Key PointsQuestion
Does the use of acetylcholinesterase inhibitors (AChEIs), commonly prescribed for Alzheimer disease (AD), influence the incidence of age-related macular degeneration (AMD)?
Findings
This cohort study discovered that patients with AD treated with AChEIs had a slightly lower hazard of developing AMD compared with untreated patients. AChEI treatment showed a reduction in AMD risk, while memantine treatment exhibited no association with AMD incidence.
Meaning
These results suggest potential benefits of AChEIs in reducing the risk of AMD, if confirmed in randomized clinical trials; further research is required to validate these findings across diverse populations.
Importance
Age-related macular degeneration (AMD) is a serious and common ophthalmologic disorder that is hypothesized to result, in part, from inflammatory reactions in the macula. Alzheimer disease (AD) treatment, acetylcholinesterase inhibitors (AChEIs), have anti-inflammatory effects and it remains unclear if they modify the risk of AMD.
Objective
To investigate the association between AChEI medications and the incidence of AMD.
Design, Setting, and Participants
This propensity score–matched retrospective cohort study took place at health care facilities within the US Department of Veterans Affairs (VA) health care system from January 2000 through September 2023. Participants included patients diagnosed with AD between ages 55 and 80 years with no preexisting diagnosis of AMD in the VA database.
Exposure
AChEIs prescription dispensed as pharmacologic treatments for AD.
Main Outcomes and Measure
The first diagnosis of AMD.
Results
A total of 21 823 veterans with AD (mean [SD] age, 72.3 [6.1] years; 21 313 male participants [97.7%] and 510 female participants [2.3%]) were included. Propensity score–matched Cox model reveals each additional year of AChEI treatment was associated with a 6% lower hazard of AMD (hazard ratio, 0.94; 95% CI, (0.89-0.99).
Conclusions and Relevance
This observational study reports a small reduction in the risk of AMD among veterans with AD receiving AChEIs. Randomized clinical trials would be needed to determine if there is a cause-and-effect relationship and further research is required to validate these findings across diverse populations.