AAO links HRT to glaucoma risk
- The American Academy of Ophthalmology’s April 17 roundup highlighted a new Finnish study linking postmenopausal hormone replacement therapy use to higher glaucoma incidence in women over 50. - In the study of 6,576 Finnish women, any hormone therapy was linked to higher glaucoma odds, with estrogen-only treatment showing a 1.33 adjusted odds ratio. - The finding cuts against earlier research suggesting estrogen might protect the optic nerve, underscoring unsettled evidence on hormones and eye disease. (pubmed.ncbi.nlm.nih.gov)
Glaucoma is damage to the optic nerve, the cable that carries visual signals from the eye to the brain. An American Academy of Ophthalmology roundup on April 17 pointed to a new study suggesting postmenopausal hormone replacement therapy may raise that risk. (aao.org) (pubmed.ncbi.nlm.nih.gov) The study, published online April 12 in *Acta Ophthalmologica*, tracked Finnish women age 50 and older and compared 1,096 women with incident glaucoma against 5,480 age-matched controls. Researchers measured glaucoma by the start of special reimbursement for glaucoma treatment between January 1, 2015, and December 31, 2017. (pubmed.ncbi.nlm.nih.gov) Researchers looked back at hormone prescriptions started during 2001 through 2010 and counted women as exposed if they redeemed at least two prescriptions a year. In the academy’s summary, 60.6% of women who developed glaucoma had used hormone therapy at some point in the prior 20 years, versus 53.1% of controls. (aao.org) (reviewofoptometry.com) After adjustment for diabetes, socioeconomic status, statin exposure, and hospital district, the association remained across all hormone categories. Estrogen-only therapy carried an adjusted odds ratio of 1.33, progestogen-only 1.25, and combined estrogen-progestogen 1.19. (pubmed.ncbi.nlm.nih.gov) Primary open-angle glaucoma is the most common form of the disease, and in that subgroup the signal held only for estrogen-only therapy. The adjusted odds ratio there was 1.31, with a 95% confidence interval of 1.10 to 1.56. (pubmed.ncbi.nlm.nih.gov) The paper does not show that hormone therapy causes glaucoma. It is a nested case-control analysis using registry and prescription data, and the authors said more research is needed to confirm the association and explain the mechanism. (pubmed.ncbi.nlm.nih.gov) (aao.org) That caution matters because the new result conflicts with some earlier ophthalmology research. Coverage of an American Academy of Ophthalmology 2024 meeting report described hormone replacement therapy and longer estrogen exposure as potentially protective against glaucoma risk. (ophthalmologyadvisor.com) (ophthalmology360.com) The same April 17 academy roundup also flagged a second paper on intraocular lens dislocation after cataract surgery. That study used 12 years of data from eight United Kingdom clinical centers and found 145 surgical dislocations among 176,572 planned phacoemulsification cases, or 0.08%. (aao.org) (pubmed.ncbi.nlm.nih.gov) In that cataract study, the strongest risk factor was posterior capsule rupture during the original surgery, with an adjusted relative risk of 16.4. Pseudoexfoliation, a condition that weakens the eye’s support fibers, carried an adjusted relative risk of 5.7, and later YAG capsulotomy carried 2.8. (pubmed.ncbi.nlm.nih.gov) For patients, the practical takeaway is narrower than the headline: the new hormone study adds one observational signal, not a treatment rule. The authors and the academy both pointed to follow-up research rather than a change in care on April 17. (pubmed.ncbi.nlm.nih.gov) (aao.org)
