Hormonal therapy use associated with later glaucoma diagnosis in postmenopausal women
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Key takeaways:
- Age of menopause was the greatest predictor of age at glaucoma diagnosis.
- Hormonal therapy use was associated with later diagnosis of glaucoma.
Hormonal therapy may delay glaucoma onset in postmenopausal women, with longer duration of treatment linked to later diagnosis of glaucoma, according to a study in Investigative Ophthalmology & Vision Science.
“Our previous case-only study found that the age of menopause was the most significant predictor for the diagnosis of glaucoma,” the study authors wrote. “Here, we aim to examine the association between [hormonal therapy] and the onset of glaucoma in a case-only population.”
In a retrospective study of female veterans with open-angle glaucoma, researchers used VA records between 2000 and 2019 to identify 1,926 women with a history of hormonal use and 1,026 without. They matched patients on age of menopause (early: aged 35-45 years; normal: aged 45-55 years; and late: aged 55-65 years), as well as BMI, blood pressure, antihypertensive medication and comorbidity index, among other covariates.
According to results, the average duration of hormonal therapy decreased with age of menopause diagnosis. Specifically, the percentage of patients using hormonal therapy for less than 2 years increased with age of menopause diagnosis, while the percentage using for more than 5 years decreased with age of diagnosis.
Hormonal therapy use was associated with later diagnosis of glaucoma, with treatment for 0 to 2 years associated with 2.2 years later diagnosis, while treatment for 2 to 5 years and more than 5 years was associated with 3.74 years and 4.51 years later diagnosis, respectively.
Overall, age of menopause was the greatest predictor of age at glaucoma diagnosis, and Black or African American women were younger at age of glaucoma diagnosis in both the hormonal therapy and untreated groups compared with white women.
“Our findings suggest that the protective effect of [hormonal therapy] on glaucoma onset may be modulated by the age of menopause and potentially influenced by racial background,” the study authors wrote. “These results contribute to the growing understanding of the protective role of estrogen in glaucoma.”
Perspective
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Menopause marks the end of a woman’s reproductive years, typically occurring between ages 45 and 55 years. It involves a decline in estrogen and progesterone production, leading to various symptoms such as hot flashes, night sweats and mood changes. Hormone therapy can be an effective treatment for managing these symptoms, typically involving the administration of estrogen, which may also be combined with progesterone.
Through this retrospective study of female veterans with open-angle glaucoma, Hogan and colleagues found that the largest predictor for the age at diagnosis of glaucoma was the age of menopause. As well, the use of hormone therapy was associated with a later diagnosis of glaucoma in postmenopausal women, suggesting a potential protective role of estrogen.
The use of hormone therapy has been shown to have benefits such as relief of symptoms and reduced risk for osteoporosis and heart disease, as well as increased risk for breast cancer, blood clots and stroke. There is a growing, yet small, body of evidence that supports the potential protective nature of estrogen in the pathogenesis of glaucoma.
Although more studies are needed, these findings make this another consideration for this critical diagnosis, especially when managing a patient who may have additional risk factors for this sight-threatening disease.
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