COMMENTARY

Atorvastatin: A Drusen Disintegrator?

Brianne N. Hobbs, OD

Disclosures

February 26, 2016

Regression of Some High-Risk Features of Age-Related Macular Degeneration (AMD) in Patients Receiving Intensive Statin Treatment

Vavvas DG, Daniels AB, Kapsala ZG, et al
EBioMedicine. 2016 Feb 9. [Epub ahead of print]

Age-related macular degeneration (AMD) is the leading cause of blindness in Americans older than 65 years. Heart disease is the leading cause of death in the United States.

Of note, these two conditions may share a common pathogenesis. The Bruch membrane may be conceptualized as analogous to the vascular intima of blood vessels; therefore, cholesterol may accumulate in the Bruch membrane just as it does in the vessel walls in atherosclerosis, the most common cause of heart disease.

The logical assumption is that statins may help treat AMD, but the results have been conflicting thus far. This new study may help change the way in which we manage dry AMD.

Study Summary

The study conducted by Vavvas and colleagues was based on the outcome of high-dose statin treatment in a 63-year-old man who experienced a 12-letter visual acuity gain and complete resolution of his soft drusen within 12 months of beginning treatment.

On the basis of these dramatic results, the investigators enrolled 23 participants with large, soft drusenoid pigment epithelial detachments into a trial where all participants received 80 mg of atorvastatin daily. The minimum duration of treatment with atorvastatin was 1 year.

A complete eye examination, including fundus photographs and optical coherence tomography, was performed every 6 months. The primary outcome measure was drusen volume reduction by > 50%.

Although the effects of atorvastatin in the initial case report were encouraging, the results of the pilot trial were less so.

Ten of the 23 patients were considered "responders" to the statin treatment and experienced regression of the drusen. However, treatment had to be administered for an average of 12 months before improvement was seen. The visual acuity of responders improved by an average of 3.3 letters, whereas nonresponders lost an average of 2.3 letters; however, all patients received the treatment, so this statistic can be somewhat misleading.

Surprisingly, the patients who responded to statin therapy with drusen resolution did not have lower cholesterol levels than the nonresponders.

One promising result was that none of the patients in the study progressed to choroidal neovascularization even though they had high-risk characteristics.

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