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Abstract

We appreciate Pekel and Pekel's interest in our study 1 Modjtahedi B.S. Fong D.S. Jorgenson E. Van Den Eeden S.K. Quinn V. Slezak J.M. The relationship between non-steroidal anti-inflammatory drug use and age-related macular degeneration. Am J Ophthalmol. 2018; 188: 111-122 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar and their thought-provoking commentary. Our study had several limitations intrinsic to its study design and source data. We invite readers to read the discussion of our manuscript, which more fully outlines the limitations of this study, including the fact exposure was assessed based on 2 surveys in 2002 and 2006, that these results in men may not be generalizable to women, and that nonsteroidal anti-inflammatory drug (NSAID) dose was not known. Our cohort was derived from the California Men's Health Study (CMHS), which was designed to evaluate the general medical status of responders. The questions asked on the CMHS were not specifically focused on ophthalmic disease and the data entered within patients' electronic medical records (EMR) that can be extracted for study purposes is limited to what is coded electronically. As such, very detailed information such as sunlight exposure, iris color, and family history of age-related macular degeneration (AMD) could not be determined in this large cohort (N = 51 371); however, while the different factors listed by Pekel and Pekel have been found to be associated with AMD risk (with variable amounts of scientific evidence), these would only influence our results if there were differences in NSAID use between those who possessed and did not possess these factors. Ultimately, the influence of NSAIDs on AMD risk appears modest and NSAIDs are unlikely to be a significant modulator of disease risk for most patients. Although these unaccounted confounders could have influenced our findings, we suspect that accounting for the majority of variables listed by Pekel and Pekel would not have shifted our results towards demonstrating a strong effect for NSAID use and thus it is unlikely that our findings would have meaningfully changed, especially considering our large and diverse study population. The Relationship Between Nonsteroidal Anti-inflammatory Drug Use and Age-related Macular DegenerationAmerican Journal of OphthalmologyVol. 189PreviewWe read the article by Modjtahedi and associates1 with great interest. The authors concluded that long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) may have a protective effect on exudative age-related macular degeneration (AMD).1 They also reported that new users of any NSAIDs had a lower risk of nonexudative AMD only in short-term use.1 Since inflammation is a risk factor in the pathogenesis of AMD,2 this study is beneficial in searching for new treatment options in AMD. Full-Text PDF