Abstract
Purpose :
Menopause is characterized by the cessation of the menstrual cycle for 12 consecutive months, accompanied by disruptions in estrogen and progesterone secretion. It was shown to have detrimental effects on the cardiovascular system, yet its impact on posterior pole vasculature remains inconsistently reported. In this study, we conducted a cross-sectional analysis using UK Biobank data to examine the influence of menopausal status on choroidal thickness (CHT) and retinovascular indices in healthy women, utilizing spectral-domain optical coherence tomography (OCT) and colour fundus photography (CFP).
Methods :
This analysis included 67,311 UK Biobank participants aged 40-69 who underwent OCT and CFP. We derived CHT from macula-centred OCT, and retinovascular indices (vessel density, fractal dimension and vascular tortuosity) from CFP using a deep-learning model. We excluded individuals with poor image quality, self-reported eye disease, reduced vision, diabetes, hypertension and neurodegenerative disease. Female-specific variables were defined through self-report. We excluded women with irregular cycles, on oral contraceptives, pregnant, on hormonal replacement therapy or in surgically induced post-menopause. Linear mixed-effects models were utilized to investigate associations between menopausal status and CHT and retinovascular indices with adjustments made for age, socioeconomic status, smoking, and body mass index (BMI).
Results :
Data from 13,715 healthy women with retinal imaging were included. 4,128 women were pre-menopausal (mean age 46±4 years) and 8,836 in spontaneous post-menopause (mean age 60±5 years). After adjustment for confounders, CHT was thinner in the post-menopausal group but not statistically significant (-1.9μm, 95% CI -8.7, 4.9, p = 0.58). Among retinovascular indices, post-menopause was significantly associated with increased vascular density (1.4e-03, 95% CI 1.8e-04, 2.6e-03, p=0.03), fractal dimension (5.0e-03, 95% CI 8.9e-04, 9.8e-03, p=0.02), and vascular tortuosity (4.5e-03, 95% CI 5.7e-04, 0.0, p=0.02).
Conclusions :
After adjusting for age, socioeconomic status, smoking, and BMI, post-menopause was linked to increased retinovascular indices. This suggests nuanced changes in retinal microvasculature morphology, potentially associated with the decrease in estrogen in this period. Choroidal thickness did not show an independent association.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.