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R. Seitzman, A. L. Coleman, F. Yu, J. A. Cauley, K. E. Ensrud, K. Stone, K. Pedula, G. Thomas, C. Mangione, Study of Osteoporotic Fractures Research Group; Reproductive Hormone Exposures and Five-Year Incidence of Age-Related Macular Degeneration in Older Women. Invest. Ophthalmol. Vis. Sci. 2007;48(13):2095.
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To examine the associations of reproductive hormone exposures with incidence of age-related macular degeneration (AMD) in older women.
Subjects included participants in the Study of Osteoporotic Fractures attending the year 10 and year 15 follow-up visits that had fundus photographs gradable for early or late AMD in both eyes at both visits (n=1699). Forty-five degree stereoscopic fundus photographs were graded for AMD using a modification of the Wisconsin Age-Related Maculopathy Grading System. History of postmenopausal hormone therapy use, hysterectomy and surgical menopause were determined with questionnaires. Estrogen therapy (ET) and estrogen plus progestin therapy (HT) could be distinguished for Caucasians only. Total hip BMD, a potential surrogate for lifetime endogenous estrogen exposure, was measured with dual energy x-ray absorptiometry. Logistic regression was used to test whether these risk factors were associated with incident early or late AMD. Interactions between each reproductive factor and smoking were tested.
Approximately 57% of subjects reported ET or HT use. The 5-year AMD incidence was 18.6% for early and 5.5% for late. None of the reproductive factors was associated with early AMD in the complete sample; however, HT use was associated with a lower risk of early AMD in Caucasians (OR=0.45; 95% CI: 0.22-0.92). Compared to the lowest BMD quartile, quartiles two and three combined, but not quartile four, was associated with a significantly lower risk of late AMD (OR Q2+Q3 =0.56; 95% CI: 0.33-0.97; OR Q4=0.86; 95% CI:0.44-1.67).
Use of postmenopausal hormone therapy was not significantly associated with early or late AMD in the complete sample; however, HT use was associated with reduction of early AMD risk in Caucasians. This association should be examined in other subgroups. Furthermore, BMD may be associated with late AMD risk. Further research is needed to understand the biological mechanisms that underlie these associations.
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