Jae H Kang,Zhiyu Wu,Megan Yu,Hannah H Hwang,Namuunaa Juramt,Bernard A Rosner,Louis R Pasquale,Janey L Wiggs
{"title":"女性生殖因素与剥脱性青光眼或疑似青光眼的危险有关。","authors":"Jae H Kang,Zhiyu Wu,Megan Yu,Hannah H Hwang,Namuunaa Juramt,Bernard A Rosner,Louis R Pasquale,Janey L Wiggs","doi":"10.1016/j.ajo.2025.06.046","DOIUrl":null,"url":null,"abstract":"PURPOSE\r\nIncidence studies have reported higher rates of exfoliation syndrome and glaucoma (XFG) in women, implicating female-specific factors. We evaluated associations between female reproductive factors and incident XFG.\r\n\r\nDESIGN\r\nProspective cohort study of 121,098 females in the Nurses' Health Study (NHS; 1980-2018) and NHSII (1991-2019).\r\n\r\nMETHODS\r\nEligible participants were ≥40 years old, postmenopausal, had no history of XFG or cataract extraction, had data on reproductive factors, and reported ophthalmic examinations. Incident XFG or exfoliation glaucoma suspect (XFGS) cases (n=440 affected eyes) were confirmed with medical records. Per-eye Cox proportional hazards models were used to estimate multivariable-adjusted hazard ratios (MVHRs) and 95% confidence intervals (CIs). False discovery rate (FDR) was used to correct for multiple comparisons.\r\n\r\nRESULTS\r\nOverall, reproductive history indicative of a greater lifetime estrogen exposure was suggestively associated with higher XFG/XFGS risk. Each 1-year increase in age at menarche was associated with 9% lower risks (MVHR=0.91; 95%CI: 0.85, 0.97; FDR-corrected p-trend=0.047). Parity was not associated, longer durations of oral contraceptive use and breastfeeding were inversely associated, and earlier age at menopause and duration of menopausal hormone therapy was adversely associated, although no FDR-corrected p-trends were significant. Among those with high genetic susceptibility for XFG, surgical menopause (bilateral oophorectomy) was inversely associated with XFG/XFGS compared to natural menopause (MVHR=0.37; 95% CI: 0.15, 0.92; FDR-corrected p-interaction=0.0007).\r\n\r\nCONCLUSION\r\nLater age at menarche was associated with a lower XFG/XFGS risk. Surgical versus natural menopause was inversely associated with XFG/XFGS risk only among those with high genetic susceptibility. These results need confirmation.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"641 1","pages":""},"PeriodicalIF":4.1000,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Female reproductive factors in relation to risk of exfoliation glaucoma or glaucoma suspect.\",\"authors\":\"Jae H Kang,Zhiyu Wu,Megan Yu,Hannah H Hwang,Namuunaa Juramt,Bernard A Rosner,Louis R Pasquale,Janey L Wiggs\",\"doi\":\"10.1016/j.ajo.2025.06.046\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"PURPOSE\\r\\nIncidence studies have reported higher rates of exfoliation syndrome and glaucoma (XFG) in women, implicating female-specific factors. We evaluated associations between female reproductive factors and incident XFG.\\r\\n\\r\\nDESIGN\\r\\nProspective cohort study of 121,098 females in the Nurses' Health Study (NHS; 1980-2018) and NHSII (1991-2019).\\r\\n\\r\\nMETHODS\\r\\nEligible participants were ≥40 years old, postmenopausal, had no history of XFG or cataract extraction, had data on reproductive factors, and reported ophthalmic examinations. Incident XFG or exfoliation glaucoma suspect (XFGS) cases (n=440 affected eyes) were confirmed with medical records. Per-eye Cox proportional hazards models were used to estimate multivariable-adjusted hazard ratios (MVHRs) and 95% confidence intervals (CIs). False discovery rate (FDR) was used to correct for multiple comparisons.\\r\\n\\r\\nRESULTS\\r\\nOverall, reproductive history indicative of a greater lifetime estrogen exposure was suggestively associated with higher XFG/XFGS risk. Each 1-year increase in age at menarche was associated with 9% lower risks (MVHR=0.91; 95%CI: 0.85, 0.97; FDR-corrected p-trend=0.047). Parity was not associated, longer durations of oral contraceptive use and breastfeeding were inversely associated, and earlier age at menopause and duration of menopausal hormone therapy was adversely associated, although no FDR-corrected p-trends were significant. Among those with high genetic susceptibility for XFG, surgical menopause (bilateral oophorectomy) was inversely associated with XFG/XFGS compared to natural menopause (MVHR=0.37; 95% CI: 0.15, 0.92; FDR-corrected p-interaction=0.0007).\\r\\n\\r\\nCONCLUSION\\r\\nLater age at menarche was associated with a lower XFG/XFGS risk. Surgical versus natural menopause was inversely associated with XFG/XFGS risk only among those with high genetic susceptibility. These results need confirmation.\",\"PeriodicalId\":7568,\"journal\":{\"name\":\"American Journal of Ophthalmology\",\"volume\":\"641 1\",\"pages\":\"\"},\"PeriodicalIF\":4.1000,\"publicationDate\":\"2025-06-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Ophthalmology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.ajo.2025.06.046\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OPHTHALMOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Ophthalmology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ajo.2025.06.046","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
Female reproductive factors in relation to risk of exfoliation glaucoma or glaucoma suspect.
PURPOSE
Incidence studies have reported higher rates of exfoliation syndrome and glaucoma (XFG) in women, implicating female-specific factors. We evaluated associations between female reproductive factors and incident XFG.
DESIGN
Prospective cohort study of 121,098 females in the Nurses' Health Study (NHS; 1980-2018) and NHSII (1991-2019).
METHODS
Eligible participants were ≥40 years old, postmenopausal, had no history of XFG or cataract extraction, had data on reproductive factors, and reported ophthalmic examinations. Incident XFG or exfoliation glaucoma suspect (XFGS) cases (n=440 affected eyes) were confirmed with medical records. Per-eye Cox proportional hazards models were used to estimate multivariable-adjusted hazard ratios (MVHRs) and 95% confidence intervals (CIs). False discovery rate (FDR) was used to correct for multiple comparisons.
RESULTS
Overall, reproductive history indicative of a greater lifetime estrogen exposure was suggestively associated with higher XFG/XFGS risk. Each 1-year increase in age at menarche was associated with 9% lower risks (MVHR=0.91; 95%CI: 0.85, 0.97; FDR-corrected p-trend=0.047). Parity was not associated, longer durations of oral contraceptive use and breastfeeding were inversely associated, and earlier age at menopause and duration of menopausal hormone therapy was adversely associated, although no FDR-corrected p-trends were significant. Among those with high genetic susceptibility for XFG, surgical menopause (bilateral oophorectomy) was inversely associated with XFG/XFGS compared to natural menopause (MVHR=0.37; 95% CI: 0.15, 0.92; FDR-corrected p-interaction=0.0007).
CONCLUSION
Later age at menarche was associated with a lower XFG/XFGS risk. Surgical versus natural menopause was inversely associated with XFG/XFGS risk only among those with high genetic susceptibility. These results need confirmation.
期刊介绍:
The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect.
The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports.
Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.