Statins May Not Halt Progression from AMD to nAMD

Erica Smith, MD

Findings from a study presented at the Association for Research in Vision and Ophthalmology (ARVO) Virtual Meeting indicate that 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors have no protective effect on progression from age-related macular degeneration (AMD) to neovascular AMD (nAMD).

The retrospective, observational clinical study was led by Erica Smith, MD, of Loyola Medical Center, and consisted of chart reviews for AMD patient encounters between 2009 - 2019. The ultimate goal of the study was the determine whether statins could prevent disease progression in similar ways to vitamin supplementation and modulation of risk factors.

Overall, the team assessed 1631 patients, 57.3% of whom were on statin therapy. Using ICD-9 and ICD-10 diagnostic codes, they determined whether patients progressed to nAMD in at least one eye at a follow-up encounter.

Smith and colleagues then used chi-square and odds ratio statistical analysis to ascertain and evaluate any differences between the treatment cohorts in terms of disease progression.

Among those who took statin therapy, 12.6% developed nAMD. However, 11.2% of non-statin users progressed to nAMD. As such, the team concluded that statins did not offer any benefit in respect to AMD progression (Χ² (2, N = 1631) = 0.75, P = 0.3).

Therefore, the odds ratio was 1.14 with a 95% confidence interval (CI) of 0.84-1.54).

These results come in the wake of prior studies demonstrating that hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors can be beneficial for retinal physiology. Of course, as the investigators noted, more research on this drug class is warranted for patients with AMD.

“Further studies regarding the relationship between statins and AMD as well as other treatment options for AMD are important due to the prevalence of this sight-threatening disease,” the investigators wrote. 

Halting Progression

A similar study presented last year at ARVO 2020 showed that high intensive statin treatment may not halt progression from dry to wet forms of AMD.

Investigators of a retrospective study noted that 75% of patients on atorvastatin who did not progress to nAMD presented with mild AMD; however, 80% of patients who went on to progress in disease had intermediate AMD (P = .027)

Various other methods are currently being investigated for reducing neovascularization risk in patients with AMD. A study presented at this year’s conference evaluated the utility of a regulated at-home screening device in older patients at risk for blindness by way of choroidal neovascularization.

The 5-year assessment showed that the device — dubbed the ForeseeHome Preferential Hyperacuity Perimeter (PHP) — had a 22% false negative rate and yet offered both patients and physicians the opportunity for continuous risk-monitoring through remote means.

The study, “An evaluation of the use of 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors (statins) and progression of age-related macular degeneration,” was presented at ARVO 2021.