Abstract
Purpose :
Purpose: Altered oestrogen levels may play a role in the pathophysiology of dry eye in women. During IVF (in vitro fertilisation) treatment, circulating oestrogen levels increase 10-50x, providing a platform to observe the effects of systemic oestrogen on dry eye symptoms and signs. This study examined changes in ocular pain and in symptoms and signs of dry eye with IVF treatment and the relationship between sex hormones and ocular symptoms and signs.
Methods :
Methods: A 2 visit study of women undergoing antagonist IVF treatment was conducted. The baseline visit was on the first day of menstruation when oestrogen levels are lowest, and the peak oestrogen visit was on day 9-11 of the treatment. Symptoms were examined using the Ocular Surface Disease Index (OSDI), Meibomian Gland Dysfunction specific questionnaire (MGD-14), Instant Ocular Symptoms Score (IOSS) and Ocular Pain Assessment Survey (OPAS). Signs of dry eye including Non-Invasive Breakup Time (NIBUT), Phenol Red Thread (PRT), meibomian gland grading and ocular surface staining were assessed. Serum levels of a panel of sex hormones, their precursors, and metabolites were assessed using mass spectrometry and immunoassay methods. Wilcoxon signed-rank test was used to assess changes in symptoms and signs. Spearman and Pearson correlations were used to evaluate association between sex hormones and symptoms and signs.
Results :
Results: 40 women (36.2 ± 4.0 years) completed the study. Baseline oestradiol levels were 28.9 pg/ml (20) (median (IQR)) and peak oestradiol levels were 1360 pg/ml (1276). OPAS and SANDE scores worsened (p=0.02 and p<0.01) and NIBUT and PRT values decreased (p=0.005 and 0.01) at peak oestrogen visit relative to baseline. Higher oestradiol (E2) and lower luteinising hormone (LH) were associated with worsening of OSDI scores (rho = 0.34 p=0.03, rho= -0.49 p=0.001). A greater oestradiol to testosterone (E2: T) ratio was associated with shorter NIBUT (rho= -0.32, p=0.04) and lower progesterone (P4) was associated with greater ocular pain (rho= 0.39, p=0.01).
Conclusions :
Conclusions: An extreme rise in oestradiol levels and changes in other sex hormones (E2: T, LH, P4) during IVF treatment resulted in increased symptoms of ocular dryness, ocular pain, and tear film alterations analogous to mild dry eye. Ocular surface symptoms and clinical signs were higher at peak oestrogen visit, but the change was not clinically significant.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.