The People's Perspective on Medicine

Will Your Aspirin Lead to Blindness?

An observational study shows that regular aspirin users have a greater risk of developing macular degeneration that could result in blindness.

We are generally pretty enthusiastic about aspirin. Unlike other pain relievers, aspirin has cardiovascular benefits, particularly for those who already have heart disease. In addition, regular aspirin use has been associated with a lower risk of a wide range of cancers. (You can read more about that here and here.)

Risks as Well as Benefits:

Aspirin is not innocuous, however. It has well-known gastrointestinal side effects and has been associated with bleeding ulcers. That is a very serious outcome.

We are also concerned about another risk. Epidemiologists have found links between aspirin use and the debilitating eye disease, age-related macular degeneration. This connection surfaced about three years ago. Here is what we wrote at that time:

Aspirin Is Associated with Macular Degeneration:

In case you missed it, an article was published in the journal JAMA Internal Medicine (formerly the Archives of Internal Medicine) on January 21, 2013, titled “The Association of Aspirin Use with Age-Related Macular Degeneration [AMD].” We felt it was newsworthy and so you will find an overview of the study in our Health News this week.

The editors of JAMA Internal Medicine were very cautious about this research. First, it was an “observational” study. That means it is not the kind of gold-standard research we need to draw definitive conclusions. The best studies are randomized, placebo-controlled trials. Second, an “eloquent Invited Commentary” by Kaul and Diamond about the research concludes that “The association between regular aspirin exposure and the risk of AMD is modest…”

Finally, and most important, the editors explain their concerns about publishing this research:

“The eloquent Invited Commentary by Kaul and Diamond illustrates the great care that must be taken before concluding that an association described in an observational study truly represents a cause-effect relationship. In our discussion of the article by Liew and colleagues, the editors believed that it provided useful incremental data about an important condition. However, as with many good studies, the data are not definitive enough to suggest changes in clinical practice. Rather, we hope the study galvanizes more research on the relationship between aspirin and macular degeneration.

“After the editors decided to accept this article, we discussed the risk that press reports would fall into the trap of reporting this study as definitive. This study provides an opportunity to educate the public about the subtleties and incremental nature of medical research.”

Media Coverage Lacked Nuance:

The editors had reason to be concerned. Much of the subtlety of this study was lost in the following headlines:

“Study links aspirin to blindness”

“Long-term aspirin use linked with increased risk of blindness”

“Aspirin users could double risk of blindness in old age”

“Study: Aspirin use increases blindness risk among elderly”

“Aspirin use may cause age-related blindness”

The headlines are likely to scare the dickens out of most readers. Few will forget the words “aspirin and blindness.” Even if an article points out that association is not causation, that subtlety is likely to be forgotten. Also ignored may be the fact that age-related macular degeneration is relatively uncommon (prevalence of about 1.5% in the American population). Even a doubling of risk still means that there is a relatively small absolute risk of developing this problem with regular aspirin use.

The authors of this research point out that their study confirms findings from another observational study which also found a two-fold increased risk of AMD among regular aspirin users. But what was pretty much ignored in the news reports was their acknowledgement that two large, gold-standard randomized clinical trials (The Physicians’ Health Study and the Women’s Health Study) reported “no increased AMD risk during 7 to 10 years among aspirin users.”

So, What’s the Bottom Line on Aspirin and AMD?

Age-related macular degeneration is certainly worrisome. Even though it is relatively rare it does lead to blindness in as many as 500,000 Americans. That is why it is essential to get regular eye exams to detect any signs of this disease at the earliest stages. This condition can often be treated with some new medications such as Lucentis (ranibizumab), Avastin (bevacizumab), Eylea (aflibercept), Macugen (pegaptanib) or Visudyne (verteporfin). There is also laser photocoagulation therapy.

  • The story on aspirin and AMD is confusing. The data are clearly not definitive. If the risk exists, it takes 10 to 15 years to show up. We will need long-term randomized, double-blind studies to establish a cause and effect relationship.
  • What should we all do in the meantime? The authors of this research conclude that there is “insufficient evidence to recommend changing clinical practice” regarding aspirin use. In other words, if your doctor believes that aspirin is important for reducing the risk of cardiovascular disease (heart attacks or strokes) or cancer, it is best to follow that advice and not discontinue aspirin suddenly because of scary headlines.
  • If an eye exam reveals the early stages of age-related macular degeneration, it is essential to discuss the dangers of continued aspirin use.

More Recent Research:

A meta-analysis evaluated ten studies of this association and found that aspirin use slightly increased the risk of age-related macular degeneration (Journal of Clinical Pharmacy and Therapeutics, Apr., 2015). It had differential effects on the types of AMD, however, increasing the risk of “wet” macular degeneration (neovascularization) and decreasing the risk of “dry” AMD (geographic atrophy). This confirmation that aspirin has a “weak but statistically significant association” with AMD suggests that people who already have this condition and those who may be at higher risk for AMD should definitely follow the advice above and discuss any aspirin use with their doctors.

