Sex Hormone Exposure and Age–Related Maculopathy in Elderly Women

Abstract

Abstract: : Purpose: To explore the association between sex hormone exposures and age–related maculopathy (ARM) in women 75 years of age and older. Methods: A cross–sectional analysis was conducted on a random sample of Caucasian women enrolled in the Study of Osteoporotic Fractures (SOF) who attended the year 10 follow–up clinic visit in 1997–1998 (n=1123). ARM status was determined by grading 45–degree fundus photographs using a modification of the Wisconsin Age–Related Maculopathy Grading System 6–level severity scale. ARM was defined by the presence of at least one of the following conditions in at least one eye: soft drusen (≥95 microns) with drusen area <960 microns and RPE depigmentation; soft drusen (≥95 microns) with drusen area ≥960 microns with or without pigmentary abnormalities; sub–foveal geographic atrophy; or exudative macular degeneration. Proxy variables for endogenous estrogen exposure included number of reproductive years, age at menopause, hysterectomy, and surgical/natural menopause. Exogenous estrogen exposure variables include estrogen and progestin use, duration of use, and dosage. Adjusted odds ratios were estimated with logistic regression models while controlling for age, smoking status, body mass index, education, health status, and hypertension. Results: Among 1123 randomly sampled Caucasian women, 1074 had gradable photos. Of those, 546 (51%) had at least early ARM. Among 1120 with hormone use data at year ten, 224 (20%) reported current estrogen use. Of those, 158 (70%) used estrogen alone. Among 1105 subjects with estrogen data at baseline and year 10, 55% reported having ever used estrogen therapy. Neither current estrogen (OR=1.00; 95% CI .61–1.65) or progestin use (OR=.93, 95% CI .46–1.91), ever estrogen (OR=.87, 95% CI .64–1.18) or progestin use (OR=.75, 95% CI .41–1.36), duration of current estrogen (OR=1.05, 95% CI .93–1.80) or progestin use (OR=.89, 95% CI.76–1.04), hysterectomy (OR=.77: 95% CI.53–1.11), nor number of reproductive years (OR=1.01: 95% CI .98–1.04) were significantly associated with ARM. Conclusions: Sex hormone exposure does not appear to be associated with ARM in women 75 years of age and older.

Keywords: age-related macular degeneration • clinical (human) or epidemiologic studies: risk factor assessment