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C Younan, P Mitchell, RG Cumming, E Rochtchina; Estrogen and the Incidence of Cataract and Cataract surgery: The Blue Mountains Eye Study . Invest. Ophthalmol. Vis. Sci. 2002;43(13):936.
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Purpose:A number of epidemiological studies have shown an increased prevalence, with a few studies reporting an increased incidence, of cataract in women. The cause of the gender difference is not clear, but could be related to the hormonal differences between women and men. We aimed to assess the relationship between endogenous and exogenous estrogen exposure and the incidence of age-related cataract and cataract surgery. Methods:The Blue Mountains Eye Study examined 2072 women aged 49 years or older during the period 1992-4, and then 1343 (74.0%) of survivors after 5 years, during the period 1997-9. Baseline information on reproductive factors and use of hormone replacement therapy was collected using an interviewer-administered questionnaire. Lens photographs were graded for presence and severity of cortical, nuclear and posterior subcapsular cataract using the Wisconsin Cataract Grading System. Participants with either no eyes or one eye affected at baseline were considered at risk of incident cataract or cataract surgery. Logistic regression models calculated odds ratios (OR) and 95% confidence intervals (CI) to assess associations by subject. Results:Women who had ever used hormone replacement therapy had a decreased incidence of cortical cataract compared to never users (OR 0.7, CI 0.4-1.0), as did women who had ever used oral contraceptives (OR 0.6, CI 0.4-0.9). Older age at menarche was associated with increased incidence of cataract surgery (OR 2.6, CI 1.3-5.2) and a significant trend for increasing incidence of nuclear cataract (p=0.04). There was also a significant trend for decreasing incidence of cataract surgery with increasing duration of reproductive years (p=0.008). Conclusion:These epidemiological data provide some evidence that the incidence of at least two types of age-related cataract and cataract surgery may be related to estrogen exposure. Although little benefit was found for use of postmenopausal estrogen replacement, a number of significant protective trends for a longer duration of reproductive years is suggestive of the potential benefits of estrogen on the lens.
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