A new study in JAMA Internal Medicine reported that regularly using aspirin to prevent heart attacks may be linked with age-related macular degeneration (ARMD). Particularly, those already suffering from ARMD, are at a higher risk for vision loss, by developing “wet” ARMD.
How is vision loss associated with “wet” ARMD?
“Wet” ARMD is also known as neovascular or exudative ARMD, because there is the formation of weak new blood vessels in the retina that can ultimately lead to blood and protein leakage below the macula. This bleeding and leaking can eventually cause irreversible damage to the cells in the eye that are responsible for sight, and if untreated can lead to rapid vision loss.
The above photograph shows an example of wet macular degeneration with blood and fluid throughout the central retina resulting in significant vision loss.
The effect of aspirin on vision loss
Only about 10% of patients suffering from macular degeneration develop the “wet” type. However, in this recent study, the number of “dry” ARMD patients were increasingly more likely to develop the “wet” type the longer they took aspirin. The total number of participants in the study was 2,389 and 257 of those took aspirin regularly. The study analyzed these patients for a total of fifteen years. After ten years, it was found that 7 percent of the people regularly taking aspirin developed the “wet” type of ARMD, compared to only 1.6 percent among the non-users. After fifteen years, the percentage rose to 9.3 percent among the users, and 3.7 percent among the non-users.
There have been several other studies that have conflicting or inconclusive results in terms of aspirin’s affect on ARMD. Therefore, if anything, this study suggests the need for further research to deduce if aspirin is truly a risk factor for developing the “wet” type.
Should one stop taking aspirin if they have ARMD?
The vast majority of specialists agree that this study does not provide enough evidence to stop taking aspirin. Dr Emily Chew, deputy director of the Division of Epidemiology and Clinical Applications at the National Eye Institute believes there is not enough evidence to change clinical guidelines.
“The totality of evidence from both the observational studies and the randomized controlled clinical trials of aspirin would suggest that there is no major harmful association of aspirin use with AMD,” says Dr Chew. “Persons affected with AMD should consider aspirin when medically indicated.”
This study may also indicate that there is simply a correlation between heart disease and ARMD. The patients taking the aspirin were most likely using it to treat cardiovascular disease. Dr Tien Yin Wond, MD, PhD, of Singapore Eye Research Institute, reported online in Ophthalmology in a large prospective study, that patients with ARMD had a 50% greater risk of heart disease than those without it. Researchers stated that “this provides further support that age-related macular degeneration is associated with underlying systemic vascular disease.”
In my last blog entry, I discussed the role of inflammation and the risk of macular degeneration. Chronic inflammation is also linked to cardiovascular disease.
“In many of the studies that suggest risk, it isn’t clear whether aspirin use actually causes the slight increase in advanced AMD or it just correlates with the risk,” says Dr. Stephen Rose, chief research officer, Foundation Fighting Blindness. “…I strongly encourage AMD patients with questions to consult with their cardiologist or doctor who advises them to take the aspirin, because it’s most likely for a heart disease.”
Other doctors believe that one must weigh the individual risks before deciding whether or not to continue taking aspirin regularly.
Shawn Wilker, MD, of University Hospitals Case Medical Center in Cleveland, stated in an interview that “I think a reasonable circumstance when you could ask a patient not to take aspirin might be one in which there is a very low risk of mortality from cardiovascular disease or if that person is at very great risk of losing vision from macular degeneration.”
Lifestyle changes for your eyes and your heart
Although, it isn’t advisable to stop taking aspirin if it was recommended by your cardiologist, it is important to remember that you shouldn’t solely rely on a pill to benefit your heart and your eyes. There are many things one can do both in regards to nutrition and lifestyle that you will benefit from.
I recommend taking a look at Dr. Andrew Weil’s web page on “cardiovascular disease overview” to learn more about some healthy ways to benefit your heart. These recommendations will also benefit your eyes. Remember, everything is connected, and when you’re dealing with degenerative disease you must look at the whole puzzle, not just a piece.
Dr Weil’s website can be found here:
Long-term Use of Aspirin and Age-Related Macular Degeneration; Barbara E. K. Klein, MD, MPH; Kerri P. Howard, MS; Ronald E. Gangnon, PhD; Jennifer O. Dreyer, BS; Kristine E. Lee, MS; Ronald Klein, MD, MPH; JAMA. 2012;308(23):2469-2478. doi:10.1001/jama.2012.65406