Hormone Therapy and Conversion to Advanced Age-Related Macular Degeneration

Abstract

Purpose : To evaluate the relationship between self-reported hormone therapy (HT) use and conversion to the advanced forms of age-related macular degeneration (AMD) among a cohort of female patients with the intermediate phenotype of AMD.

Methods : Female patients aged 55 and older with intermediate AMD (iAMD) enrolled in the University of Colorado AMD Registry between July 2014 and July 2023 were included in this study, with follow up for conversion through September 2023. Patients with less than 30 days follow up were excluded. Conversion from iAMD to the advanced forms of AMD, geographic atrophy (GA) or neovascular (NV) AMD, was assessed with meticulous review of patients’ electronic health record (EHR) and multi-modal imaging. At the time of enrollment, history of HT use was patient self-reported and current HT use was confirmed in the EHR. Kaplan-Meier curves and Cox proportional hazards modeling was used to assess time to event for conversion. Hazard ratios, 95% confidence intervals, and p-values are presented for multivariable models.

Results : 237 female patients with iAMD were assessed with an average follow-up time of 2.95 (SD: 2.18) years. A total of 59 (24.9%) patients converted during the follow-up period to GA (n = 30) or NV (n = 29). Unadjusted Kaplan-Meier curves demonstrated that patients with past HT use (n = 86) had higher rates of conversion compared to patients who never used HT (n = 107) and patients who were on HT at time of enrollment in the study (n = 44) (Figure 1). Possible confounders included in the adjusted analysis were age, reticular pseudodrusen, history of smoking, and family history of AMD. In multivariable analysis, past HT use was associated with a 2.49 (95% CI: 1.35, 4.61) times greater risk of conversion to either advanced form of AMD (p = 0.004) while current HT use at the time of enrollment was not associated with an increased risk of conversion (Table 1).

Conclusions : This cohort of iAMD patients had a 24.9% conversion rate in the 2.95-year average follow-up time. Self-reported past use of HT was associated with a significantly increased risk of conversion among women with iAMD.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.