Study suggests menopause may increase risk of glaucoma, but estrogen therapy may help

It is largely accepted glaucoma risk increases with age, but a new study suggests menopause may also play a role.

Glaucoma is the leading cause of incurable blindness worldwide. Developing from a gradual deterioration of retinal cells, gender has not been strongly linked to glaucoma in the past even though 59% of people with this condition are female.

A new study, published in Cellular and Molecular Neurobiology, makes the case that shifting estrogen levels triggered by menopause could increase the risk for glaucoma and other vision changes in women.

The decrease in sex hormones like estrogen that comes with menopause brings a cascade of biological changes to every system in the body. The paper notes that menopause is already linked to an increased risk of developing various cardiovascular and bone health problems, but it has been difficult to draw a similar connection to glaucoma.

To determine if menopause alone could be seen as a risk for developing glaucoma, the research team compared trends on bone fracture and cardiovascular disease risks in women after menopause begins, and among those who experience surgical or early menopause. Several studies cited in the report found that women who experienced early or surgical menopause through bilateral oophorectomy were at an increased risk of developing glaucoma compared to those who experienced menopause naturally or in the average age ranges.

Increased pressure in the eyes is one specific characteristic that is associated with glaucoma, but the paper suggests it’s also a symptom linked to shifting estrogen levels. Researchers note that post-menopausal women in one study had intraocular pressure between 1.5 and 3.5 mmHg higher than pre-menopausal women of the same age. Additionally, post-menopausal women on hormone-replacement therapies containing estrogen saw intraocular pressures drop by 0.5 to 3 mmHg.

Estrogen, estrogen signaling, and changes in these systems brought on by menopause are known to have far-reaching effects on a variety of tissues in the body, according to the report, but this new analysis sheds light on the impact menopause may have on eye health, too. The strong link between estrogen changes and increased intraocular pressure appears to solidify the theory that menopause could be a risk factor in glaucoma development, the report concludes. Linking menopause to increased eye pressure and possibly glaucoma could influence clinical decision making, especially when evaluating glaucoma in post-menopausal women.

Acknowledging estrogen’s role in the development of glaucoma could also have implications for treatment, according to the study. Estrogen-based glaucoma treatments have been proposed, but the lack of clinical research and evidence has prevented widespread trials. If estrogen-based therapies were to show promise in treating glaucoma in post-menopausal women, the research team suggests that treatments targeting estrogen receptor targets could have potential to offer neuroprotective benefits against other eye conditions like optic neuropathy. Furthermore, the research team says understanding the precise role of estrogen and the impact of menopause as a glaucoma risk factor could open the door to new clinical advances in glaucoma management overall.

Reference

Douglass A, Dattilo M, Feola AJ. Evidence for Menopause as a Sex-Specific Risk Factor for Glaucoma. Cell Mol Neurobiol. 2023;43(1):79-97. doi:10.1007/s10571-021-01179-z