerning aspirin use for those living with macular degeneration.
Aspirin may be the closest thing to a wonder drug because, in addition to decreasing pain and fever, it decreases the risk of heart attacks or strokes in people who are at risk. There is also evidence that it decreases the risk of colorectal cancer.
Aspirin is ancient. Hippocrates used the “aspirin” in willow bark powder to treat pain and fever thousands of years ago. It works by inhibiting cyclooxygenases (COX1 and 2), reducing the production of fever and pain-causing prostaglandins. Further, by inhibiting COXs in platelets, it reduces clotting.
Many people have decided to take an aspirin a day, even without consulting an internist; however, there is some increased risk of bleeding from the gastrointestinal tract and bleeding (hemorrhagic) strokes.
The Australian Blue Mountain Eye Study raised concern about aspirin risk for patients with age-related macular degeneration (AMD), as it hinted that aspirin may increase the risk of wet AMD. However, there were many limitations to the study; only half of the patients completed the 15 year study, and aspirin use was determined only at the beginning of the 15 year study period. Also, it was an observational study rather than a prospective study, making it more difficult to draw firm conclusions. Results of other observational studies on AMD risk in aspirin users have been inconsistent.
Two large prospective clinical trials, which are generally more reliable than observational studies, found no significant effect of aspirin on development of AMD or vision loss from AMD. Taken together, these study results are inconclusive.
Many patients with AMD ask if they should stop taking aspirin. Some of them have had heart attacks or strokes, and were put on the aspirin by their physicians. Whether or not you have AMD should not be a factor in the decision, given the current inconclusive state of clinical trial evidence mentioned above. It is best to follow the advice of your physician concerning aspirin use because he or she is familiar with your current medication regimen and medical history. For example, some people with certain risk factors or who take other medications should not take aspirin. It is also important to note that all medicines have risks and benefits, and they should not be stopped or started without consulting your doctor first.
Joshua Dunaief, MD, received his BA magna cum laude in Biology from Harvard (1987), MD/PhD from Columbia College of Physicians and Surgeons (1996), completed ophthalmology residency at the Wilmer Eye Institute, Johns Hopkins in 2000, and medical retina fellowship at Scheie Eye Institute, University of Pennsylvania in 2004.
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