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Ferhina Ali, Joshua D Stein, Taylor Blachley, Sarah Ackley, Jay M Stewart; Use of Hormone Replacement Therapy and the Risk of Incident Macular Holes. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2054.
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© ARVO (1962-2015); The Authors (2016-present)
Macular hole (MH) incidence increases in women >50 years old. We hypothesize that estrogen plays a protective effect in the onset of this pathology during premenopausal years and that effect is lost after menopause among women not receiving HRT. The purpose of this study is to compare the risk of MH in women exposed to estrogen containing postmenopausal hormone replacement therapy (ecHRT) with others not on HRT.
All women age≥40 years old enrolled in a managed care network were followed for development of a MH. Persons with pre-existing MH were excluded. Cox proportional hazard regression was used to identify factors associated with MH development requiring vitrectomy. The key predictor was ecHRT exposure. Models were adjusted for sociodemographic factors, medical comorbidities, and incisional ophthalmic surgery.
Of 231784 eligible women, 960 women (0.4%) developed a MH requiring vitrectomy and 38.3% had any use of ecHRT. Compared to women aged 40-45, women aged 56-60 had a 97% increased hazard of MH (hazard ratio (HR), 1.97; P=0.01), and women > 60 years old had an even higher risk of 205% (HR 3.05; P<0.0001). Each additional year of continuous ecHRT exposure was associated with a 3% decreased hazard of MH development, a finding that was not significantly different (HR, 0.97; P=0.34) than those not taking ecHRT during that time frame. Blacks, Latinos and Asians did not have an increased risk for MH requiring vitrectomy when compared to Whites. The presence of cataract conferred a 82% increased hazard for MH requiring vitrectomy (HR 1.82; P<0.0001). Pseudophakia/aphakia was associated with a 119% increased hazard for MH requiring vitrectomy (HR 2.19; P<0.0001).
ecHRT use did not reduce the risk of MH requiring vitrectomy in perimenopausal women. Risk of macular hole requiring vitrectomy increased significantly for women greater than 55 years of age. Further research is needed to understand how hormonal changes during menopause may play a role in this disease.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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