Effects of Sex Hormones on Ocular Blood Flow and Intraocular Pressure in Primary Open-angle Glaucoma: A Review

Purpose To perform an epidemiological survey of all patients in Denmark diagnosed with primary congenital glaucoma (PCG) from 1977 to 2016. Methods A retrospective, nationwide study based on a review of medical files of all children with PCG born in Denmark from 1977 to 2016. PCG was defined as glaucoma due to isolated angle dysgenesis affecting children from birth and including late onset/late recognized PCG, excluding glaucoma associated with other congenital abnormalities. Incidence and risk factors of PCG including gender, consanguinity, family history, ethnicity, comorbidity and prematurity were evaluated and stratified by decade (1977–1986, 1987–1996, 1997–2006 and 2007–2016). Age at first symptoms, age at diagnosis, age at time of first surgery and possible diagnostic delay were assessed. Results Of 118 patients were identified, annual incidence of PCG was 4.8 per 100 000 live born. 62.3% of cases were bilateral. The relative risk (RR) of PCG was significantly higher in boys (62.7% of patients, RR 1.60 (95% CI 1.10–2.32)). 13.6% had comorbidity. Median age at time of first symptoms was 75 days, median age at time of diagnosis was 150 days and median diagnostic delay was 75 days with no significant difference throughout the decades. Unilateral cases presented symptoms and were diagnosed significantly later than bilateral cases. Conclusion We provide unique nation‐based information on the incidence of PCG from a single country covering 40 years. Male gender was a risk factor. Diagnostic delay was unchanged throughout the 4 decades and a high percentage of comorbidity was revealed. Introducing a standardized paediatric screening of all PCG children should be considered.

show abstract

“…The potential role of testosterone on ocular health is less proven with no consensus regarding its effects POAG (Patel et al. ).…”

Section: Discussionmentioning

confidence: 99%

“…Increased oestrogen exposure has been associated with a reduced risk of POAG (Dewundara et al 2016) with a lowering of IOP, increased ocular blood flow and neuroprotection of the retina. The potential role of testosterone on ocular health is less proven with no consensus regarding its effects POAG (Patel et al 2018).…”

Section: Incidence and Risk Factorsmentioning

confidence: 99%

Primary congenital glaucoma in Denmark, 1977–2016

Pedersen

Kappelgaard

Kessel

et al. 2019

Acta Ophthalmologica

View full text Add to dashboard Cite

show abstract

“…21 This lower exogenous oestrogen exposure may also play a role in the higher glaucoma risk in this group as some studies have shown oestrogen to be protective for glaucoma. 6 To date there have been no studies directly examining the relationship between the etonogestrel vaginal ring and glaucoma. Further research into the risk of glaucoma with individual HCs is required given the paucity of evidence in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…To date, the role of gender and sex hormones in the pathogenesis of glaucoma remains uncertain. Although the role of oestrogen is thought to exert a protective effect 6 in postmenopausal women, the effect of both oestrogen and progesterone in younger women (<45 years of age) is less clear and might be detrimental to the overall risk of glaucoma in this demographic. 7 Currently there are no studies that have examined the risk of glaucoma with HCs including non-oral formulations such as the intrauterine device (IUD), vaginal rings or intramuscular injections.…”

Section: Introductionmentioning

confidence: 99%

The association between hormonal contraceptive use and glaucoma in women of reproductive age

