NSAIDs and Macular Degeneration: Safety and Recommendations

Safety Profile and Risk Considerations

The American Heart Association suggests that NSAIDs can increase cardiovascular risks, including myocardial infarction, stroke, heart failure, and hypertension, in patients with macular degeneration 1, 2.
Patients with prior cardiovascular disease are at higher risk for adverse cardiovascular effects when taking NSAIDs, according to the American College of Cardiology 2.
The American Geriatrics Society notes that diclofenac has been identified as having potentially higher cardiovascular risk compared to other traditional NSAIDs 3.
NSAIDs increase the risk of gastrointestinal bleeding, ulceration, and perforation, particularly in older adults, as reported by the American Academy of Family Physicians 4, 5.
Risk factors for NSAID-related GI complications include prior ulcer disease or complications, advanced age, and concomitant use of aspirin, antiplatelet drugs, steroids, or anticoagulants, according to the American Gastroenterological Association 5, 6.

The American Geriatrics Society recommends that acetaminophen should be considered as the first option before NSAIDs for patients requiring pain relief who have macular degeneration, especially in older adults 3.
If NSAIDs are necessary, the American Academy of Family Physicians suggests using the lowest effective dose for the shortest duration possible 4, 6.
The American College of Gastroenterology notes that ibuprofen at lower anti-inflammatory doses may be safer from a gastrointestinal perspective 5.
Naproxen may have a more neutral cardiovascular risk profile compared to other NSAIDs, according to the American Heart Association 1, 2.
The American Geriatrics Society advises avoiding indomethacin in older adults with macular degeneration due to its higher risk of adverse effects, including CNS effects 6.

The American Gastroenterological Association recommends co-prescription of a proton pump inhibitor for patients at high risk of gastrointestinal complications 3, 5.
The American Heart Association suggests monitoring renal function and blood pressure in patients taking NSAIDs, especially those with preexisting hypertension, renal disease, or heart failure 2.
For patients taking aspirin for cardioprotection who also need an NSAID, the American College of Cardiology notes that timing is important, with ibuprofen taken at least 30 minutes after aspirin or at least 8 hours before aspirin to avoid reducing aspirin's cardioprotective effects 2.

The American Academy of Ophthalmology notes that short-term topical NSAIDs may be used for specific ophthalmic conditions, but with close monitoring due to concerns about corneal melting or perforation 7.
There is no evidence that topical ophthalmic NSAIDs worsen macular degeneration, according to the American Academy of Ophthalmology 7.
Patients with macular degeneration taking NSAIDs should be monitored for changes in visual symptoms, signs of gastrointestinal bleeding, changes in blood pressure or renal function, and cardiovascular symptoms, as recommended by the American Academy of Ophthalmology and the American Heart Association 1, 2, 3, 6, 8.