A different analysis of aspirin studies looked specifically at randomized controlled trials of aspirin for preventing heart disease and considered the side effects found in those studies (US Preventive Services Task Force Syntheses, Sep., 2015). These scientists could detect no difference in the risk of AMD between those taking aspirin and those on placebo.

What Do You Think?

What is your experience with AMD? Have you received treatment? Has it worked? Were you satisfied? Have you experienced AMD after long-term regular aspirin use? We would love to hear your story below.

Should you wish to listen to a radio interview about the pros and cons of aspirin we offer “Aspirin Secrets Revealed,” Show # 842). It tells about the latest research involving aspirin against cancer.

We also have a FREE Guide to Key Aspirin Information.

We try to bring you the stories behind the health headlines and explain the subtleties that are often left out of the popular press. Please let us know how we did with this complex aspirin story.

Revised 2/25/16

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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Personally I believe staring at computer screens as many of us have had to do, could be more harmful to the eyes than a baby aspirin. Retired now but my eyes felt like two pickled boils from my 10 hours a day on computers at work when I would leave at end of day?

Are there studies available for that?

Interesting. Because of a stroke in 2000, I take baby aspirin daily. 11 years later, I’ve had cataracts surgery in both eyes, and an almost detached retina. No such family history. I always blamed the stroke… I have something else to worry about!

Did the researchers take into consideration where the aspirin was made? We already know about the substandard conditions of some of the 3rd world pharmaceutical drug factories, not to mention how some medications are adulterated. Is there a reason that otc drugs would be any different?

I would like to hear more about this subject, Please.


Are heart medications, in particular those given for congestive heart failure related to macular degeneration? It appears in a segment of the population that I am familiar with, who are using these meds. Also, was no family history of macular degeneration. It did not seem to be related to those who used diuretics, or high blood pressure meds.

About 5 years ago my optometrist gave me one of those grid charts to look at. The lines in a certain sector were wavy when I looked at it in the manner specified, and the print said that indicated the likelihood of AMD. I began taking Lutein 20 units a day and Astaxanthin. After a couple of years the lines were, and are, no longer wavy. That is hardly a scientific study but is my experience.

I have had regular opthomologist check ups over the years. As a precaution when some build-up in my carotid artery was determined, my regular physician put me on a low dose aspirin. Shortly after that (within a month) there was an occlusion of vision in my right eye. It seemed to clear, but recently became a major central blind area and the retinal specialist has determined that it is the “wet” Macular degeneration. I am being treated with injections in the eye on a monthly basis to try and restore some amount of vision. I have never taken aspirin in the last 50 years so it does not fit the study of 10 years previous usage, but i do wonder about the cause and effect.

Eight years ago, my eye doctor told me that if I didn’t want any more bleeders in my eyes, I needed to stop taking my daily baby aspirin. I stopped taking aspirin by tapering….yes, even tapered baby aspirin.

For a 70-year-old who has been on .81mg for many years and has early signs of MD, questions arise. One would hope the doctors will have time to actually talk to one another and agree on a recommendation; otherwise the patient will have to make his own calculation. I am appreciative to the People’s Pharmacy.
PEOPLE’S PHARMACY RESPONSE: We definitely urge you to discuss this research with both your regular doctor and your eye doctor!

Thank you for the additional information, which adds further questions:
Australia has much worse UV exposure than most of the United States. Probably, therefore, higher baseline D3 levels. Don’t know anything about the correlation between skin cancers and AMD. Do the people who die of melanoma at a young age take themselves out of the pool of people who would otherwise develop AMD later in life?

I am 86 and have been taking an aspirin each day since a med student told me about the benefits in 1970. So, after some 40+ years, I am not going to stop now.

I got the “idea” from hearing it on Oiling of America, a talk by Sally Fallon. However you can find other sources on the web, such as this one. I guess I meant that MIs were rare. Heart attacks.

DS: Where did you get the idea that heart disease was ever “rare”??

