title: Is medication use associated with the incidence of early age-related maculopathy? Pooled findings from 3 continents.
abstract: OBJECTIVE
  To investigate whether there is an association between the use of medication and the incidence of early age-related maculopathy (ARM).
  
  
  METHODS
  Pooled data from 3 prospective, population-based cohort studies.
  
  
  METHODS
  Subjects without early and late ARM at baseline who participated in the follow-up of the Beaver Dam Eye Study (n = 3012), the Rotterdam Study (n = 3434), and the Blue Mountains Eye Study (n = 2203).
  
  
  METHODS
  Stereoscopic color fundus photographs of all participants were graded according to a standardized protocol. At baseline, current use of prescription and over-the-counter medication was assessed by interview, and the drug name was confirmed at the research centers. Procedures and definitions were similar at both baseline and follow-up across the 3 study sites.
  
  
  METHODS
  Incidence of early ARM, defined as the presence at follow-up of either soft distinct drusen with pigmentary changes or soft indistinct or reticular drusen.
  
  
  RESULTS
  In the pooled cohort, 53.3% of participants used at least one of the medications selected for this study. Within a mean period of 5.6 years, a total of 683 subjects developed early ARM. Users of antihypertensive medication in general, and beta-blockers in particular, had a borderline statistically significant increased risk of early ARM (odds ratio [OR] for beta-blockers, 1.3; 95% confidence interval [CI], 1.0-1.6) when adjusted for systolic (or diastolic) blood pressure and other confounders. A protective effect of borderline significance was found among women using hormone replacement therapy (OR, 0.6; 95% CI, 0.4-1.0) and in persons using tricyclic antidepressants (OR, 0.4; 95% CI, 0.2-1.0). In contrast with beta-blockers, the direction and magnitude of the association with hormone replacement therapy and tricyclic antidepressants were inconsistent among the 3 study populations.
  
  
  CONCLUSIONS
  Pooled data from 3 population-based studies showed no strong associations between medication use and the incidence of early ARM. Of borderline significance were a slightly increased risk among users of beta-blockers and a reduced risk among users of hormone replacement therapy and users of tricyclic antidepressants. Although beta-blocker use could be a proxy for systemic hypertension, these findings warrant further investigations, preferably including information on the dosage and duration of drug exposure.
authors.affiliation: Department of Epidemiology & Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Redmer
authors.initials: R
authors.lastname: van Leeuwen
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Tomany
authors.forename: Jie Jin
authors.initials: JJ
authors.lastname: Wang
authors.forename: Ronald
authors.initials: R
authors.lastname: Klein
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.forename: Barbara E K
authors.initials: BE
authors.lastname: Klein
authors.forename: Johannes R
authors.initials: JR
authors.lastname: Vingerling
authors.forename: Robert G
authors.initials: RG
authors.lastname: Cumming
authors.forename: Paulus T V M
authors.initials: PT
authors.lastname: de Jong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008268:Macular Degeneration / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009517:New South Wales / Q000453:epidemiology; D055656:Prescriptions / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D014922:Wisconsin / Q000453:epidemiology