June 2017
Volume 58, Issue 8
ARVO Annual Meeting Abstract  |   June 2017
Racial Differences in the Effect of Hormone Therapy on Incident Open-Angle Glaucoma
Author Affiliations & Notes
  • Thasarat S Vajaranant
    Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, United States
  • Roberta Ray
    Women's Health Initiative Central Cooridinating Center, Seattle, Washington, United States
  • Louis R Pasquale
    Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Pauline M Maki
    Pshychiatry, University of Illinois at Chicago, Chicago, Illinois, United States
  • Julie A Mares
    Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, United States
  • Robert Ritch
    The New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
  • Emily West Gower
    Gillings School of Global Public Health , University of North Carolina at Chapel Hill, Chapel Hill Chapel Hill, North Carolina, United States
  • Mary N Haan
    Department of Epidemiology and Biostatistics, University of California at San Franscisco, San Francisco, California, United States
  • Rebecca D Jackson
    Center for Clinical and Translational Research, Ohio State University, Columbus, Ohio, United States
  • Footnotes
    Commercial Relationships   Thasarat Vajaranant, None; Roberta Ray, None; Louis Pasquale, None; Pauline Maki, None; Julie Mares, None; Robert Ritch, None; Emily Gower, None; Mary Haan, None; Rebecca Jackson, None
  • Footnotes
    Support  NH Grant K23EY022949; NH Grant EY015473; NH Grants AG12975, DK60753; Research to Prevent Blindness; the Ablon Family Research Fund of the New York Glaucoma Research Institute, New York, NY
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 3718. doi:
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      Thasarat S Vajaranant, Roberta Ray, Louis R Pasquale, Pauline M Maki, Julie A Mares, Robert Ritch, Emily West Gower, Mary N Haan, Rebecca D Jackson; Racial Differences in the Effect of Hormone Therapy on Incident Open-Angle Glaucoma. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3718.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : In an observational study, hormone therapy (HT) containing estrogen, but not a combination of estrogen and progesterone, decreased the risk of primary open-angle glaucoma. As there has been no randomized trial designed to assess the effect of HT on OAG, we conducted a secondary analysis of a large, randomized, placebo-controlled trial to test if HT decreased the risk of open-angle glaucoma (OAG), and if the risk reduction varied by race.

Methods : We analyzed a Medicare-linked database from 25,535 women in the Women’s Health Initiative Hormone Trial (1993 through 2014). The women without a uterus were randomized to receive either oral conjugated equine estrogens (CEE 0.625mg/day) or placebo; women with a uterus were randomized to receive oral CEE and medroxyprogesterone acetate (CEE 0.625mg/day+MPA 2.5mg/day) or placebo. We excluded women 1) who enrolled in Medicare after the trial concluded, 2) lacked eye examinations during a 4-year look-back period of continuous Medicare enrollment, or 3) had prevalent OAG (≥1 OAG-related codes during the look-back period). We used cox proportional hazards models to calculate hazard ratios (HR), considering possible confounders (age, race, age at menopause, diabetes, hypertension, alcohol intake, smoking, and body mass index). Effect modification by race was further tested.

Results : Final analysis included 8,102 women (mean age=68.5±4.8years). The incidence of OAG was 10.7% (mean follow-up=13.2±5.3years; mean HT duration=6.0±1.8years). Women included in the analysis were older, more likely to be white or hypertensive, and less likely to be smokers, compared to those excluded. Increased age (p-trend=0.005) and African-American race (HR 2.46, 95%CI=2.00 to 3.02; white as a reference) were significant risk factors for incident OAG. We found no overall benefit of HT in reducing incident OAG (HR 1.00, 95%CI=0.81 to 1.23 in CEE trial, and HR 0.95, 95%CI=0.80 to 1.13 in CEE+MPA trial). However, a borderline risk reduction was demonstrated among African-American women treated with CEE (HR 0.61, 95% CI=0.37 to 1.01, p-interaction=0.06), but not CEE+MPA (HR 0.75, 95%CI=0.40 to 1.43, p-interaction=0.52), compared to placebo.

Conclusions : Our analysis suggests that HT containing estrogen, but not a combination of estrogen and progesterone, may reduce the risk of incident OAG among African-American women. Further investigation is needed.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.


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