>Please let us know how we did with this complex aspirin story.
Better than normal, because it is a complex story. Unfortunately, in the very same email, you have another link to the same story not covered anywhere nearly as thoroughly.
Comment here, comment there, follow what people are saying try to keep your website links straight in my mind. Not clear why this newsletter needed two links to the same core story.
N = 1 apocryphal story from an un-named eye doctor says that macular degeneration is primarily a Caucasian problem, while African Americans need to worry more about glaucoma. Ethnicity not addressed in the article.
Of all the risk factors for eye problems, it seems to me that regular aspirin use is simply the easiest to ask about, and therefore possibly the easiest to raise red flags over. Inquiring minds want to know:
HOW MUCH ASPIRIN IS “REGULAR?” For crying out loud, this HAS to be dose-dependent. 81mg / day? Hands-full every four hours? What about all the other NSAIDs? Surely the study asked how MUCH aspirin people were taking?
Then there are all the other variables: Colored vegetables in the diet, over years. Exposure to sun / UV and sunglass wearing habits; the demographics of AMD suggest people with AMD today are of the generation that thought tanning was “cool,” not just for poor farm workers, and were ahead of the sunscreen addiction we have now. What are the VitD levels of the people with and without AMD?
I understand that it is not possible for the PP to report on data that aren’t addressed in the study itself.
It would also be useful to know if the people who got AMD from aspirin might otherwise have died from the conditions that aspirin helped to prevent. THERE’S a double-blind that will never get past the ethics committee…
PEOPLE’S PHARMACY RESPONSE: The study was conducted in Australia (the Blue Mountains Eye Study) and the authors note that the 10% taking regular aspirin were PROBABLY using the most common cardiovascular prevention dose prescribed in Australia, 150 mg. Not a dose readily available in the US, but certainly higher than our 81 mg “heart” dose.
The Blue Mountain Eye Study has collected tons of information on diet (this was the study showing that fish eaters are less susceptible to AMD). None of that was included in this study, though, and it isn’t clear that they ran regression analyses to see if it mattered. No data on ethnicity, but the mix is different in Australia than in the U.S. although European extraction was probably the main background of the participants.
The researchers did collect information on blood pressure, BMI and other risk factors, including a genetic factor. They did point out that the benefits of aspirin use in preventing second heart attacks, etc., might very well have outweighed the risks of AMD for these individuals.

I have a related question regarding aspirin. I am used to buying aspirin that is labeled “aspirin.” Now it is it labeled “aspirin NSAID.” Are these the same?
PEOPLE’S PHARMACY RESPONSE: Aspirin is a type of NSAID. Read the label to make sure that aspirin is the only pain reliever in your pill.

Again, let us be careful and reiterate that no drug can be regarded as “miracle” drug….including aspirin. It’s so amusing that some of friends who have no knowledge of medicine and/or alternative means, confidently say that “don’t worry” just take one aspirin first thing in the morning!!
I subscribe to a news letter who advocates CAM all the time. It is so interesting that what he says now in his news letter becomes headlines in the regular media anywhere from 5 to 10 years down the road. One of the example was demonization of eggs. I am watching with great interest that he is and has been totally against using a daily aspirin regimen. And if this story further develop to the extent with conclusion in future to for the recommendation to avoid this regimen, by George, he will be right again.
Let’s watch this carefully and see what happen.

ARK, Are you speaking of Dr. Andrew Weil, or another doctor involved with Complimentary Medicine? It would be interesting to know. Thanks!

A possible article about the link between statin drug use and early cataracts would be welcome. I’ve heard this stated by medical authorities.
This connection has been established. Here is a link you may find of interest:

WHY is it important to follow a doctor’s advice since he is probably misinformed? It seems there is a lot of misinformation out there. I think misinformation has killed a lot of people in the past half-century. Heart disease was rare until doctors climbed onto the “saturated fat is evil” bandwagon.
PEOPLE’S PHARMACY RESPONSE: It is important for patients to do their own homework and find a well-informed doctor with whom they can interact in a partnership.

As I recall from reading a different summary, only wet form of amd and not the dry form were associated with aspirin. Don’t recall seeing the strength of aspirin mentioned either.
PEOPLE’S PHARMACY RESPONSE: You are correct. Only the wet form of macular degeneration was associated with aspirin use. The usual dose of aspirin in Australia for heart protection is 150 mg–about half a regular tablet here.

I don’t know if taking aspirin is worth the risks. There are the stomach issues as well as this possible link to AMD.

My father had age-related macular degeneration and he had taken BC powders like candy for 20+ years…coincidence? Probably not.

All articles are very informative. Serious research seems to be a goal. When you let people know more study has to take place on a article, and inform people not to stop a program given by their doctor, until more research is conducted, this makes a good report and allows the reader to check further on their individual situation and as we all should do, ASK QUESTIONS.

My husband has been on a baby aspirin a day regime since the mid 1980’s and is suffering from AMD, which was diagnosed sometime in the 1990’s and is now going into a more advanced stage. He has had the laser treatment as well as injections when some blood blister (for lack of the proper term) was found in the back of one eye. Now he is continuing the aspirin theraphy, along with plavix, following the installation of a stent, even though it’s past the normal year after. The doctor said it was a stoke prevention theraphy.

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