Statins for age-related macular degeneration.
BACKGROUND
Age-related macular degeneration (AMD) is a progressive late onset disorder of the macula affecting central vision. Age-related macular degeneration is the leading cause of blindness in people over 65 years in industrialized countries (Congdon 2003). Recent epidemiologic, genetic and pathological evidence has shown AMD shares a number of risk factors with atherosclerosis, leading to the hypothesis that statins may exert protective effects in AMD.


OBJECTIVE
To examine the effectiveness of statins compared with other treatments, no treatment, or placebo in delaying the onset and/or progression of AMD.


METHODS
We searched CENTRAL in The Cochrane Library, MEDLINE, EMBASE and LILACS on 30 April 2009 and the WHO International Clinical Trials Registry Platform on 11 May 2009. We searched reference lists and the Science Citation Index. There were no language or date restrictions in the search for trials.


METHODS
We included randomized controlled trials (RCTs) that compared statins with other treatments, no treatment, or placebo in participants who were either susceptible to or diagnosed as having early stages of AMD.


METHODS
Two authors independently evaluated the search results against the selection criteria. Two Italian speaking colleagues extracted data. One author entered data. We did not perform a meta-analysis because only one completed RCT was identified.


RESULTS
Two studies met the selection criteria. One trial reported insufficient details to assess the risk of bias; the other trial is ongoing.Of the completed trial, the analyses of 30 participants did not show a statistically significant difference between the simvastatin and the placebo arm in visual acuity at three months of treatment (decimal visual acuity 0.21+/- 0.56 in simvastatin and 0.19+/- 0.40 in placebo arm) or 45 days after the completion of treatment (decimal visual acuity 0.20+/- 0.50 in simvastatin and 0.19+/- 0.48 in placebo arm). The lens and retina status were unchanged during and after the treatment period for both groups.Of the ongoing trial, the preliminary analyses of 42 participants who completed 12 months follow-up did not show a statistically significant difference between the simvastatin and the placebo arm in visual acuity, drusen score or visual function (effect estimates and confidence intervals were not available). We contacted the investigators and will update the review as data become available.


CONCLUSIONS
Evidence from currently available RCTs was insufficient to conclude that statins have any role in preventing or delaying the onset or progression of AMD.
Gehlbach
Peter
P
Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 1550 Orleans Street, Cancer Research Building #2, Baltimore, MD 21231, USA.
Li
Tianjing
T
Hatef
Elham
E
D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008268:Macular Degeneration / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D019821:Simvastatin / Q000627:therapeutic use*
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019821:Simvastatin