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Estrogen deficiency accelerates aging of the optic nerve

Vajaranant, Thasarat S. MD1; Pasquale, Louis R. MD2

doi: 10.1097/gme.0b013e3182443137
Review Article

The aim of this study was to provide a comprehensive review on hormone-based pathophysiology of aging of the optic nerve and glaucoma, including a literature review and expert opinions. Glaucoma, a group of intraocular pressure-related optic neuropathies, is characterized by the slow progressive neurodegeneration of retinal ganglion cells and their axons, resulting in irreversible visual sensitivity loss and blindness. Increasing evidence suggests that glaucoma represents the accelerated aging of the optic nerve and is a neurodegenerative disease of the central nervous system. This review highlights the high burden of glaucoma in older women and the importance of understanding the hormone-related pathophysiology of optic nerve aging and glaucoma in women. Strong epidemiological, clinical, and experimental evidence supports the proposed hypothesis that early loss of estrogen leads to premature aging and increased susceptibility of the optic nerve to glaucomatous damage. Future investigations into the hormone-related mechanisms of aging and glaucoma will support the development of novel sex-specific preventive and therapeutic strategies in glaucoma.

From the 1Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL; and 2Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA.

Received November 9, 2011; revised and accepted November 29, 2011.

Funding/support: This study was supported by grant K12HD055892 (T.S.V.) from the National Institute of Child Health and Human Development (NICHD) and the Office of Research on Women’s Health and EY015473 (L.R.P.) from the National Eye Institute (NEI). Dr. Pasquale is also supported by a Research to Prevent Blindness Physician Scientist award, the Harvard Glaucoma Center of Excellence, and a Distinguished Ophthalmology Scholar from the Department of Ophthalmology, Harvard Medical School.

The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NICHD or NEI.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Thasarat S. Vajaranant, MD, 1855 W Taylor St, Chicago, IL, USA. E-mail:

©2012The North American Menopause Society