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Original Investigation
May 7, 2020

Macular Abnormalities Associated With 5α-Reductase Inhibitor

Author Affiliations
  • 1Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
JAMA Ophthalmol. Published online May 7, 2020. doi:10.1001/jamaophthalmol.2020.1279
Key Points

Question  Is there an association between the male sex hormone antagonist 5α-reductase inhibitor and abnormalities in the eye?

Findings  In this case-control study of 31 male participants, medication that inhibits androgenic hormones for the treatment of benign prostatic hypertrophy and androgenic alopecia in male patients was associated with macular optical coherence tomography imaging abnormalities including cystoid abnormalities, foveal cavitation, or hypolucent outer foveal defects.

Meaning  The findings of this investigation suggest that macular abnormalities may be associated with a male sex hormone antagonist.


Importance  The neuroprotective action of sex hormones has been described. Data on the association between 5α-reductase inhibitor (5-ARI), a male sex hormone antagonist, and macular abnormalities are lacking to date.

Objective  To assess the association between the use of 5-ARI for treatment of benign prostate hypertrophy and/or androgenic alopecia in men and macular abnormalities on optical coherence tomography imaging.

Design, Setting, and Participants  This retrospective case-control, cross-sectional study included electronic health record data from 31 male patients who showed foveal cavitation on spectral-domain optical coherence tomography imaging from January 1, 2016, to June 30, 2019.

Exposures  Receipt of 5-ARI for at least 2 years as treatment of benign prostate hypertrophy and/or androgenic alopecia.

Main Outcomes and Measures  Clinical data and multimodal imaging findings and the proportion of 5-ARI users.

Results  Among 31 male patients with foveal cavitation, 5-ARI was used for 10 of 14 patients (71.4%) with macular abnormalities of unknown origin and for 2 of 17 patients (11.8%) with macular abnormalities of well-known specific origin (P = .001). The mean age of these 14 patients was 74.7 years (range, 60.1-88.0 years). In the 15 eyes of 10 patients who had received 5-ARI for macular abnormalities of unknown origin, mean (SD) age was 72.8 (7.5) years, mean (SD) length of time receiving 5-ARI was 72.3 (39.2) months, and mean (SD) logMAR visual acuity was 0.08 (0.10) (Snellen equivalents, 20/24 [20/25]). Optical coherence tomography imaging showed a disease spectrum ranging from tiny foveal cavitation to an impending macular hole. Of the total male patients, 80.0% (8 of 10) had no symptoms.

Conclusions and Relevance  The findings suggest that macular abnormalities associated with 5-ARI are characterized by cystoid abnormalities and foveal cavitation in male patients, which may progress to outer foveal defect and macular hole. These macular abnormalities associated with a male sex hormone antagonist suggested by this investigation warrant further corroboration.

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