The menopause is an important risk factor for the occurrence of primary open-angle glaucoma (POAG) and, therefore, the hypothesis that there is a positive correlation between oestrogen hormone replacement therapy and the occurrence of POAG in post-menopausal women is of great interest.
The study on this topic was published in IOVS in October 2024. Postmenopausal Hormone Therapy Was Associated With Later Age of Onset Among Glaucoma Cases.
This is a retrospective study, conducted by US researchers at Emory University in Atlanta, of clinical data from a large sample of female veterans who had been diagnosed with primary open-angle glaucoma. Data from 1,926 women who had used hormone replacement therapy were compared for the period 2000-2019 with those of 1,026 female veterans who had never used it.
The researchers also associated other factors, such as age at menopause, body mass index (BMI), blood pressure and possible comorbidities.
Women who had taken oestrogen hormone replacement therapy were found to have a delayed onset of glaucoma, with later diagnoses associated with longer periods of hormone treatment.
It should be noted that all post-menopausal womenRegardless of age, they have an intraocular pressure (IOP: IntraOcular Pressure) 1.5 to 3 mm Hg higher than pre-menopausal women of the same age.
Post-menopausal women taking a hormone therapy containing oestrogen have a lower IOP (between 0.5 and 3 mmHg) than post-menopausal women not on therapy, so much so that some studies have suggested the use of oestrogen-based formulations as a potential treatment for glaucoma.
In addition, preclinical studies from the same Atlanta University have shown how surgical menopause, which is accompanied by an abrupt decline in oestrogen levels, causes an increased loss of retinal ganglion cells and subsequent visual dysfunction. Studies have shown that oestrogen therapy is able to counteract this ganglion cell damage. All this supports the hypothesis that oestrogen 'modulates' the risk of the onset of glaucoma and that oestrogen therapy can influence both the risk of optic neuropathy and the timing of its onset.
The data analysed show that the use of oestrogen hormone therapy is associated with an older age of onset of glaucomatous disease and that more prolonged hormone therapies correspond to an older age of glaucoma diagnosis.
On the basis of multivariate analysis, age at menopause is the first predictor of glaucoma occurrence, followed by: use of hormone replacement therapy or not, belonging to the white race and taking antihypertensive medication.
Specifically, women taking hormone replacement therapy from 0 to 2 years had a delay in the diagnosis of glaucoma of 2.20 years, with therapy from 2 to 5 years the delay was 3.74 years, and with more than 5 years the diagnosis of glaucoma slipped 4.51 years.
On the subject of glaucoma, see also:
- Glaucoma: the frontiers of research - Oculista Italiano
- Systemic Diseases and the Risk of Glaucoma? - Italian Ophthalmologist
- Glaucoma and neuroprotective properties of natural substances - Oculista Italiano
- Diet and risk of open-angle glaucoma - Oculista Italiano
- Hogan K, Xiangqin C, Giangiacomo A, Andrew J. Feola AJ; Postmenopausal Hormone Therapy Was Associated With Later Age of Onset Among Glaucoma Cases. Invest. Ophthalmol. Vis. Sci. 2024;65(10):31. https://doi.org/10.1167/iovs.65.10.31.
- Madjedi KM, Stuart KV, Chua SY, et al. The association of female reproductive factors with glaucoma and related traits: a systematic review. Ophthalmol Glaucoma. 2022; 5: 628-647.
- Douglass A, Dattilo M, Feola AJ. Evidence for menopause as a sex-specific risk factor for glaucoma. Cell Mol Neurobiol. 2023; 43: 79-97.
- Hogan K, Cui X, Giangiacomo A, Feola AJ. Association of age of menopause and glaucoma diagnosis in female veterans. Invest Ophthalmol Vis Sci.2024; 65(10): 32, https://doi.org/10.1167/iovs.65.10.32.
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