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. 2024 Aug 1;65(10):31.
doi: 10.1167/iovs.65.10.31.

Postmenopausal Hormone Therapy Was Associated With Later Age of Onset Among Glaucoma Cases

Kelleigh Hogan  1   2   3 , Xiangqin Cui  1   4 , Annette Giangiacomo  5 , Andrew J Feola  1   2   3
Affiliations

Postmenopausal Hormone Therapy Was Associated With Later Age of Onset Among Glaucoma Cases

Kelleigh Hogan et al. Invest Ophthalmol Vis Sci. .

Abstract

Purpose: Hormonal therapy (HT) has been suggested to lower the risk of developing glaucoma. Our goal was to investigate the association between HT use and the onset of glaucoma diagnosis in postmenopausal women.

Methods: This retrospective case-only study included female veterans with open-angle glaucoma from VA records between 2000 to 2019. Propensity score matching was used to match HT (n = 1926) users to untreated (n = 1026) women on multiple covariates (e.g., age of menopause, BMI, blood pressure, antihypertensive medications, and a co-morbidity index). A simple linear regression was used to evaluate the impact of HT duration on the age of glaucoma diagnosis, and multivariate linear regression analysis was used to determine which factors contributed to the age at diagnosis of glaucoma.

Results: We found a linear relationship between the age at diagnosis of glaucoma and menopause in women with (r = 0.54) and without HT (r = 0.57) use. HT users tended to have a later diagnosis of glaucoma. Our multivariate analysis found that 0-2 years, 2-5 years, and >5 years of HT use were associated with a 2.20 [confidence interval (CI), 1.64, 2.76], 3.74 [CI, 3.02, 4.46], and 4.51 [CI, 3.84, 5.18] years later diagnosis of glaucoma. An interaction (-0.009 [-0.015, -0.003]) was observed between HT duration and age of menopause diagnosis, with the impact of HT decreasing for later menopause ages.

Conclusions: Longer duration of HT use was associated with a later diagnosis of glaucoma in postmenopausal women in this case-only analysis. The impact of HT may be modulated by menopausal age, although further study is needed. The findings support a protective role of estrogen in glaucoma pathogenesis.

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Conflict of interest statement

Disclosure: K. Hogan, None; X. Cui, None; A. Giangiacomo, None; A.J. Feola, None

Figures

Figure 1.
Figure 1.
Inclusion and exclusion criteria for the overall study. The final cohort of 3781 was selected from 31,809 patients with at least one glaucoma medication prescription or record of glaucoma treatment. Patients were excluded if diagnosis criteria for glaucoma or menopause were not met, and they presented with any excluded conditions (i.e. diabetic retinopathy or macular degeneration). See the Methods section for details regarding ICD and CPT codes.
Figure 2.
Figure 2.
Linear regression between age at diagnoses of menopausal women with and without hormone therapy (HT) and glaucoma. (A) Mean (dotted line) and 95% confidence intervals (shaded region) of the age of glaucoma diagnosis for each age of menopause for women with HT (red; r = 0.538, P < 0.001) or untreated (Black; r = 0.569; P < 0.001) groups. Solid lines represent the linear regression lines. The age of menopause was rounded down to the nearest integer. The HT and untreated slopes were 0.67 and 0.75, and y-intercepts were 59.1 and 55.7, respectively. (B) Patients were binned based on HT use into 0–2 years (light pink), 2–5 years (salmon), and 5+ years (red); the percentage of the HT group for each menopause cohort in each bin was reported followed by the numbers in parentheses.
Figure 3.
Figure 3.
Relationship between HT use and glaucoma diagnosis as modulated by self-reported descent. (A) Linear regressions for HT and untreated groups as stratified by self-reported race as signified by line type (solid: Black or African American descent, dashed: White descent). The HT regression slope for the Black or African American descent was 0.70 and 0.57 for HT women of White descent. (B) Age of glaucoma diagnosis for Black/African American descent and White descent divided by age of menopause: early (<45 years of age), normal (45–55 years of age), late (>55 years of age). (C) Percentage of patients in the 0–2-year bin, 2–5 years, and 5+ years of HT use in women of Black or African American and White descent cohorts across all menopause cohorts. As stratified by self-reported descent, the percentage of the HT group for each menopause cohort in each bin was reported followed by the numbers in parentheses.
Figure 4.
Figure 4.
Relationship between HT use and glaucoma diagnosis as stratified by age of menopause diagnosis. (A–C) Distribution of age of glaucoma diagnosis by age of menopause with the outline color signifying group (HT: red, untreated: black) and fill color signifying age of menopause: early (green: <45 years of age), normal (blue: 45–55 years of age), and late (purple: >55 years of age). (D) Distributions of percentile differences between untreated and HT groups. All distributions had significant positive shifts: EH-EU (median of 3.93 years), NH-NU (3.71 years), LH-LU (2.74 years). Points and error bars represent mean and 95% confidence intervals and significance are *P < 0.05, **P < 0.01, and ***P < 0.001. EH, early menopause + HT; EU, early menopause + untreated; NH, normal menopause + HT; NU, normal menopause + untreated; LH, late menopause + HT; LU, late menopause + untreated.
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