Does Hormonal Replacement Therapy Affect the Risk for Age–Related Maculopathy in Postmenopausal Women?

Abstract

Abstract: : Purpose: To assess the effect of hormonal replacement therapy (HT) as well as lifetime endogenous and exogenous estrogen and progesterone exposure on the risk for age–related maculopathy (ARM) in postmenopausal women. Methods: A cross–sectional, controlled study design was employed. A total of 102 women from 60 to 80 years of age who were receiving HT and 100 controls underwent a full clinical ocular exam and stereoscopic fundus photography to identify the presence and degree of ARM–related funduscopic changes. Grading of the photographs was performed in a masked fashion by three ophthalmologists using a modification of the international ARM classification system. A standardized questionnaire regarding lifetime endogenous and exogenous hormonal exposure, vascular risk factors, and post menopausal HT was completed by all participants. Student’s t–test, chi–squared test, and a multivariate logistic regression model were used for statistical data analysis. Results: Prevalence rates of early (11% v 15%), late dry (6% v 6%), or late wet (2% v 2%) ARM were not significantly different between the HT and control study groups. Women with ARM were significantly older than women without ARM (average age 69 vs. 66 years; P= 0.001, 95% CI = 0.008 – 0.027) and had a higher prevalence of ischemic heart disease (21% vs. 9%; OR = 2.86, P= 0.03, 95% CI = 0.020 – 0.360). No significant differences were noted between patients with ARM as compared to those with no signs of maculopathy in terms of lifetime exogenous and endogenous hormonal exposures. Conclusions: In our cohort of women aged 60 to 80 years, the risk for either early or late ARM was not significantly affected by the use of postmenopausal HT. Moreover, neither exogenous nor endogenous lifetime hormonal exposure seemed to have any effect on this risk. As previously reported, a history of cardiovascular disease may be associated with a higher risk for ARM.

Keywords: age–related macular degeneration • clinical (human) or epidemiologic studies: risk factor assessment • drug toxicity/drug effects