Postmenopausal Estrogen Use, Type of Menopause, and Lens Opacities

Worzala, Katherine; Hiller, Rita; Sperduto, Robert D.; Mutalik, Karen; Murabito, Joanne M.; Moskowitz, Mark A.; D’Agostino, Ralph B.; Wilson, Peter W.F.

doi:10.1001/archinte.161.11.1448

Cited by 68 publications

(44 citation statements)

References 47 publications

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“…Female gender is a well-described risk factor for cataract [7][8][9][10][11] though not all studies have found a difference in cataract prevalence between males and females [12,13]. The reduction in female hormones encountered during menopause may provide part of the explanation for the higher prevalence of cataract in females since hormon replacement therapy has been shown to prevent or postpone cataract development [14]. We found an increased proportion of females in age groups 60 years or older than would be expected based on the national demographic data but there was no gender difference in the age group 59 years or younger and this may support the view that the change in hormones during menopause is related to the increased risk of cataract in females.…”

Section: Resultsmentioning

confidence: 99%

Time Trends in Indication for Cataract Surgery

Kessel¹,

Haargaard²,

Boberg-Ans³

et al. 2011

J Clinic Experiment Ophthalmol

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performed from 2002 to 2010 (excluding congenital and childhood cataracts) were drawn from the database yielding a total of 14,701 eyes (9,474 first eye surgeries and 5,227 second eye surgeries). To avoid problems with inter-eye interaction, the analyses were separated into first eye surgeries and second eye surgeries. However, only second eyes that were operated on within one year of the first eye were included in the second eye analyses (n=4.677). Thus, 550 eyes that were operated more than 1 year later than the first eye were excluded from the study.At the pre-operative visit all patients had a full ophthalmic examination including determination of best corrected visual acuity and a thorough slitlamp examination after pharmaceutical pupil dilation as well as biometric measurements including determination of axial length and radii of curvatures. Furthermore, patients were interviewed about cataract related symptoms as well as general health status. Any ocular co-morbidities were evaluated. For the statistical analyses, patients were grouped into those with ocular co-morbidities thought to be of significance for the visual acuity (e.g. age-related macular degeneration, glaucoma, previous retinal detachment, or previous vitreoretinal surgery) and those who did not have visually significant ocular co-morbidity (e.g. no other eye disease except cataract or visually insignificant eye disease such as blefaritis).Statistical analyses were performed using the SAS computer AbstractBackground: Due to the increasing proportion of elderly citizens the need for cataract surgery is expected to increase markedly within the next two decades but also the indication level for cataract surgery will influence the need for surgery. The aim of the present study was to examine if the indication for cataract surgery has remained stable over an eight year period in a university clinic setting in the Capitol Region of Copenhagen, Denmark.Methods: All pre-operative visits from 2002 to 2010 were evaluated yielding a total of 14,701 eyes (9,474 first eye surgeries and 5,227 second eye surgeries). Information was drawn from a database where pre-, peri-and postoperative data regarding all cataract surgeries (except for congenital and childhood cataract) performed at the clinic had been entered at the time of examination/surgery. Evaluation of the indication level for cataract surgery was assessed primarily based on visual acuity. Results:In the 8 year period, mean visual acuity increased significantly from 0.18 to 0.24 Snellen (corresponding to 0.74 to 0.62 logMAR) in the eyes that underwent surgery first and in second eyes from 0.29 to 0.41 Snellen (corresponding to 0.54 to 0.39 LogMAR, respectively, p-values <0.0001) and concomittantly the mean age of patients at the time of surgery decreased from 75.4 to 71.6 years in females and 72.1 to 69.1 years in males. Conclusion:During the time period from 2002 to 2010 the indication for cataract surgery changed towards patients being operated at better visual acuities and at younger ages. In the ...

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Section: Resultsmentioning

confidence: 99%

Time Trends in Indication for Cataract Surgery

Kessel¹,

Haargaard²,

Boberg-Ans³

et al. 2011

J Clinic Experiment Ophthalmol

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“…Estrogens reduce low density lipoprotein (LDL) 1 cholesterol levels and elevate HDL cholesterol levels (2-4), although these beneficial lipid changes may not translate into favorable clinical results (5). Estrogens may also inhibit the development of colon cancer (5), inhibit the development of Alzheimer's disease (6), and inhibit development of cataracts (7,8). The multitude of estrogen responses matches the widespread distribution of estrogen receptors (ERs) throughout numerous organs, with ER␣ expression the highest in uterus, pituitary, kidney, and adrenal gland and ER␤ expression highest in ovary, uterus, bladder, and lung (9).…”

mentioning

confidence: 99%

Estrogen Receptor α Regulates Expression of the Orphan Receptor Small Heterodimer Partner

