Association of Ocular Antihypertensive Medications and the Development and Progression of Age-related Macular Degeneration in a U.S. Insurance Claims Database

ABSTRACT

Purpose/Aim: To assess whether ocular antihypertensives are associated with the development and progression of age-related macular degeneration (AMD).

Materials and Methods: This retrospective, observational cohort study using healthcare claims data from a U.S. nationwide managed-care network between January 1, 2006 and December 31, 2016, included enrollees ≥40 years old with primary open-angle glaucoma with or without a diagnosis of nonexudative AMD at the index date. Hazard ratios (HR) for developing AMD or progressing from nonexudative to exudative AMD with exposure to ocular antihypertensive medications were analyzed.

Results: Of 132 963 eligible enrollees, 118 174 (87.5%) had no diagnosis of AMD at baseline while 14 789 (12.5%) had adiagnosis of nonexudative AMD. Prostaglandin analog exposure had adecreased hazard of developing AMD among individuals without baseline disease (HR, 0.90; 95% CI, 0.87–0.94; p< .0001), while topical alpha₂-agonist exposure demonstrated an increased hazard of AMD development (HR, 1.08; 95% CI, 1.03–1.14; p= .004). Among patients with baseline nonexudative AMD, topical carbonic anhydrase inhibitor exposure was associated with adecreased hazard of progressing to exudative disease (HR, 0.84; 95% CI, 0.71–0.99; p= .04) while topical alpha₂-agonists had increased hazard (HR, 1.17; 95% CI, 1.01–1.36; p= .04).

Conclusions: Certain ocular antihypertensive medications may be associated with development or progression of AMD. Their role in AMD pathogenesis should be better understood as they are considered for therapeutics in this disease.

KEYWORDS:

• Age-related macular degeneration
• ocular antihypertensives
• primary open-angle glaucoma

Author contributions

Concept and design: Wubben, Besirli, Wang; Acquisition, analysis, or interpretation of data: Eton, Wubben, Wang; Drafting of manuscript: Eton, Wang; Critical revision of manuscript for important intellectual content: Eton, Wubben, Besirli, Wang; Final approval of manuscript and accountability for all aspects of the work: Eton, Wubben, Besirli, Wang.

Declaration of interests

Thomas J. Wubben has participated in the Allergan (Irvine, CA) Fostering Innovative Retina Stars of Tomorrow (FIRST) program. Cagri G.Besirli consults for and has equity in iRenix Medical, and receives royalties from iRenix Medical and ONL therapeutics. These financial interests are not directly related to the subject matter of this manuscript.

Data sharing

The data used in this study is available from Clinformatics DataMart.

Additional information

Funding

The authors have no funding for this study to disclose.