Women’s eye health series to examine ocular complications, systemic disease

Series focusing on women’s eye health will spotlight female ocular complications with systemic diseases.

Women make up two-thirds of the 40 million visually impaired and two-thirds of the blind. Ophthalmologists need to be aware of the unique etiology of this patient group and how other health factors in women can contribute to ocular problems.

Ocular Surgery News is launching a series on the visual complications in women that ophthalmologists encounter daily.

Elizabeth A. Davis, MD, FACS, will oversee the ongoing “Women’s Health and the Eye” series, which aims to look closely at systemic diseases and social implications in women’s lives that affect their ocular health.

Dr. Davis said she hoped this series would bring these gender implications “to the forefront of people’s thinking when considering differential diagnoses in women and how some of those eye diseases might affect therapeutic treatments or surgical outcomes, rather than treating all patients the same.”

Common ocular disease

Although the intent of this series is to look at the ophthalmic effects of systemic diseases and environmental concerns, ophthalmologists should be aware of the diseases of the eye that are, alone, more prevalent in women.

Elizabeth A. Davis

The National Eye Institute (NEI) explained that there are no differences in the prevalence of vision problems in older adults, but there are more visually impaired women than men because, on average, especially in developed nations, women live longer than men.

Due to this age discrepancy, women are at a greater risk for age-related diseases such as macular degeneration and cataracts. Cataracts in the United States, for example, affect 1.5 times as many women as men according to the Foundation for the American Academy of Ophthalmology.

“Because there are many more women than men who are 80, there are going to be many more women with glaucoma than there are men with glaucoma,” Janine Smith, MD, of the NEI, said.

Studies have also found that diseases affecting the tear film on the surface of the eye are of particular concern among women of various ages.

In a recent study, Debra A. Schaumberg, ScD, OD, MPH, stated that 8.1% of women age 55 and older have dry eye. OSN will focus on this later in the series when experts discuss the effect of menopause on the female eye.

At the extreme end of dry eye afflictions, the AAO said that Sjögren’s syndrome affects 2 to 3 million Americans, more than 90% of whom are women.

From a corneal aspect, Fuchs’ dystrophy, a slowly progressing disease, is slightly more common in women than men, as is iridocorneal endothelial syndrome (ICE).

ICE can lead to glaucoma, of which chronic-open angle glaucoma also affects more women than men, but Dr. Smith said this, too, can be attributed to age. Finally, optic neuritis, which strikes about 25,000 Americans per year, primarily targets women as well.

In addition, older women are more likely to experience idiopathic macular hole development, which is detrimental to vision, difficult to fix and puts the patient at greater risk for retinal detachment.

Attention to systemic disease

While some women are affected by ocular conditions that more greatly affect their sex, other women find themselves with ocular complications from more systemic diseases and gynecologic conditions.

This series will look at various conditions as they affect women’s eyes, ranging from autoimmune disorders and cardiovascular conditions to neurological disorders and gynecologic ocular complications.

One series will look specifically at autoimmune diseases, which disproportionately affect women due to differences in their immune systems.

“The immune system between men and women is different,” Dr. Smith said. “Even the way men respond to viruses and women respond to infections, there are differences.”

These differences leave women more susceptible to autoimmune diseases such as rheumatoid arthritis, which can affect their eyes.

Women are also greatly affected by the changes in their hormones during significant life events such as pregnancy and menopause and they are more likely to suffer from certain neurological diseases, such as multiple sclerosis.

Ophthalmologists are often aware of purely ophthalmic conditions that affect primarily women, but they must also be aware of other conditions that can easily affect eyesight in female patients.

Awareness of systemic diseases more common in women and the ocular implications of them “assists in differential diagnosis and appropriate care and treatment on an individualized basis,” Dr. Davis said. “It really assists in the complete care of the patient, taking gender into account.”

Social implications

Along with biological factors, people’s health is affected by socio-economic and psycho-sociological factors, especially the eye health of women.

In developing nations, women do not have the standing within their families or financial security within their communities to make the decisions necessary to obtain their own healthcare, Dr. Davis said in a recent publication with John B. Pinto, OSN Practice Management Section Editor.

Often, they said, the women are not allowed to leave their caste or community to access the necessary medical care, Dr. Davis said. Dr. Smith agreed with that sentiment and said wearing glasses is not desirable for women in some cultures.

“For example, in Asia and Africa overall, there are more women with cataract than men because if a person in the family gets cataract surgery, it is much more likely to be the man … because of cultural reasons,” Dr. Smith said.

In the developed countries, women create a larger bulk of the visually impaired for multiple reasons, Dr. Davis said. She said the women live longer and are more likely to seek out care for themselves and their family members.

“They’re the most significant consumer of health care, so ophthalmologists do and should expect to see a high percentage of women patients in their practice,” Dr. Davis said. “They are caregivers for their family members, and I think that they represent typically a large proportion of a physician’s practice.”

Even in her research studies, Dr. Davis said 60% of her subjects are female because they represent the population of patients she treats.

Beyond the eye

Dr. Smith said a series such as this offers ophthalmologists an awareness and a reminder that they must sometimes look beyond the eye to find the source of the ocular problems.

“The eye is part of a whole human being and ophthalmologists are physicians in that we have a responsibility to our patients to be aware of their medical health overall,” she said.

If an ophthalmologist did not inquire about joint pain, for example, they may not make a link between ocular health and rheumatoid arthritis, she said. Sjögren’s syndrome often takes up to 7 years to diagnose because of miscommunication, Dr. Smith added.

“Your overall health status and disease status is important to the health of your eyes,” she said. “There are things that our overall health is critical for our eye health and the things we can do to take care of ourselves in general.”

In the November 15 issue

Neuro-ophthalmologists will discuss the neurological disorders more prevalent in women and their affect on visual health, which can be one of the first symptoms of neurological problems.

For more information:

• Elizabeth A. Davis, MD, FACS, can be reached at Minnesota Eye Consultants, 710 E. 24th St., Minneapolis, MN 55404; 952-885-2467. Dr. Davis is a consultant for AMO, STAAR Surgical, Bausch & Lomb and IntraLase.
• Janine Smith, MD, Deputy Clinical Director of the National Eye Institute, can be reached at the National Institutes of Health, 31 Center Drive, MSC 2510, Bethesda, MD, 20892; 301-496-9058.

• Katrina Altersitz is an OSN Staff Writer who covers all aspects of ophthalmology.