Department of Ophthalmology, College of Medicine, University of Florida, Gainesville, Florida, United States.
Clinical and Translational Science Institute, University of Florida, Gainesville, Florida, United States.
Invest Ophthalmol Vis Sci. 2019 Apr 1;60(5):1470-1477. doi: 10.1167/iovs.18-26422.
AMD is the leading cause of irreversible blindness in older individuals in the Western world, and there are currently no therapies to halt disease progression. Studies suggest that the commonly prescribed antidiabetic drug, metformin, is associated with decreased risk of several ocular diseases, but no work has investigated the effect of metformin use on development of AMD. Thus, we aim to investigate whether metformin use is associated with decreased risk of developing AMD.
In this retrospective case-control study, we used medical records from patients older than 55 who have visited a University of Florida health clinic. Three controls were matched for every AMD case, defined by International Classification of Diseases, Ninth Revision code, based on the Charlson Comorbidity Index to ensure comparable baseline overall health status. Univariate and conditional multivariable logistic regressions were used to determine the association between a variety of covariates, including metformin use, and AMD diagnosis.
Metformin use was associated with decreased odds of developing AMD, independently of the other covariates investigated, with an odds ratio of 0.58 and a 95% confidence interval of 0.43 to 0.79. Other medications assessed were not associated with decreased odds of developing AMD.
Patients who had taken metformin had decreased odds of developing AMD, suggesting that metformin may have a therapeutic role in AMD development or progression in those who are at risk. Further work should include clinical trials to investigate prospectively whether metformin has a protective effect in those at risk for developing AMD.
AMD 是西方世界导致老年人失明的主要原因，目前尚无治疗方法可以阻止疾病的进展。研究表明，常用的降糖药物二甲双胍与多种眼部疾病的风险降低有关，但尚无研究调查二甲双胍的使用对 AMD 发展的影响。因此，我们旨在研究二甲双胍的使用是否与 AMD 发病风险降低有关。
本回顾性病例对照研究使用了佛罗里达大学健康诊所就诊的年龄大于 55 岁的患者的病历。根据国际疾病分类第 9 版代码和 Charlson 合并症指数，基于每位 AMD 病例定义了 3 个对照，以确保基线整体健康状况具有可比性。使用单变量和条件多变量逻辑回归来确定各种协变量（包括二甲双胍的使用）与 AMD 诊断之间的关联。
二甲双胍的使用与 AMD 的发病风险降低独立相关，其优势比为 0.58，95%置信区间为 0.43 至 0.79。评估的其他药物与降低 AMD 发病风险无关。
服用二甲双胍的患者发生 AMD 的几率降低，这表明二甲双胍可能在有风险的患者中具有治疗 AMD 发展或进展的作用。进一步的工作应包括临床试验，前瞻性地研究二甲双胍是否对有发生 AMD 风险的患者具有保护作用。