Lai¹,

Harnish²,

Evans³

2003

Journal of Biological Chemistry

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Hormonal status can influence diverse metabolic pathways. Small heterodimer partner (SHP) is an orphan nuclear receptor that can modulate the activity of several transcription factors. Estrogens are here shown to directly induce expression of the SHP in the mouse and rat liver and in human HepG2 cells. SHP is rapidly induced within 2 h following treatment of mice with ethynylestradiol (EE) or the estrogen receptor ␣ (ER␣)-selective compound propyl pyrazole triol (PPT). SHP induction by these estrogens is completely absent in ER␣KO mice. Mutation of the human SHP promoter defined HNF-3, HNF-4, GATA, and AP-1 sites as important for basal activity, whereas EE induction required two distinct elements located between ؊309 and ؊267. One of these elements contains an estrogen response element half-site that bound purified ER␣, and ER␣ with a mutated DNA binding domain was unable to stimulate SHP promoter activity. This ER␣ binding site overlaps the known farnesoid X receptor (FXR) binding site in the SHP promoter, and the combination of EE plus FXR agonists did not produce an additive induction of SHP expression in mice. Surprisingly, induction of SHP by EE did not inhibit expression of the known SHP target genes cholesterol 7␣-hydroxylase (CYP7A1) or sterol 12␣-hydroxylase (CYP8B1). However, the direct regulation of SHP expression may provide a basis for some of the numerous biological effects of estrogens.Estrogens exert biological effects in numerous organs throughout the body. The role of estrogens in reproductive biology, the prevention of postmenopausal hot flushes, and the prevention of postmenopausal osteoporosis are well established (1). Estrogens reduce low density lipoprotein (LDL) 1 cholesterol levels and elevate HDL cholesterol levels (2-4), although these beneficial lipid changes may not translate into favorable clinical results (5). Estrogens may also inhibit the development of colon cancer (5), inhibit the development of Alzheimer's disease (6), and inhibit development of cataracts (7,8). The multitude of estrogen responses matches the widespread distribution of estrogen receptors (ERs) throughout numerous organs, with ER␣ expression the highest in uterus, pituitary, kidney, and adrenal gland and ER␤ expression highest in ovary, uterus, bladder, and lung (9). Although many of these actions of estrogens are due to the classic signaling pathway in which an ER binds to an estrogen response element in the promoter of a gene (10), it is now clear that many actions of estrogens are mediated by interaction of ER with other signaling pathways. For example, estrogens inhibit chronic and acute liver inflammation in the mouse by a mechanism that does not require ER activation of gene expression (11,12). This in vivo activity of ER correlates with the in vitro ability of ER to inhibit NFB signaling (13, 14), likely through a coactivator competition mechanism (15). Similarly, ER can regulate gene expression via interaction with AP-1 response elements (16).An additional mechanism by which ER could influence diverse s...

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“…However, higher DHEAS levels were associated with lower odds of cataract (OR 0.81; 95% CI 0.66, 0.99); this association remained significant after adjustment for other cataract risk factors. Other studies of post-menopausal women have shown that women who reported ever using HT, current use of HT, or use of HT for a longer period of time had a reduced risk of cataracts [30,[32][33][34][35][36][37]. In contrast, it should be noted that studies by Eisner et al [38] have shown no changes in the optic cups of users of anastrozole, an aromatase inhibitor that blocks estrogen production, compared to a control group, suggesting no association between estrogen and visual changes.…”

Section: Discussionmentioning

confidence: 99%

Endogenous hormones, participant characteristics, and symptoms among midlife women

et al. 2008

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Objectives-The primary aim of this study was to examine the associations between endogenous hormone levels and symptoms other than hot flashes in a sample of midlife women.Methods-Data from a community-based sample of 603 women aged 45 to 54 years who had never used hormone therapy were analyzed. Each participant completed a questionnaire to obtain data on demographic and lifestyle characteristics as well as symptoms, including headache, insomnia, vision problems, vaginal discharge and dryness, irritability, and incontinence. In addition, each participant provided a blood sample that was used to measure estrogen, androgen, and sex hormone binding globulin (SHBG) concentrations by enzyme-linked immunosorbent assay.Results-Prevalence rates of symptoms ranged from 51.4% (irritability) to 18.6% (vision problems). In adjusted analyses, the free estradiol index (FEI) was significantly and positively associated with the reporting of insomnia (odds ratio (OR) 1.28; 95% confidence interval (CI) 1.01, 1.61). Further, higher SHBG levels were significantly associated with lower odds of reporting vision problems (OR 0.44; 95% CI 0.23, 0.81).Conclusions-This study provides evidence that hormones are associated with insomnia and visual problems during midlife. However, some of these results conflict with previous findings. Given the overall paucity of literature on these issues, more investigation is warranted.

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Postmenopausal Estrogen Use, Type of Menopause, and Lens Opacities

Abstract: Data from our study and other studies suggest that a reduction in the risk of lens opacities may be an additional benefit of postmenopausal estrogen use.

Cited by 68 publications

References 47 publications

Time Trends in Indication for Cataract Surgery

Time Trends in Indication for Cataract Surgery

Estrogen Receptor α Regulates Expression of the Orphan Receptor Small Heterodimer Partner

Endogenous hormones, participant characteristics, and symptoms among midlife women

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