Attributes of female reproductive aging and their relation to primary open-angle glaucoma: a prospective study.
OBJECTIVE
We investigated the relation between age at menopause, postmenopausal hormone (PMH) use, and incident primary open-angle glaucoma (POAG).


METHODS
We followed 66,417 women in the Nurses' Health Study prospectively from 1980 to 2002. Eligible participants were > or =40 years old, free of POAG at baseline, provided information on menopausal status, and reported receiving eye examinations during follow-up. Relevant exposure data and POAG risk factors were updated using biennial questionnaires. We identified 447 POAG cases during follow-up. We used proportional hazards models to calculate multivariable rate ratios (MVRR) of POAG and 95% confidence intervals.


RESULTS
Among postmenopausal women overall, entering menopause before age 45 [MVRR=0.85 (0.63 to 1.14)] or at age > or =54 [MVRR=0.84 (0.60 to 1.18)] was not significantly associated with POAG compared with entering menopause at age 50 to 54. However, in secondary analysis, among postmenopausal women aged > or =65 years, entering menopause at age > or =54 years was associated with reduced risk of POAG compared with entering menopause at age 50 to 54 [MVRR=0.53 (0.32 to 0.89)]. Overall, compared with never use of PMH, past PMH use [MVRR=0.84 (0.61 to 1.18)], and current PMH use [MVRR=0.89 (0.70 to 1.13)] was not significantly associated with POAG. In secondary analysis, compared with never use of PMH, current use of estrogen with progestin [MVRR=0.58 (0.36 to 0.94)] was associated with a reduced risk of POAG characterized by intraocular pressure >21 mm Hg before visual field loss; current use estrogen alone [MVRR=0.93 (0.63 to 1.35)] was not significantly associated.


CONCLUSIONS
These data suggest a possible role for declining sex hormones in POAG pathogenesis.
Pasquale
Louis R
LR
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA. louis_pasquale@meei.harvard.edu
Rosner
Bernard A
BA
Hankinson
Susan E
SE
Kang
Jae Hee
JH
D000328:Adult; D000368:Aged; D000375:Aging / Q000502:physiology*; D015914:Estrogen Replacement Therapy; D005260:Female; D005902:Glaucoma, Open-Angle / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007429:Intraocular Pressure; D008593:Menopause / Q000502:physiology*; D008597:Menstrual Cycle / Q000502:physiology*; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States; D016387:Women's Health