Abstract
Purpose :
Age of menopause has been associated with the risk of developing glaucoma (Hogan et al., ARVO 2023). and this could be mediated through the hormone estrogen as mutations in the estrogen metabolic pathway are associated with glaucoma and supplementation of estrogen through hormone replacement therapy (HRT) decreases IOP (Vajaranant et al., 2016; Pasquale et al., 2013). To assess this relationship, we evaluated the use of HRT on the age of glaucoma onset in a study of Veterans.
Methods :
Using the VA Corporate Data Warehouse, the study included female patients with a recorded initiation of glaucoma treatment (pharmacological or surgical) preceded by a negative ophthalmological screening and with a menopause diagnosis preceded by a prior visit within the VA Healthcare System. Patients were grouped by HRT use and stratified by age of menopause onset: early menopause cohort (EM, 35-45 years), normal (NM, 45-55), and late (LM, 55-65). Due to demographic differences between the cohorts, propensity-score matching on recorded covariates (race, ethnicity, body-mass index, blood pressure, anti-hypertensive medication use, co-morbidity index) was done between the untreated and HRT groups in each cohort (EM: n=395; NM: n=1,617; LM: n=791).
Results :
After matching on covariates, the HRT groups developed glaucoma on average 3.0 years later compared to the untreated groups. When stratifying by age of menopause, the delay in age of glaucoma was largest in the EM cohort (4.1 years), followed by the NM (3.1 years) cohort, and then the LM (2.5 years) cohort. The effect of HRT and its decreasing impact was reflected in separate linear regressions in each cohort that found similar effect sizes for age of menopause (EM: 0.74 [0.48,1.01], NM: 0.73 [0.62,0.85], LM: 0.76 [0.60,0.92]) but decreasing effect sizes for HRT treatment (EM: 4.0 [2.7,5.3], NM: 3.0 [2.3,3.6], LM: 2.2 [1.2,3.1]). We then performed a combined linear regression amongst all cohorts that confirmed an interaction between HRT and age of menopause, with HRT’s efficacy decreasing with each additional year delay in menopause onset.
Conclusions :
The use of systemic HRT delayed the onset of glaucoma, though the magnitude of the delay decreased with a later onset of menopause. This study indicates a potential benefit of HRT for delaying the onset of glaucoma and implications estrogen as a relevant agent in glaucoma.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.