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Original Investigation | Socioeconomics and Health Services

The Potential Association Between Postmenopausal Hormone Use and Primary Open-Angle Glaucoma

Paula Anne Newman-Casey, MD, MS1; Nidhi Talwar, MA1; Bin Nan, PhD2; David C. Musch, PhD, MPH1,3; Louis R. Pasquale, MD4,5; Joshua D. Stein, MD, MS1
[+] Author Affiliations
1Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor
2Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor
3Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
4Department of Ophthalmology, Harvard Medical School, Cambridge, Massachusetts
5Department of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Cambridge, Massachusetts
JAMA Ophthalmol. 2014;132(3):298-303. doi:10.1001/jamaophthalmol.2013.7618.
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Importance  Retinal ganglion cells are known to express estrogen receptors and prior studies have suggested an association between postmenopausal hormone (PMH) use and decreased intraocular pressure, suggesting that PMH use may decrease the risk for primary open-angle glaucoma (POAG).

Objective  To determine whether the use of 3 different classes of PMH affects the risk for POAG.

Design, Setting, and Participants  Retrospective longitudinal cohort analysis of claims data from women 50 years or older enrolled in a US managed-care plan for at least 4 years in which enrollees had at least 2 visits to an eye care provider during the period 2001 through 2009.

Exposure  Postmenopausal hormone medications containing estrogen only, estrogen + progesterone, and estrogen + androgen, as captured from outpatient pharmacy claims over a 4-year period.

Main Outcomes and Measures  Hazard ratios (HRs) for developing incident POAG.

Results  Of 152 163 eligible enrollees, 2925 (1.9%) developed POAG. After adjustment for confounding factors, each additional month of use of PMH containing estrogen only was associated with a 0.4% reduced risk for POAG (HR, 0.996 [95% CI, 0.993-0.999]; P = .02). The risk for POAG did not differ with each additional month of use of estrogen + progesterone (HR, 0.994 [95% CI, 0.987-1.001]; P = .08) or estrogen + androgen (HR, 0.999 [95% CI, 0.988-1.011]; P = .89).

Conclusions and Relevance  Use of PMH preparations containing estrogen may help reduce the risk for POAG. If prospective studies confirm the findings of this analysis, novel treatments for this sight-threatening condition may follow.

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Selection of Beneficiaries for Analysis

The 152 163 eligible for analysis includes 70 292 women using postmenopausal hormone (PMH) and 81 871 women not using PMH. Some women appear in more than 1 group because they used more than 1 type of PMH. CPT indicates Current Procedural Terminology; PCOS, polycystic ovarian syndrome; POAG, primary open-angle glaucoma; SERM, serum estrogen receptor modulator.

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