Attributes of female reproductive aging and their relation to primary open-angle glaucoma: A prospective study

Purpose: 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 > 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 > 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 > 65 years, entering menopause at age > 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.