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Associations of systemic health and medication use with the enlargement rate of geographic atrophy in age-related macular degeneration
  1. Liangbo L Shen1,
  2. Yangyiran Xie2,
  3. Mengyuan Sun3,
  4. Aneesha Ahluwalia4,
  5. Michael M Park5,
  6. Benjamin K Young6,
  7. Lucian V Del Priore7
  1. 1Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
  2. 2Department of Ophthalmology and Visual Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
  3. 3Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, Connecticut, USA
  4. 4Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, USA
  5. 5Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
  6. 6Department of Ophthalmology and Visual Science, University of Michigan Medical School, Ann Arbor, Michigan, USA
  7. 7Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr Lucian V Del Priore, Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT 06520-8055, USA; lucian.delpriore{at}


Background The associations of geographic atrophy (GA) progression with systemic health status and medication use are unclear.

Methods We manually delineated GA in 318 eyes in the Age-Related Eye Disease Study. We calculated GA perimeter-adjusted growth rate as the ratio between GA area growth rate and mean GA perimeter between the first and last visit for each eye (mean follow-up=5.3 years). Patients’ history of systemic health and medications was collected through questionnaires administered at study enrolment. We evaluated the associations between GA perimeter-adjusted growth rate and 27 systemic health factors using univariable and multivariable linear mixed-effects regression models.

Results In the univariable model, GA perimeter-adjusted growth rate was associated with GA in the fellow eye at any visit (p=0.002), hypertension history (p=0.03), cholesterol-lowering medication use (p<0.001), beta-blocker use (p=0.02), diuretic use (p<0.001) and thyroid hormone use (p=0.03). Among the six factors, GA in the fellow eye at any visit (p=0.008), cholesterol-lowering medication use (p=0.002), and diuretic use (p<0.001) were independently associated with higher GA perimeter-adjusted growth rate in the multivariable model. GA perimeter-adjusted growth rate was 51.1% higher in patients with versus without cholesterol-lowering medication use history and was 37.8% higher in patients with versus without diuretic use history.

Conclusions GA growth rate may be associated with the fellow eye status, cholesterol-lowering medication use, and diuretic use. These possible associations do not infer causal relationships, and future prospective studies are required to investigate the relationships further.

  • retina
  • treatment medical
  • macula
  • degeneration
  • imaging

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors LLS was involved in conception and design. LLS, MS, AA, MMP and BKY were involved in data collection. LLS was involved in data analysis. LLS and LVDP were involved in data interpretation. LLS and LVDP obtained funding. LLS, MS, AA, MMP, BKY and LVDP were involved in manuscript writing


  • Funding This publication was made possible by the James G. Hirsch Endowed Medical Student Research Fellowship from Yale School of Medicine (Grant number: None; Recipient: Shen) and P30 EY026878 from the National Eye Institute (NEI) (Recipient: Yale Vision Science Core).

  • Disclaimer The sponsor or funding organisation had no role in the design or conduct of this research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the institution or funder.

  • Competing interests LLS is consultant with Boehringer Ingelheim. LVDP is consultant with Astellas Institute for Regenerative Medicine, LambdaVision and Boehringer Ingelheim; is in the scientific advisory board of Tissue Regeneration Sciences; and is scientific and clinical advisor in CavTheRx.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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