Abstract
Purpose :
Although data are inconsistent, several incidence studies have reported higher rates of exfoliation syndrome (XFS) and exfoliation glaucoma (XFG) in women, implicating female-specific factors. We evaluated the association between female reproductive factors and the incidence of exfoliation glaucoma/glaucoma suspect (XFG/XFGS).
Methods :
We conducted a prospective cohort study of 127,292 female participants enrolled in the Nurses’ Health Study (1980–2018) and the Nurses’ Health Study II (1991–2019), followed biennially for updated health and lifestyle information. Eligible subjects at each 2-year risk period were 40+ years old, postmenopausal, free of XFG/XFGS, had data on female reproductive factors and reported ophthalmic examinations. We confirmed incident XFG/XFGS cases using medical record review. We used per-eye Cox proportional hazards models, accounting for inter-eye correlations, to estimate multivariable-adjusted relative risks (MVRRs) and 95% confidence intervals (CIs).
Results :
During 3,208,341 eye-years of follow-up, 444 eyes with XFG/XFGS were documented. Overall, reproductive history consistent with a greater lifetime estrogen exposure was associated with a higher XFG/XFGS risk. Each 1-year increase in age at menarche was associated with an 8% lower risk of XFG/XFGS (MVRR=0.92; 95%CI=0.86, 0.99). Compared to having 2 children, nulliparity was associated with a 59% higher risk (MVRR=1.59; 95%CI=1.12, 2.24); use of oral contraceptive use for 2+ years compared to never use was non-significantly inversely associated (MVRR=0.84; 95%CI=0.65, 1.08). History of surgical menopause (with bilateral oophorectomy) versus natural menopause was associated with a lower risk (MVRR=0.73; 95% CI=0.54, 0.99). Although risk did not differ by age at menopause in the range of 45-60 years, age at menopause of 20-44 (versus 50-53 years) was associated with an elevated risk of XFG/XFGS (MVRR=1.62; 95% CI=1.16, 2.26). Current use (versus never use) of postmenopausal hormones was associated with a higher risk (MVRR=1.51, 95% CI=1.02, 2.22).
Conclusions :
Our findings support female reproductive factors as potential risk factors for XFG/XFGS risk.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.