Abstract
Purpose :
End-stage FECD is a leading cause of corneal blindness. Treatment involves corneal transplantation, which can have complications and is limited by the availability of donor tissue. Limited epidemiologic data exist on the prevalence and incidence of FECD in the general population and its potential risk factors. Existing literature shows that the prevalence of FECD increases after menopause in women. We hypothesize that estrogen exposure may protect against the development of FECD in women.
Methods :
Using data from the Women’s Health Initiative (WHI) Observational Study (OS) we examined associations between incident FECD, identified from Medicare claims data from WHI OS baseline (1993-1998) to 2019. We examined associations between incident FECD and 1) baseline measures of exogenous estrogen exposure from menopausal hormone therapy (HT) use and duration (n=27,877 [n=1,675 incident FECD]), and 2) estimated lifetime endogenous estrogen exposure (n=26,552 [n=1,599 incident FECD]) calculated from data on age at menarche, age at menopause, pregnancy, and breastfeeding. We estimated the hazard ratio (HR) and 95% confidence intervals (CI) for the risk of FECD using Cox proportional hazard models adjusting for age, race, education, smoking status, smoking packyears, body mass index, and diabetes status. We ran models with these time-fixed exposures as assessed at baseline and with the time-varying exposure of HT use (yes/no) assessed annually at 7 repeated follow-up visits after baseline.
Results :
An annualized incidence rate of FECD in the sample of 27,877 women was 4.3 per 1,000 person-years. The adjusted HR (95% CI) for FECD was 0.98 (0.86-1.13) and 0.90 (0.81-1.00) for past and current HT use at baseline, respectively. Adjusted HRs (95% CIs) were 0.91 (0.81-1.03) and 0.94 (0.84-1.06) for ≤10 and >10 years, respectively, of hormone use, compared to no use. The adjusted HR (95% CI) was 0.99 (0.87-1.11) for tertile 3 versus 1 for years of endogenous estrogen exposure. When HT use (yes/no) was allowed to vary over time, the HR (95% CI) for use compared to no use was 0.96 (0.86-1.08).
Conclusions :
In this cohort of postmenopausal women, exposure to menopausal HT use, duration of use, and lifetime endogenous estrogen exposure were not associated with the development of incident FECD.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.