TOPLINE

A retrospective study of more than 3600 men with erectile dysfunction and type 2 diabetes found that the use of phosphodiesterase type 5 (PDE5) inhibitors was associated with a lower rate of development of proliferative diabetic retinopathy, an advanced, sight-threatening eye disease, during a follow-up of up to 7 years.

METHODOLOGY

• Researchers conducted a retrospective cohort study using patient records from a global health database to examine whether the use of PDE5 inhibitors was associated with the risk for diabetic retinopathy in men aged 50 years or older with both erectile dysfunction and type 2 diabetes.
• They compared 1823 men who were prescribed sildenafil, tadalafil, vardenafil, or avanafil within 1 year of both diagnoses with 1823 propensity-matched nonusers and followed up on both groups for up to 7 years after that first year.
• All participants were required to have at least one documented eye examination during follow-up, and their mean age was about 62 years.
• Men with pulmonary hypertension or an enlarged prostate were left out because PDE5 inhibitors are also prescribed for those conditions. Men with type 1 diabetes or legal blindness or those who had undergone prior eye removal surgery were excluded, as were those who already had diabetic retinopathy before follow-up began.
• The main outcome was incident diabetic retinopathy, while secondary outcomes were mild, moderate, and severe nonproliferative diabetic retinopathy and proliferative diabetic retinopathy, diabetic macular edema, and the need for eye injections or laser treatment.

TAKEAWAY

• During follow-up, the use of PDE5 inhibitors was associated with a 17% lower rate of development of diabetic retinopathy (P = .0139), but this difference did not remain significant after adjustment for multiple comparisons (adjusted P = .0626).
• The strongest association was noted for proliferative diabetic retinopathy, which developed in 1% of men who used PDE5 inhibitors compared with 2.8% of those who did not, and the association remained statistically significant after researchers adjusted for multiple comparisons (adjusted P < .0009).
• No statistically significant associations were noted between the use of PDE5 inhibitors and diabetic macular edema, eye injections, or laser treatment, while moderate nonproliferative diabetic retinopathy showed a borderline association that did not hold after adjustment for multiple comparisons.

IN PRACTICE

"Given the widespread use of PDE5I [PDE5 inhibitor] and the growing burden of diabetic retinopathy worldwide, these findings may be relevant to future research into modifiable factors associated with DR [diabetic retinopathy] risk," the researchers reported.

SOURCE

The study was led by Natan Lishinsky-Fischer of the Hadassah Medical Center in Jerusalem, Israel. It was published online on September 25 in Eye.

LIMITATIONS

As the study identified diabetic retinopathy using billing and diagnostic codes rather than from eye exams or standardized photographic grading, some cases may have been missed or misclassified. Drug use was based on prescription records, which did not include the dose, how often men took the pills, or whether they took them at all. Furthermore, although the researchers matched the two groups for many characteristics, men who used these drugs may have simply been healthier and more health-conscious, with better medical follow-up and habits that could independently lower their risk for eye disease.

DISCLOSURES

The authors reported no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.