Daily Aspirin: Can it Make You Go Blind?

Wednesday, November 21, 2012 4:04 PM
By Nick Tate

Aspirin has been touted as a wonder drug, with many studies showing a daily dose can lower the risks of heart disease and cancer. But new research suggests aspirin’s risks may outweigh its benefits for some seniors by posing a threat to their vision.
A major European study found that daily aspirin among older people doubles the risk of an advanced form of age-related macular degeneration (AMD), a debilitating eye disease that is a leading cause of blindness. The link was strongest for the so-called "wet" form of AMD, and was less pronounced for the more common, less serious "dry" AMD variety, according to the study published in the journal Ophthalmology.
Although the scientists stress that more research is needed, lead researcher Dr. Paulus de Jong said the findings are a cause for concern for millions of seniors who routinely take over-the-counter aspirin for pain, inflammation, blood-clot management, and to reduce their risk of heart disease or other health conditions.
Experts say the findings throw cold water on the idea that even healthy individuals should take a daily aspirin to boost their health and longevity.
“If you look at the big picture, you really have to balance the risks and benefits,” of aspirin, notes Stephanie Haridopolos, M.D., a board-certified family practitioner in Melbourne, Fla. “Should everyone be taking an aspirin for prevention [of heart disease and cancer] or not? I say ‘No,’ you really have to talk to your doctor and discuss the risks and benefits of aspirin to see what’s right for you.”
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If you have wet AMD or are at risk for it, you should probably not take daily aspirin.
Dr. Haridopolos adds, however, that the new study should not prompt doctors to stop recommending aspirin for patients with cardiovascular risks that may pose a greater health threat than AMD.
“It’s not good to have good vision if you’re going to have a heart attack,” she notes. But doctors and patients need to weigh the options and consider individual health conditions before making a decision about aspirin.
“I looked at the studies looking at wet [AMD], and aspirin is a risk for bleeding in the retina and causing loss of sight quickly,” she explains. “So my patients with wet [AMD] aren’t allowed to be on aspirin or any other [blood-thinning] anti-coagulants. But for patients with heart disease, aspirin can be [beneficial].”
AMD typically strikes seniors, impairing vision required for reading, driving, and getting around. What happens in AMD is the retinal core of the eye — called the macula — becomes exposed to leaking or bleeding because of abnormal blood vessel growth. The macula allows us to see colors and details. As we age, the macula can deteriorate. In dry AMD, the macula thins and can become tainted with debris. In the wet form, blood vessels beneath the retina may leak blood and fluids (and aspirin can cause small hemorrhages under the retina).
Dr. Haridopolos explains that dry AMD accounts for about 90 percent of cases, so the wet form is rarer. “It’s a small risk,” she says. “Only 10 percent of cases are wet [AMD], and those are the ones that have the [greatest] risk from aspirin.”
To determine whether aspirin can promote AMD, Dr. de Jong and his colleagues tracked the health of nearly 4,700 European and Norwegian men and women over age 65 between 2000 and 2003. The researchers examined the patients’ blood samples, aspirin use, smoking and drinking history, stroke and heart attack records, blood pressure, and socio-demographic factors. Detailed images of each participant's eyes were also analyzed for signs of AMD.
The results showed that seniors who took an aspirin every day were twice as likely to suffer late-stage wet AMD, and to a lesser degree, the onset of early dry AMD, regardless of their age, history of heart disease, and other factors that increase the predisposition to AMD. About one-third of the seniors with the wet form of the disease took a daily aspirin, compared to just 16 percent of those who did not have the condition.
The findings show that seniors who already have early or late AMD should not take aspirin, said Dr. de Jong, an emeritus professor of ophthalmic epidemiology at the Netherlands Institute for Neuroscience of the Royal Academy of Arts and Sciences in Amsterdam.
He added that the research doesn’t warrant a change in current doctors’ recommendations that older patients coping with heart disease consider daily aspirin use, suggesting the benefits outweigh the risks.
But he advised people with AMD who take aspirin to prevent heart disease — but have no prior history of cardiovascular problems or elevated risk factors — to consult their doctor on whether to continue taking the painkiller, in light of the newly discovered risks.
The problem, Haridopolos says, is many seniors may have a hard time sorting out the details of studies like Dr. de Jong’s and reconciling them with other widely reported research findings that have linked aspirin to lower heart disease and cancer risks. That’s why it’s so important for patients to talk with their doctors before they start taking aspirin. A doctor consultation can if determine aspirin is the best option or whether other prevention strategies — such as lowering cholesterol, blood pressure, and improving diet and exercise habits — make more sense and pose lower risks.
“Everyone is thinking about being on aspirin as a preventive medication, but we have to be sure they have no evidence of wet [AMD] before they start on a daily preventive aspirin, especially if it’s just for prevention and they don’t have any other cardiovascular risks,” she adds.
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