阿斯匹林（aspirin）作为一种经典的解热镇痛药，已往它主要被用于治疗疼痛和/或发热。近年来，则有建议中老年人每天服用小剂量（75～100mg per day）阿斯匹林，以有益于心、脑血管的健康而预防冠心病、中风等。晚近，更有研究显示长期服用小剂量的阿斯匹林有利于预防癌症的发生。由此可见，阿斯匹林之功效与应用的广泛性。

日前，来自欧洲的研究却提示“长期服用阿斯匹林似可加速老年人视网膜黄斑退行性变性（macular degeneration），即可能增加老年人的视力丧失（loss of vision）”。这项由荷兰学者主持完成的研究，收集并分析了包括英国、法国、意大利、西班牙和挪威等欧洲多国年龄大于65岁、近4700个老年人的病历资料，结果显示“每100个服用阿斯匹林的老年人约有4人患有黄斑退行性变性，而非服用阿斯匹林的同龄老年人，每100人仅约有2人患有黄斑退行性变性”。尽管这一结果尚不能够肯定地说“长期服用阿斯匹林就一定损害老年人的视力，但它确实给广大医务工作者提出了关于应用阿斯匹林时应该关注的新问题”。值得重视啊！

Daily aspirin tied to risk of vision loss

NEW YORK (Reuters Health) - Seniors who take aspirin daily are twice as likely to have late stage macular degeneration, an age-related loss of vision, than people who never take the pain reliever, a new European study reports.

The data do not show that aspirin causes vision loss. But the findings are of concern if aspirin somehow exacerbates the eye disorder, researchers say, given how many seniors take it daily for heart disease.

"For people who have age-related macular degeneration, it probably isn't wise to recommend taking aspirin," said William Christen of Brigham and Women's Hospital in Boston, who was not involved in this study.

Researchers led by Dr. Paulus de Jong at the Netherlands Institute for Neuroscience and Academic Medical Center collected health and lifestyle information from nearly 4,700 people over age 65.

The study, published in the journal Ophthalmology, included Norwegian, Estonian, British, French, Italian, Greek and Spanish seniors.

Of the 839 people who took aspirin each day, 36 had an advanced form of the disease called wet macular degeneration.

This equates to about four out of every 100 daily aspirin users.

In comparison, roughly two out of every 100 people who took aspirin less frequently had the same type of macular degeneration.

The wet form of the eye condition, caused by leaking blood vessels in the eye, leads to vision loss in the center of the eye's field of vision.

The dry form of macular degeneration is more common and less severe, although people still suffer visual impairment.

Together, wet and dry macular degeneration make up the leading causes of vision loss among people over age 60, afflicting millions of Americans.

The researchers found that aspirin use was not tied to the dry form, nor to earlier stages of the disease.

"I don't think that's surprising," Christen told Reuters Health. "I think the effects of aspirin may be different in the early stages of age-related macular degeneration than in the late stages."

Aspirin is often taken to prevent cardiovascular disease, and Paulus told Reuters Health there has been controversy over the link between cardiovascular disease and macular degeneration.

Paulus wrote in an email that his team "analyzed as meticulously as possible" whether cardiovascular disease might have influenced the results, and still found that aspirin users -- regardless of their heart health -- are at a greater risk of the more serious type of vision loss.

While it's a good idea to caution people that aspirin might have a deleterious role in macular degeneration, "a healthy eye with full visual capacities is of no use in a dead body," Paulus said.

In other words, for people with cardiovascular disease who take aspirin to prevent the condition from worsening, the benefits of the drug outweigh the risks to visual health.

Paulus said larger studies that follow people over time and document their aspirin use and vision will help resolve aspirin's role in macular degeneration.

SOURCE: http://bit.ly/qrELJP Ophthalmology, online September 13, 2011.