Sex Disparities in Neuro-Ophthalmologic Disorders

Abstract

Many neuro-ophthalmic diseases have a clear sex predilection, which is important to recognize in making the diagnosis based on risk stratification and understanding the pathogenesis of the disease. This review discusses the more common neuro-ophthalmic diseases with a female predilection, including idiopathic intracranial hypertension, cerebral venous sinus thrombosis, meningioma, multiple sclerosis, migraine, breast-cancer associated neuro-ophthalmic manifestations, sarcoidosis, bisphosphonate-associated orbital inflammation, and pregnancy-related neuro-ophthalmic disorders. In addition, the male predominance in the clinical manifestation of Leber's Hereditary Optic Neuropathy is discussed. Lastly, the etiology of the sex discrepancies for each disease is explored.

Visual function assessed by visually evoked potentials in adults with orbital and other primary intracranial tumors

“…Overall, the main mechanisms of VEP impairment by brain tumors in this small case series were as follows: (1) damage to external optic nerve fibers caused by compression, involving fibers from eccentric areas of the retina that are related to peripheral visual fields, whereas the macular fibers responsible for VA located more internally inside the orbital optic nerve remain preserved, 13,39 (2) progressive optic nerve strangulation and ischemia, 30 (3) the desynchronizing effect of estradiol on cortical glutamatergic synapses, 38,40 and (4) axonal conduction blockade. 22 Since PRVEPs are closely related to VA scores, reduced PRVEP amplitude in affected or in contralateral eyes presenting good VA scores were suggestive of optic nerve ischemia or silent tumor growing without disturbing fibers of the macular bundle that are located deeply inside the optic nerve.…”

“…3 In the current series, intraorbital meningiomas in middle-aged women were the most frequent type of tumor observed. Since meningiomas have a clear sex predilection, as many other neuro-ophthalmic diseases do, 38 the adoption of gender-based normative values to analyze VEP results instead of assuming the same normative VEP value for both genders was important to avoid an erroneous interpretation of the results. However, because of the small sample size, it could not be possible to associate VEP abnormalities to tumor location.…”

Multiple sclerosis and breast cancer

“…Nevertheless, similar immune reactions [33] and the interplay of sex-specific factors or the genetic background [34] linking MS and BC cannot fully explain a potentially protective effect of MS on BC. We attempted to shed light on the possible contribution of the sex-specific factors to the risk of BC in MS by also analyzing male population in our data base.…”