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Risk of glaucoma after early bilateral oophorectomy

Vajaranant, Thasarat S. MD1,2; Grossardt, Brandon R. MS3; Maki, Pauline M. PhD4; Pasquale, Louis R. MD5; Sit, Arthur J. SM, MD6; Shuster, Lynne T. MD7; Rocca, Walter A. MD, MPH2,8

doi: 10.1097/GME.0b013e31829fd081
Original Articles

Objective Because early estrogen deficiency may increase the susceptibility of the optic nerve to glaucoma, we studied the association of early bilateral oophorectomy with glaucoma.

Methods In the Mayo Clinic Cohort Study of Oophorectomy and Aging, we studied the risk of glaucoma by comparing women who underwent bilateral oophorectomy from 1950 to 1987 with age-matched referent women who did not undergo unilateral or bilateral oophorectomy. Glaucoma diagnostic codes were identified in the records linkage system of the Rochester Epidemiology Project. Hazard ratios (HRs) were calculated during a median follow-up of 25.5 years. Analyses were stratified by age at the time of bilateral oophorectomy (in tertiles).

Results Of 1,044 women who underwent bilateral oophorectomy before menopause, 147 developed glaucoma. Of 1,070 referent women, 133 developed glaucoma. Women who underwent bilateral oophorectomy showed no increased risk of glaucoma in the overall group (HR, 1.12; 95% CI, 0.89-1.42). However, women who underwent oophorectomy before the age of 43 years (n = 344; first tertile) had a significantly increased risk of glaucoma (HR, 1.60; 95% CI, 1.15-2.23). The results did not change after adjustment for hypertension, obesity, diabetes, or disorders of lipid metabolism at baseline. Approximately 11% of women who had undergone bilateral oophorectomy before the age of 43 years were treated with estrogen up to the age of 50 years; however, treatment did not reduce the association (HR, 1.59; 95% CI, 0.81-3.13).

Conclusions Bilateral oophorectomy before the age of 43 years may increase the risk of glaucoma, and estrogen treatment does not seem to attenuate the risk.

From the 1Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL; Divisions of 2Epidemiology and 3Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN; 4Department of Psychiatry, University of Illinois at Chicago, Chicago, IL; 5Department of Ophthalmology and Channing Division of Network Medicine, Harvard Medical School, Boston, MA; and Departments of 6Ophthalmology, 7Internal Medicine, and 8Neurology, Mayo Clinic, Rochester, MN.

Received April 19, 2013; revised and accepted June 6, 2013.

Funding/support: This work was supported by the National Institute of Neurological Disorders and Stroke (R01 NS033978), National Institute on Aging (R01 AG034676), National Eye Institute (K23EY022949-01), and National Institute of Child Health and Human Development and Office of Research on Women’s Health (K12HD055892; support for T.S.V.).

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Walter A. Rocca, MD, MPH, Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail:

© 2014 by The North American Menopause Society.