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Editors Selection IGR 9-4

Risk factors: Postmenopausal hormone

Comment by Linda Zangwill on:

20120 Attributes of female reproductive aging and their relation to primary open-angle glaucoma: A prospective study, Pasquale LR; Rosner BA; Hankinson SE et al., Journal of Glaucoma, 2007; 16: 598-605

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The Nurses Health Study is a study of over 66,000 women followed prospectively from 1980 to 2002. Numerous hypotheses have been tested in this cohort. For this analysis, Pasquale et al. (1345) examined whether age at menopause, and postmenopausal hormone (PMH) use were associated with primary open angle glaucoma. The results of the few studies that have investigated this issue have been incon-sistent. A very large sample size is required to adequately address this hypothesis. With 447 POAG cases identified through self-report and confirmed by medical record review, and thousands of controls (the number varied by analysis) included, no statistically significant association between POAG and age at menopause or PMH use was found. Many secondary analyses were conducted on subgroups of the population identified for analysis. In a few of these secondary analyses identified as such by the author, significant associations were found. Specifically, among older women (> 65 years of age, entering menopause after 54 yrs was associated with a reduced risk of POAG. In addition, use of estrogen with progestin was associated with a reduced risk of POAG with elevated IOP, while current use of estrogen alone was not. The authors conclude that suggestive fi ndings in secondary analyses indicate that the interactions between age at menopause, PMH and POAG should be explored further. It should be noted that the authors provide evidence of the biologic plausibility for a relationship between estrogen and glaucoma; retinal ganglion cells express certain estrogen receptors. This study relies heavily on self-reported conditions, including menopausal status and PMH use, so that validation of this information is important. Self reported reproductive history information has been evaluated in the Nurses Health Study and was found to be very accurate, a clear advantage of studying a cohort of nurses. In addition, as the study did not include an ophthalmologic exam, an extensive confirmation on POAG was conducted through contact with ophthalmologists and ophthalmic record review; glaucoma was not confirmed in over in 4463 participants who reported having POAG.

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