Abstract
Purpose :
FECD is more common in women than men, and many diseases with a sex disparity have associations with estrogen exposure. The purpose of our study was to investigate differences in multiple measures of estrogen exposure in patients with mild and severe FECD to test the hypothesis that estrogen exposures vary based upon severity of FECD.
Methods :
Patients were recruited from a cornea clinic at the Ross Eye Institute in Buffalo, NY. We enrolled participants age >55 with mild (central guttae with no confluence) and severe (>5 mm confluent guttae or corneal transplant for FECD) FECD. Patients provided written informed consent for this observational study. All participants completed corneal thickness measurements, Scheimpflug tomography, and questionnaires on demographics, medical history, and their exposure to potential risk factors for FECD. Women completed a reproductive questionnaire to calculate lifetime estrogen exposure (menopause age – menarche age – duration breastfeeding + duration postmenopausal hormone replacement therapy). Calcaneal ultrasound (bone density) was measured as a surrogate of lifetime estrogen exposure. Blood was drawn to measure total and free estradiol and sex hormone binding globulin (SHBG). Data for the mild and severe FECD patients were compared with unpaired t-tests and chi-square tests.
Results :
We enrolled 43 participants (mild FECD: 17 women, 3 men; severe FECD: 15 women, 8 men). Compared to the mild cohort, corneas in the severe cohort were thicker and more frequently displayed tomographic signs of FECD (Table). There were no statistically significant differences in age, height, weight, body mass index, ultraviolet light exposure, smoking history, history of heart disease, history of diabetes, or family history of FECD between mild and severe patients. Hypertension was less prevalent in those with mild vs. severe FECD. Measures of estrogen exposure (calcaneal bone density, serum free estradiol, total estradiol, and SHBG) did not differ between mild and severe patients. Null results were also found when estrogen exposure analyses (including lifetime estrogen exposure) were restricted to women, except for bone density speed of sound measurements. These were greater in women with mild vs. severe FECD.
Conclusions :
There are no consistent trends in multiple measures of estrogen exposure comparing participants with mild and severe FECD.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.