Lower Use of Hormone Replacement Therapy among Cases of Age-related Macular Degeneration

Abstract

Purpose : The purpose of this study was to determine if any use of hormone replacement therapy (HRT) is related to the development of neovascular (NV) age-related macular degeneration (AMD), geographic atrophy (GA) or early /intermediate AMD.

Methods : A case control study was conducted from July 2014 to October 2017. Cases were women with AMD recruited into an AMD registry and controls were women with age-related cataract and no AMD. AMD was categorized into NV-AMD, GA, and early/intermediate AMD. Demographic and clinical data were gathered by patient interview and verified by chart review. Image data were reviewed by vitreo-retinal specialists. Chi-square and t-tests between each of the three AMD groups versus controls and between HRT users and non-users were used to determine potential confounders (p-values<0.05). Adjusted odds ratios (ORs) from multivariate logistic regressions are presented for each AMD group.

Results : A total of 291 female AMD patients and 128 controls were included in the analytic database. Almost half (49.5%) of the female AMD patients had NV-AMD, 15.1% had GA, and 35.4% had early/intermediate AMD. Among all study participants, 72 (17.2%) reported currently using HRT, 131 (31.5%) reported historic HRT use, and 215 (51.3%) had never used HRT. Current and historic users were combined into any use of HRT for statistical analyses. Controls were significantly more likely to have any HRT use (67.2%), compared to about one-third of NV-AMD (34.0%, p<0.001), 40.9% (p=0.002) of GA, and half of early/intermediate AMD (49.5%, p=0.007). Adjusted for potential confounders of age and treated hypertension, cases were significantly more likely to have lower HRT use compared to controls: NV-AMD, OR=0.28 (95%CI: 0.16-0.50), GA, OR=0.40 (95%CI: 0.17-0.91), and early/intermediate AMD, OR=0.49 (95%CI: 0.28-0.86).

Conclusions : Some previous studies have found that HRT is protective for AMD, particularly for NV-AMD, however, many other published studies have found no association. Our case-control study found that current or previous use of HRT was associated with a lower odds of NV-AMD, GA and the early/intermediate forms of AMD. The protective effect of HRT therapy may provide important insights into systemic mechanisms related to the risk of macular degeneration.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.