The impact of systemic long-term medications for the development of age-related macular degeneration.

PURPOSE Age-related macular degeneration (AMD) is a leading cause of central vision loss in the elderly; however, the systemic factors that modulate its incidence and progression remain unclear. We sought to determine whether long-term use of systemic medications, including diabetes and antithrombotic medications, corticosteroids and immunosuppressants, is associated with the development of AMD. METHODS The data included a pooled cohort of two follow-up studies: the Kuopio Osteoporosis Risk Factor and Prevention Study and the Kuopio Fall Prevention Study. A total of 16 518 women born between 1932 and 1946 living in eastern Finland were followed up between 1993 and 2021. The long-term medication use was indicated as ≥5 years of regular purchase of drugs. Incidence for AMD was analysed per long-term medication group, but also during the 5 years period in age matched groups. RESULTS We observed increased odds for AMD among long-term users of systemic corticosteroids (HR 1.348, p < 0.001), immunosuppressants (HR 1.623, p = 0.004) and antithrombotic (HR 1.145, p = 0.042) medication. However, results with antithrombotic medications were not as consistent as with corticosteroids and immunosuppressants. Interestingly, the mean age at diagnosis of AMD was later among antithrombotic medication users compared to the control group (77.9 vs. 76.1, respectively, p < 0.001) and earlier among patients using other diabetes medications than metformin (75.3 vs. 77.1, p = 0.026). CONCLUSIONS People with long-term corticosteroid and immunosuppressant use are at greater risk for developing AMD. Further research on systemic components behind corticosteroid and immunosuppressant use, modulating AMD progression, is warranted.