Hogden

Mikelberg

Sodhi

et al. 2021

Brit J Clinical Pharma

View full text Add to dashboard Cite

We aimed to investigate the association between hormonal contraceptive (HC) use and the incidence of glaucoma in females of reproductive age with a focus on duration and type of HCs used.Methods: A retrospective cohort study with a case-control analysis (nested casecontrol) was undertaken using data from IQVIA's electronic medical record (IQVIA, USA) from 2008 to 2018. Within a cohort of 4 871 504 women, cases of glaucoma or ocular hypertension were identified. Subjects were followed to the first diagnosis of glaucoma. Each glaucoma case was matched to four controls by age, body mass index and follow up time. The main outcome measure was the first diagnosis of glaucoma defined by the first ICD-9/10 code for glaucoma or ocular hypertension.Results: Among 4 871 504 women identified, there were 2366 cases of glaucoma and 9464 controls. Regular users of hormonal contraceptives had an elevated risk of glaucoma compared to non-users with an adjusted incident rate ratio (aIRR) of 1.57 (95% CI: 1.29-1.92). Current users were of greatest risk (aIRR of 2.38, 95% CI: 1.81-3.13), whereas the aIRR among past users was 1.08 (95% CI: 0.82-1.43). The aIRR for glaucoma increased from 0.82 (95% CI: 0.70-0.95) among those with one or two prescriptions in the 2 years prior to the first diagnosis of glaucoma to 1.54 (95% CI: 1.32-1.81) among those with greater than four prescriptions.Conclusions: This nested case-control study demonstrated an elevated risk, albeit low, of glaucoma in females of reproductive age who use regular hormonal contraception. Future studies are needed to confirm these findings.

show abstract

“…Increasing evidence suggests that estrogen exposure may have a neuroprotective effect on the progression of glaucoma and may alter its pathogenesis [ 101 ]. The vasodilation caused by estrogen and its effects on aqueous humor outflow may contribute [ 102 ]. These estrogen receptors are abundantly expressed throughout the eye, and in particular the retina and more specifically in the RGC [ 103 , 104 ].…”

Section: Discussionmentioning

confidence: 99%

Proteomics Reveals the Potential Protective Mechanism of Hydrogen Sulfide on Retinal Ganglion Cells in an Ischemia/Reperfusion Injury Animal Model

et al. 2020

View full text Add to dashboard Cite

Glaucoma is the leading cause of irreversible blindness and is characterized by progressive retinal ganglion cell (RGC) degeneration. Hydrogen sulfide (H2S) is a potent neurotransmitter and has been proven to protect RGCs against glaucomatous injury in vitro and in vivo. This study is to provide an overall insight of H2S’s role in glaucoma pathophysiology. Ischemia-reperfusion injury (I/R) was induced in Sprague-Dawley rats (n = 12) by elevating intraocular pressure to 55 mmHg for 60 min. Six of the animals received intravitreal injection of H2S precursor prior to the procedure and the retina was harvested 24 h later. Contralateral eyes were assigned as control. RGCs were quantified and compared within the groups. Retinal proteins were analyzed via label-free mass spectrometry based quantitative proteomics approach. The pathways of the differentially expressed proteins were identified by ingenuity pathway analysis (IPA). H2S significantly improved RGC survival against I/R in vivo (p < 0.001). In total 1115 proteins were identified, 18 key proteins were significantly differentially expressed due to I/R and restored by H2S. Another 11 proteins were differentially expressed following H2S. IPA revealed a significant H2S-mediated activation of pathways related to mitochondrial function, iron homeostasis and vasodilation. This study provides first evidence of the complex role that H2S plays in protecting RGC against I/R.

show abstract

Effects of Sex Hormones on Ocular Blood Flow and Intraocular Pressure in Primary Open-angle Glaucoma: A Review

Abstract: This review explores the relationship between glaucoma and gender, showing the results of studies investigating the effects of sex hormones on intraocular pressure and ocular blood flow.

Cited by 36 publications

References 59 publications

Primary congenital glaucoma in Denmark, 1977–2016

Primary congenital glaucoma in Denmark, 1977–2016

The association between hormonal contraceptive use and glaucoma in women of reproductive age

Proteomics Reveals the Potential Protective Mechanism of Hydrogen Sulfide on Retinal Ganglion Cells in an Ischemia/Reperfusion Injury Animal Model

Contact Info

Product

Resources

About