Macular degeneration (MD) is a progressive eye disease that affects the macula, the central part of the retina responsible for sharp, central vision. While the primary risk factors are non-modifiable, such as age and genetics, certain medications have been linked to an increased risk or progression of the condition. This article provides an overview of drug classes and specific medications associated with drug-induced maculopathy.
Medications associated with increased macular degeneration risk
Hydroxychloroquine (Plaquenil)
Hydroxychloroquine is a drug used to treat autoimmune and inflammatory conditions like lupus and rheumatoid arthritis. Long-term use can lead to retinal toxicity, which involves damage to the retina that can resemble some forms of macular degeneration. The risk increases with higher cumulative dosage and longer duration of use, often after five or more years of treatment. Regular eye exams are recommended for patients on long-term therapy.
Tamoxifen (Nolvadex)
Used in the treatment of breast cancer, tamoxifen can also cause retinal damage, characterized by crystalline deposits in the macula. Although the incidence is relatively low, studies suggest that some individuals who take 20 mg of tamoxifen daily for two or more years may develop retinal damage. This damage can potentially lead to vision impairments, and stopping the medication may not reverse the visual loss.
Blood pressure medications (Antihypertensives)
Research suggests a potential link between some antihypertensive drug classes and an increased risk of developing AMD, though the findings are mixed.
- Vasodilators: The Beaver Dam Eye Study found that taking vasodilators like hydralazine was associated with a 72% higher risk of developing early-stage AMD.
- Oral Beta-blockers: This same study linked oral beta-blockers (e.g., metoprolol, atenolol) to a 71% increased risk of neovascular (wet) AMD.
- Calcium Channel Blockers: Some studies have suggested an increased risk for wet AMD with the use of second-generation calcium channel blockers such as amlodipine.
GLP-1 receptor agonists (Ozempic, Wegovy)
A recent study published in June 2025 found an association between GLP-1 drugs like semaglutide (Ozempic, Wegovy) and a higher risk of developing wet AMD in patients with type 2 diabetes. The risk was notably higher with increased duration of use, potentially due to the drug creating a more hypoxic retinal environment.
Anticholinergic Drugs (ACDs)
An association has been found between the long-term use of ACDs, particularly those with a high anticholinergic burden, and an increased risk of late AMD. A 2018 study suggested that cumulative exposure over 15 years posed a higher risk. ACDs include various antidepressants and other medications.
Bisphosphonates
Used to treat osteoporosis, continuous long-term use of bisphosphonates (such as Fosamax) has been linked in some studies to an increased risk of wet AMD.
Pentosan polysulfate sodium (PPS)
This medication, primarily used for interstitial cystitis, has been associated with a distinct form of maculopathy involving pigmentary deposits in the eye. This condition can progress even after discontinuing the drug.
Drug-induced maculopathy comparison
| Medication Class | Example Medications | Associated Macular Effect | Key Considerations |
|---|---|---|---|
| Antimalarials | Hydroxychloroquine (Plaquenil) | Retinal toxicity, bull's-eye maculopathy | Risk tied to cumulative dosage and duration; regular screening is vital |
| Hormonal Therapies | Tamoxifen (Nolvadex) | Crystalline retinopathy, retinal damage | Risk linked to dose and duration; visual loss may not be reversible |
| Antihypertensives | Vasodilators (Hydralazine), Beta-blockers (Metoprolol), Calcium Channel Blockers (Amlodipine) | Early AMD, neovascular AMD | Evidence is mixed; underlying hypertension may be a confounding factor |
| Diabetes Medications | GLP-1 agonists (Semaglutide) | Increased risk of wet AMD | Risk increases with longer treatment duration, especially in diabetics |
| Osteoporosis Drugs | Bisphosphonates (Fosamax) | Increased risk of wet AMD | Associated with continuous, long-term use |
| Anticholinergics | Various antidepressants, bladder control meds | Increased risk of late AMD | Dose-dependent risk; highest risk with prolonged use |
What to do if you are concerned
If you take any of the medications listed and have concerns about your eye health, it's important to not stop your medication abruptly. Your prescribed medication may be critical for managing another health condition. Instead, schedule an appointment with your ophthalmologist and the doctor who prescribed the medication to discuss your concerns. They can weigh the potential benefits of the drug against any risks to your vision and consider alternative treatment options if necessary. It is also crucial to maintain regular, comprehensive eye exams, especially if you have a family history of AMD or are on long-term medication known to affect the retina.
The importance of open communication
Openly discussing your medication history with your eye care professional is essential for accurate diagnosis and monitoring. In some cases, drug-induced maculopathy can mimic other conditions, so a complete history helps ensure proper management. By working collaboratively with your healthcare team, you can proactively address potential risks to your vision.
Conclusion
While a definitive causal link is often challenging to prove, a growing body of evidence suggests associations between several medications and an increased risk of macular degeneration or specific retinal toxicities. Medications such as hydroxychloroquine, tamoxifen, certain blood pressure drugs, GLP-1 agonists, and bisphosphonates are among those that warrant careful monitoring. The risk often depends on factors like dosage, duration of use, and individual susceptibility. It is imperative for patients to maintain open communication with their doctors and eye care professionals to manage these potential risks while ensuring effective treatment for their underlying health conditions. BrightFocus Foundation provides further resources on drug effects and macular degeneration.
