Age-related macular degeneration (AMD) poses a significant public health concern, with its treatment remaining challenging. Prior studies suggested a potential preventive effect of sildenafil, commonly used for erectile dysfunction (ED), on AMD development. However, recent research challenges this notion, highlighting the need for further investigation.
AMD affects millions worldwide and is a leading cause of vision impairment. Treatment options, particularly for the advanced stages, are limited and burdensome. Sildenafil, initially developed for hypertension, found success in treating ED and has been hypothesised to prevent AMD by increasing retinal blood flow.
This study was published in BMC Open Ophthalmology by Han JED and colleagues. A retrospective matched open-cohort study analyzed data from the IQVIA Medical Research Data (IMRD-UK) primary care database, encompassing 307,384 male patients aged ≥40 years with ED. The study compared AMD incidence between sildenafil users (n = 31,575) and non-users (n = 62,155) over a 20-year period.
Key Findings:
• Among the study cohort, 234 sildenafil users and 398 non-users developed AMD during the follow-up period.
• After adjusting for confounders, including age, comorbidities, and socioeconomic factors, no significant difference in AMD incidence was observed between sildenafil users and non-users (adjusted hazard ratio [aHR], 0.99; 95% CI, 0.84 to 1.16).
• Subgroup analysis before the availability of over-the-counter sildenafil yielded similar results (aHR, 0.98; 95% CI, 0.83 to 1.15).
The study, led by Nicola Jaime Adderley, PhD, MPH, from the University of Birmingham, suggests that sildenafil use is unlikely to have a clinically meaningful preventive effect on AMD development. Despite prior hypotheses linking sildenafil to increased retinal blood flow and potential AMD prevention, real-world data did not support this notion.
Given the growing prevalence of AMD and the limited treatment options, understanding potential preventive measures is crucial. While sildenafil remains a widely used medication for ED, clinicians should not rely on it as a preventive strategy for AMD. Further research is needed to explore alternative preventive approaches and enhance AMD management strategies.
Reference:
Han JED, Subramanian A, Lee WH, et al Association of sildenafil use with age-related macular degeneration: a retrospective cohort study BMJ Open Ophthalmology 2024;9:e001525. doi: 10.1136/bmjophth-2023-001525