Does long-term use of low-dose ASA affect the incidence or progression of AMD?

Age-related macular degeneration (AMD) is the most common cause of irreversible visual impairment among older adults. Treatments to reduce the severity of vision loss associated with late neovascular AMD have been available for more than a decade. However, other than advice on lifestyle, diet and nutritional supplements, no evidence-based medical intervention is available to prevent AMD development or delay its progression to late disease.Evidence suggests a role for chronic inflammation in AMD, leading researchers to investigate the possible preventive role of acetylsalicylic acid (ASA). Some studies have suggested possible benefit from ASA, while others have found no association between ASA and the development or worsening of AMD. In contrast, some studies reported an association between ASA and the development of AMD, particularly hemorrhagic neovascular AMD. To obtain a more definitive answer concerning the use of ASA to prevent or slow the development of AMD, researchers used data from the large randomized double-masked, placebo-controlled ASPREE (Aspirin in Reducing Events in the Elderly) trial. ASPREE was a multicentre, international, randomized, double-masked, placebo-controlled clinical trial investigating the efficacy of long-term low-dose ASA (100 mg/day) versus placebo in prolonging disability-free survival among older individuals.ASPREE-AMD (Aspirin in Reducing Events in the Elderly–AMD) was a substudy of ASPREE. Participants were 70 years or older without dementia, independence-limiting physical disability, cardiovascular disease, or chronic illness limiting five-year survival. Retinal photography was conducted at baseline and at three and five years after randomization. AMD status was determined using colour retinal images and treatment records. The main outcome was the incidence of AMD and progression from early/intermediate to late AMD.Results showed the following:ASPREE-AMD enrolled a total of 4,993 participants. Baseline characteristics were similar between the ASA and placebo groups. At the time of sponsor-determined trial termination, retinal follow-up data were available for 3,208 participants; 3,171 were analyzed for AMD incidence and progression (median age of 73.5 years; 51% female; median follow-up time 3.1 years).Cumulative AMD incidence was 195 of 1,004 (19.4%) in the ASA group and 187 of 979 (19.1%) in the placebo group (relative risk [RR], 1.02; 95%CI, 0.85–1.22; p=0.86). Cumulative progression from early/intermediate AMD to late AMD was seen in 14 of 615 (2.3%) participants in the ASA group and 18 of 573 (3.1%) in the placebo group (RR, 0.72; 95%CI, 0.36–1.44; p=0.36).There was no evidence to suggest that late AMD, particularly neovascular AMD, was more likely to occur in the group randomized to low-dose ASA.The investigators concluded that in this large trial of older healthy individuals, low-dose ASA administered for three years did not affect the incidence of AMD. The evidence was weaker for progression of AMD because of the low number of cases that progressed to late AMD. Overall, the researchers believe that these results do not support the idea that low-dose daily ASA prevents the development or progression of AMD.Reference:Robman LD, Wolfe R, Woods RL, et al. Effect of low-dose aspirin on the course of age-related macular degeneration. A secondary analysis of the ASPREE randomized clinical trial. JAMA Ophthalmol 2024. Published online May 23, 2024. (accessed May 30, 2024).

Does long-term use of low-dose ASA affect the incidence or progression of AMD?

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