Glaucoma in Women and Hormone Use

some cases of vision loss due to glaucoma in women may be due to hormonal changes. Women should definitely consult a vision care specialist for personal recommendations, but we are learning more about how hormonal changes can affect our vision. The link with hormones and glaucoma is there, but we are not sure exactly what that link may be. So if you have had hormonal treatments or changes you may be a candidate for early glaucoma screening. You may have tested that you have perfect vision, but if glaucoma sneaks up your vision will be compromised. About 3% of the population age 40 or older has glaucoma, and it is a disease which favors women in that over 60% of cases are in women. In a study from the Mayo Clinic we have shown that getting your ovaries out before age 43 increases your risk of glaucoma. In this cases estrogen therapy did not seem to counteract the effects. Other studies have found some conflicting results, like the Blue Mountains Eye Study. And other studies look to the effects of diabetes on glaucoma rates, and the effect of combined hormone changes and diabetes. Many studies show protective effects of estrogen on the optic nerve, but some of the evidence is that those results are actually a secondary effect of the benefits of estrogen on the prevention of diabetes and cardiovascular disease. So lots of complicated data to keep our eyes on! And look to oral contraceptives for some vision effects. Ye Elaine Wang, MD, from the University of California at San Francisco. Taking oral contraceptives for more than 3 years doubles a woman's risk for glaucoma, according to a large population-based study. Dr. Wang presented the findings here at the AmericanAcademy of Ophthalmology 2013 Annual Meeting. Her data was from the NationalHealth and Nutrition Examination Survey (NHANES). The participants completed vision and reproductive health questionnaires and underwent eye exams, so the conclusions were based on very strong information. Although the eye docs want to screen women over 40 for glaucoma, and perhaps earlier in some cases, especially if they have or are using birth control pills, there is no recommendation to change contraceptive use. The study builds on what we know about estrogen and eye disease protection. But the levels of estrogen, and the combination with progesterone may be the driving force behind the development of glaucoma in this subset of women.


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