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Association of Ocular Antihypertensive Medications and the Development and Progression of Age-related Macular Degeneration in a U.S. Insurance Claims Database

ABSTRACT Purpose/Aim: To assess whether ocular antihypertensives are associated with the development and progression of age-related macular degeneration (AMD). Materials and Methods: This retrospective, observational cohort study using healthcare claims data from a U.S. nationwide managed-care network between January 1, 2006 and December 31, 2016, included enrollees ≥40 years old with primary open-angle glaucoma with or without a diagnosis of nonexudative AMD at the index date. Hazard ratios (HR) for developing AMD or progressing from nonexudative to exudative AMD with exposure to ocular antihypertensive medications were analyzed. Results: Of 132 963 eligible enrollees, 118 174 (87.5%) had no diagnosis of AMD at baseline while 14 789 (12.5%) had adiagnosis of nonexudative AMD. Prostaglandin analog exposure had adecreased hazard of developing AMD among individuals without baseline disease (HR, 0.90; 95% CI, 0.87–0.94; p< .0001), while topical alpha2-agonist exposure demonstrated an increased hazard of AMD development (HR, 1.08; 95% CI, 1.03–1.14; p= .004). Among patients with baseline nonexudative AMD, topical carbonic anhydrase inhibitor exposure was associated with adecreased hazard of progressing to exudative disease (HR, 0.84; 95% CI, 0.71–0.99; p= .04) while topical alpha2-agonists had increased hazard (HR, 1.17; 95% CI, 1.01–1.36; p= .04). Conclusions: Certain ocular antihypertensive medications may be associated with development or progression of AMD. Their role in AMD pathogenesis should be better understood as they are considered for therapeutics in this disease.