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#Grand Rounds

Is Metformin Associated with Decreased Risk for Age-Related Macular Degeneration?

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BACKGROUND AND PURPOSE:

  • As of yet, there are no preventative measures effective against age-related macular degeneration (AMD)
    • Metformin has protective outcomes in multiple age-associated diseases such as cancer, CVD and dementia
  • Blitzer et al. (JAMA Ophthalmology, 2021) examined whether metformin use is associated with reduced odds of developing AMD

METHODS:

  • Case-control population-based study 
    • Nationwide health insurance claims database
  • Participants
    • ≥55 years 
    • Newly diagnosed with AMD between 2006 to 2017
  • Exposures
    • Dosage of metformin
    • Exposure to other prescribed medications
  • Study design
    • Patients with newly diagnose AMD were defined as cases and matched with control participants
    • Stratified by age group
    • Subgroup analysis based on diabetes diagnosis  
    • Data on known AMD risk factors were also obtained
  • Primary outcome
    • Risk of developing AMD

RESULTS:

  • AMD group: 312,404 individuals | Control group: 312,376 individuals
    • Age range 55 to 107 years
  • The AMD group had a slightly higher percentage of participants with diabetes
    • AMD: 26.0%
    • Control group: 25.5%
  • Use of metformin was associated with reduced odds of developing AMD
    • Odds ratio (OR) 0.94 (95% CI, 0.92 to 0.96)
  • The association was dose dependent | Low to moderate doses of metformin were associated with the greatest benefit (dosages over 2 years)
    • 1 to 270 g : OR 0.91 (95% CI, 0.88 to 0.94)
    • 271-600 g: OR 0.90 (95% CI, 0.87 to 0.93)
    • 601-1080 g: OR 0.95 (95% CI, 0.92 to 0.98)
    • >1080 g: no reduced odds of AMD

Diabetes subanalysis

  • Both reduction in odds and the dose-dependent response were seen in a diabetic cohort
  • Diabetes and no diabetic retinopathy
    • Decreased risk for AMD: OR 0.93 (95% CI 0.91 to 0.95)
  • Diabetes with existing diabetic retinopathy
    • Increased risk for AMD: OR 1.07 (95% CI 1.01 to 1.15)

CONCLUSION:

  • The use of metformin was associated with reduced odds of AMD
    • The association was dose-dependent, with low to moderate doses conferring the greatest benefit
  • This association was preserved in patients with diabetes, although not in cases where diabetic retinopathy was present
  • The design of this study can assess association but not causation
    • This study suggests possible role for metformin as a therapeutic agent for AMD but further research is needed
  • The authors state

This case-control study using a large, national sample suggests that metformin use over 2 years in adults aged 55 years and older is associated with 5% to 10% reduced odds ratio of developing AMD

Learn More – Primary Sources:

Association of Metformin Use With Age-Related Macular Degeneration: A Case-Control Study

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Related ObG Topics:

Do Vitamin Supplements Inhibit Macular Degeneration?
Does Metformin Improve Acne among Women with PCOS?
Are Metformin or Statins Associated with Increased Risk for Ovarian Cancer in Women with Type 2 Diabetes?

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