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    1 Comment for this article
    This study does not answer the most important question
    David Louis Keller, M.D. | Providence Medical Group
    This study did not quantify the actual milligram dose of aspirin which was taken by the subjects. The authors only state that aspirin is usually prescribed at a dose of 150 mg per day in Australia, which is an odd dose in that it too small for effective analgesia and at least double the dose required for steady-state inhibition of platelet aggregation to reduce cardiovascular thrombosis. The "dose-response effect" which the authors found refers to the "time dose" or cumulative amount of time the patient took aspirin (at any milligram dose). Most aspirin users in the USA take the lowest dose available (81 mg here) for the purpose of platelet inhibition, not analgesia. The physicians who treat these patients need to know whether an aspirin dose of 81 mg per day increases the risk of age-related macular degeneration, not a dose of 150 mg or higher, which is less commonly prescribed here.
    Original Investigation
    Feb 25, 2013

    The Association of Aspirin Use With Age-Related Macular Degeneration

    Author Affiliations

    Author Affiliations: Centre for Vision Research, Department of Ophthalmology, University of Sydney, Sydney, Australia (Drs Liew, Mitchell, and Wang and Ms Rochtchina); Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia (Drs Liew, Wong, and Wang); and Singapore Eye Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (Dr Wong).

    JAMA Intern Med. 2013;173(4):258-264. doi:10.1001/jamainternmed.2013.1583

    Objective To determine whether regular aspirin use is associated with a higher risk for developing age-related macular degeneration (AMD) by using analyzed data from a 15-year prospective cohort.

    Methods A prospective analysis was conducted of data from an Australian population-based cohort with 4 examinations during a 15-year period (1992-1994 to 2007-2009). Participants completed a detailed questionnaire at baseline assessing aspirin use, cardiovascular disease status, and AMD risk factors. Age-related macular degeneration was graded side-by-side from retinal photographs taken at each study visit to assess the incidence of neovascular (wet) AMD and geographic atrophy (dry AMD) according to the international AMD classification.

    Results Of 2389 baseline participants with follow-up data available, 257 individuals (10.8%) were regular aspirin users and 63 of the 2389 developed neovascular AMD. Persons who were regular aspirin users were more likely to have incident neovascular AMD: the 15-year cumulative incidence was 9.3% in users and 3.7% in nonusers. After adjustment for age, sex, smoking, history of cardiovascular disease, systolic blood pressure, and body mass index, persons who were regular aspirin users had a higher risk of developing neovascular AMD (odds ratio [OR], 2.46; 95% CI, 1.25-4.83). The association showed a dose-response effect (multivariate-adjusted P = .01 for trend). Aspirin use was not associated with the incidence of geographic atrophy (multivariate-adjusted OR, 0.99; 95% CI, 0.59-1.65).

    Conclusion Regular aspirin use is associated with increased risk of incident neovascular AMD, independent of a history of cardiovascular disease and smoking.