AAO flags hormone therapy glaucoma risk
- The American Academy of Ophthalmology highlighted two new eye-surgery and glaucoma papers on April 17: one tied postmenopausal hormone therapy to glaucoma, another mapped lens-dislocation risks. - In the glaucoma study, 1,096 Finnish women with incident glaucoma were compared with 5,480 controls; estrogen-only therapy carried a 1.31 adjusted odds ratio for primary open-angle glaucoma. - The lens study found just 145 surgical dislocations among 176,572 cataract cases, but pseudoexfoliation and capsule rupture sharply raised risk. (aao.org)
Glaucoma is damage to the optic nerve, the cable that carries visual signals from the eye to the brain, and it can steal sight slowly over years. A new American Academy of Ophthalmology roundup pointed to a Finnish study linking postmenopausal hormone therapy to higher glaucoma risk. (aao.org) (pubmed.ncbi.nlm.nih.gov) The Finnish paper, published online April 12 in *Acta Ophthalmologica*, used national health data to compare 1,096 women age 50 and older with incident glaucoma against 5,480 age-matched controls. The women’s hormone therapy exposure was tracked from 2001 through 2010, and glaucoma cases were recorded from January 1, 2015, through December 31, 2017. (pubmed.ncbi.nlm.nih.gov) After adjustment for diabetes, hospital district, socioeconomic status, and statin use, any postmenopausal hormone therapy was associated with higher glaucoma risk. The adjusted odds ratio was 1.33 for estrogen users, 1.25 for progestogen users, and 1.19 for combination users. (pubmed.ncbi.nlm.nih.gov) In the subgroup with primary open-angle glaucoma, the most common form of the disease, the signal held only for estrogen-only therapy. That group had an adjusted odds ratio of 1.31, with a 95% confidence interval of 1.10 to 1.56. (pubmed.ncbi.nlm.nih.gov) The authors did not call the finding proof that hormone therapy causes glaucoma. They wrote that more research is needed to confirm the association and sort out how hormone exposure and glaucoma risk may interact. (pubmed.ncbi.nlm.nih.gov) (aao.org) The Academy’s roundup paired that paper with a second explainer on intraocular lens dislocation, a cataract-surgery complication in which the artificial lens shifts out of place and sometimes needs another operation. That study was published April 14 in *Clinical Ophthalmology*. (aao.org) (pubmed.ncbi.nlm.nih.gov) Researchers reviewed 176,572 eyes that had planned phacoemulsification cataract surgery across eight United Kingdom centers over 12 years. Only 145 eyes, or 0.08%, developed lens dislocation serious enough to require surgery. (pubmed.ncbi.nlm.nih.gov) The strongest risk factor in that dataset was posterior capsule rupture during the original cataract operation, 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. (pubmed.ncbi.nlm.nih.gov) Other factors linked to later lens dislocation included male sex, ages 18 to 40 and 40 to 60, zonular dialysis, iris damage, combined cataract surgery with pars plana vitrectomy, and yttrium-aluminum-garnet capsulotomy. The Academy said surgeons can use those factors for preoperative risk stratification and surgical planning. (pubmed.ncbi.nlm.nih.gov) (aao.org) Taken together, the two papers are less a practice-changing directive than a warning label for clinic conversations. One asks ophthalmologists to look harder at hormone history in older women; the other tells cataract surgeons which eyes may need closer follow-up after an otherwise routine operation. (aao.org) (pubmed.ncbi.nlm.nih.gov 1) (pubmed.ncbi.nlm.nih.gov 2)
