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Kolomeyer, Anton M., MD, PhD*; Maguire, Maureen G., PhD†,‡; Pan, Wei, MS; VanderBeek, Brian L., MD, MPH, MSCE*,‡,§

doi: 10.1097/IAE.0000000000002059
Original Study

Purpose: To determine whether oral beta-blockers (BBs) are associated with the development of neovascular age-related macular degeneration (nAMD).

Methods: Retrospective cohort study of patients from 2000 to 2014 using data from a large national U.S. insurer's administrative medical claims database. Patients with nonexudative AMD who initiated (index date) BB, a calcium channel blocker (CCB), an angiotensin-converting enzyme/angiotensin receptor blocker, or a diuretic. Patients were excluded for <2 years in the plan before the index date, any history of nAMD or diagnosis, or treatment for an ocular disease that could be confused with nAMD. Hazard of developing of nAMD was the main outcome measure. Primary analysis compared BB with CCB patients with BB versus the other classes as secondary analyses. In addition, a sensitivity analysis was performed between BB and CCB cohorts using 1:1 propensity score matching. Cox proportional hazard regression was performed to estimate the hazard ratio (HR) of developing nAMD at 90, 180, and 365 days for BB. Covariates of interest included demographic information, year of index date, number of antihypertensive medications, and other comorbid systemic conditions.

Results: Eighteen thousand seven hundred and fifty-four BB patients and 12,784 CCB patients met criteria for inclusion. After controlling for covariates, patients on BB had a lower hazard for nAMD at both 90 and 180 days than patients on CCB (HRs: 0.67–0.71; P < 0.01 for both) and diuretics (HRs: 0.55–0.62; P < 0.01). Patients on BB versus angiotensin-converting enzyme/angiotensin receptor blocker at all time points and BB versus CCB and diuretics at 365 days did not have a significantly lower association with nAMD (HR: 0.73–0.85; P > 0.06 for all comparisons). A sensitivity analysis using propensity score matching yielded similar results with patients on BB significantly less likely to develop nAMD at 90 and 180 days (HR: 0.70–0.76; P < 0.049 for both) but not at 365 days (HR: 0.88; P = 0.30) compared with patients on CCB.

Conclusion: No evidence was found that BB usage increased the hazard for nAMD relative to other antihypertensive medications.

Using an insurance medical claims database, the authors set out to determine whether oral beta-blocker use was associated with development of neovascular age-related macular degeneration. The authors’ results did not identify an increased hazard for developing neovascular age-related macular degeneration as compared to other antihypertensive agents. Clinicians should believe reassured when prescribing oral beta-blocker to patients with nonexudative age-related macular degeneration.

*Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;

Center for Preventive Ophthalmology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;

Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and

§Leonard Davis Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Reprint requests: Brian L. VanderBeek, MD, MPH, MSCE, Scheie Eye Institute, 51 North 39th St, Philadelphia, PA 19104; e-mail:

Supported by National Institutes of Health K23 Award (1K23EY025729 – 01; B.L.V.) and University of Pennsylvania Core Grant for Vision Research (2P30EYEY001583). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Additional funding was provided by Research to Prevent Blindness, the Paul and Evanina Mackall Foundation, and the Heed Ophthalmic Research Foundation (A.M.K.).

None of the authors has any financial/conflicting interests to disclose.

© 2019 by Ophthalmic Communications Society, Inc.