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Thasarat S Vajaranant, Joelle Hallak, Joseph Baker, Louis Pasquale, Pauline M Maki; The effects of estrogen deficiency on the peripapillary retinal nerve fiber layer thickness. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5568. doi: https://doi.org/.
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To determine the association between surgery-induced estrogen deficiency and peripapillary retinal nerve fiber layer (pRNFL) thickness in postmenopausal women.
We recruited women with surgical (bilateral oophorectomy) and natural menopause without a history of cancer, chemotherapy and ocular pathologies that might have affected the pRNFL thickness. All women underwent a comprehensive eye examination to confirm the absence of media opacity and pathology of the optic nerve and retina. Main outcome measures were global pRNFL thickness by optical coherence tomography (Spectralis, Heidelberg Engineering, Heidelberg, Germany) and duration of estrogen deficiency (expected age at menopause (50) - actual age at menopause + years of hormone therapy). Multivariate regression models were used to determine the association between duration of estrogen deficiency and global pRNFL thickness, adjusting for age, race, diabetes, hypertension, intraocular pressure (IOP), axial length (AL), as well as serum estradiol, progesterone and follicular stimulating hormone (FSH). Averaged global RNFL thickness, IOP and AL from both eyes of each woman was used.
The final analysis included 55 women (25 women with surgical menopause and 30 women with natural menopause), with the mean age of 62.1 ±10 years, mean age at menopause of 47.8 ±8 years, and mean estrogen deficiency of 6.1 ±13 years. The mean global RNFL thickness was 94.3 ±9 m, with the mean IOP of 14.6 ±3 mmHg and mean AL of 23.7 ±1 mm. In the final adjusted analysis, the type of menopause did not associate with global pRNFL thickness. However, the duration of estrogen deficiency regardless of the type of menopause, was statistically associated with thinner global pRNFL thickness (p = 0.03). Adjusted for age and race, every 10 years of estrogen deficiency was associated with a decrease in the global pRNFL thickness of 2.3 μ (95% Confident Interval, -0.2 to -4.3). Serum estradiol, progesterone and FSH were not associated with the global pRNFL thickness (all p values > 0.12).
Our analysis suggests that duration of estrogen deficiency, regardless of the type of menopause, is associated with thinning of the pRNFL beyond aging alone. Further investigations are warranted to determine the clinical significance.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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