Association of sildenafil use with age-related macular degeneration: a retrospective cohort study

BMJ Open Ophthalmol. 2024 Mar 15;9(1):e001525. doi: 10.1136/bmjophth-2023-001525.


Objective: Despite significant advances in clinical care and understanding of the underlying pathophysiology, age-related macular degeneration (AMD)-a major cause of global blindness-lacks effective treatment to prevent the irreversible degeneration of photoreceptors leading to central vision loss. Limited studies suggest phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil, may prevent AMD by increasing retinal blood flow. This study explores the potential association between sildenafil use and AMD risk in men with erectile dysfunction using UK data.

Methods and analysis: Using the UK's IQVIA Medical Research Data, the study analysed 31 575 men prescribed sildenafil for erectile dysfunction and no AMD history from 2007 to 2015, matched with a comparator group of 62 155 non-sildenafil users in a 1:2 ratio, over a median follow-up of approximately three years.

Results: The primary outcome was the incidence of AMD in the two groups. The study found no significant difference in AMD incidence between the sildenafil users and the non-users, with an adjusted hazard ratio (HR) of 0.99 (95% CI 0.84 to 1.16), after accounting for confounders such as age, ethnicity, Townsend deprivation quintile, body mass index category, and diagnosis of hypertension and type 2 diabetes.

Conclusion: The study results indicated no significant association between sildenafil use and AMD prevention in UK men with erectile dysfunction, suggesting sildenafil's protective effect on AMD is likely insignificant.

Keywords: Degeneration; Epidemiology; Macula; Pharmacology.

MeSH terms

  • Diabetes Mellitus, Type 2* / drug therapy
  • Erectile Dysfunction* / chemically induced
  • Humans
  • Macular Degeneration* / chemically induced
  • Male
  • Phosphodiesterase 5 Inhibitors / adverse effects
  • Retrospective Studies
  • Sildenafil Citrate / adverse effects


  • Sildenafil Citrate
  • Phosphodiesterase 5 Inhibitors