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Study: Longer oral contraceptive use may increase risk of self-reported glaucoma, ocular hypertension
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Women aged 40 years or older who used oral contraceptives may have an increased risk of self-reported glaucoma or ocular hypertension, according to a study.
Data were pulled from the National Health and Nutrition Examination Survey, which included 3,406 female participants aged 40 years or older who took part in the interview and examination portions of the study. The interview included eye health and reproductive health questionnaires.
A multivariate logistic regression analysis controlled potential confounding factors, including age, ethnicity, general health conditions, tobacco and alcohol consumption behavior, systematic and ocular comorbidities, reproductive health conditions and gynecological history.
After adjusting for confounders, researchers found that participants who took oral contraceptives for 3 or more years were more likely to self-report glaucoma or ocular hypertension (odds ratio, 1.94; P = .007).
Older age, African-American ethnicity, history of retinopathy and later age of menarche were all significantly associated with higher odds of self-reported glaucoma.
There was a 13% increased risk of self-reported glaucoma or ocular hypertension for each additional year of later menarche.
“These data further confirm that female reproductive health has an impact on glaucoma risk, and carefully performed studies that assess [oral contraceptive] use or, more precisely, alterations in endogenous estrogen concentration in women with and without glaucoma are indicated,” the study authors said. – by Nhu Te
Disclosure: Wang reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Blair Lonsberry, OD, FAAO
Glaucoma has been described as the silent blinding disease, so determining factors that could help identify patients at risk are important.
The authors of this study report that more than 3 years of oral contraceptive (OC) use may be associated with a 13% increased risk of self-reported glaucoma or ocular hypertension.
Estrogen has been theorized to enhance nitric oxide signaling, improving outflow facility and retinal autoregulation within the trabecular meshwork and in the retinal vasculature that supplies the optic nerve. Previous studies have demonstrated that estrogen deficiency is associated with glaucoma. At first glance, OC use would seem to be protective, as many of the commonly used OC products contain estrogen, thus elevating circulating estrogen levels and inhibiting ovulation.
However, it is theorized that the use of OC results in a dramatically altered daily cycle of estrogen balance through the day and might be important in glaucomatous damage. While OC use may not be as important a risk factor as a disc hemorrhage or family history, it is worth considering during glaucoma assessment. More study is needed in this area to further understand the role of female reproductive health in the development and management of glaucoma.
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Wang YE, et al. Ophthalmology. 2016;doi:10.1016/j.ophtha.2015.11.029.
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