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Acetylcholinesterase inhibitors (AChEIs) used to treat Alzheimer’s disease may lower the risk for developing age-related macular degeneration (AMD), according to a study published last week in JAMA Ophthalmology. 

During the study, the researchers evaluated 12,487 VA patients with Alzheimer’s diagnoses who were on AChEIs and 4,898 people who took an alternative dementia drug Namenda (memantine). The team compared those patients with a control group of 8,486 people who didn’t take either drug. The participants were aged 55 to 80, and had received medical services from the US Veterans Affairs health system between 2000 and 2023. More than 85% of patients were 65 or older and the mean age was 72.

The rates of AMD were 4% lower in those who took AChEIs compared to controls. It rose to 6% per year when 4,821 people taking AChEIs were matched with people not on dementia drugs. Investigators completed about 25 years of follow-up. During that time, 299 people in the AChEI group developed AMD and 373 people in the control group developed AMD. 

Though the data shows a link between a lower risk and the medications, the researchers said they would need to conduct randomized clinical trials to see if the medicine actually causes the reduced risk. AChEIs include Aricept (donepezil), Exelon (rivastigmine) and Razadyne (galantamine), which is used to slow cognitive decline  About 18.3 million Americans over the age of 40 have early-stage AMD; 1.49 million have the late stage of the disease that impairs vision. 

“A growing body of work suggests that AChEIs have mechanisms of action beyond their cholinesterase inhibition, possibly limiting inflammation, an important target for AMD,” the authors wrote. These drugs “have been shown to promote vasoprotection, maintaining the integrity of the microvasculature of the eye, and possibly hemodynamic dysfunction that results in AMD.”