Summary

Menopause, particularly early menopause, may increase women's risk of developing glaucoma through hormonal changes that affect intraocular pressure and the vulnerability of retinal cells. Research suggests that the menopausal transition may accelerate vision loss, highlighting the importance of earlier and more frequent glaucoma screening for women during this period. Despite growing evidence linking menopause to glaucoma, significant gaps remain in understanding the underlying mechanisms and the potential protective effects of hormone therapy. Increased investment in women's health research is essential to improve early detection, develop targeted interventions, and preserve vision in postmenopausal women.

Doctor, I Have a Question: Is Menopause a Factor in Glaucoma?

 

Question answered by
Andrew J. Feola, PhD
Assistant Professor,
Emory University School of Medicine

 

Our lab’s research focuses on glaucoma from a woman’s health perspective. We have a particular interest in understanding how age, menopause, and hormonal signaling play a role in the development and progression of glaucoma. While being male or female is not technically considered a risk factor for developing glaucoma, we know that menopause is a risk-enhancing factor for women in other pathologies, including cardiovascular disease, osteoarthritis, and osteoporosis.

Our recent findings reinforce clinical evidence that early menopause heightens the risk of developing glaucoma for women and highlight the importance of considering women’s health factors in glaucoma research and treatment.

Our research explores how menopause may be associated with the risk of developing glaucoma. Understanding the impact of menopause on glaucoma and how it influences the behavior of cells in the eye has potential clinical applications in the management of glaucoma and other eye conditions.

In our work, we have shown that women within a few years of becoming menopausal have a greater probability of becoming glaucomatous. So that’s a time when we should consider having a higher rate of screening and be looking a little harder to help treat them earlier and preserve vision longer. We have these touch points for women in other diseases – for example, mammograms and cardiovascular visits. But we really don’t have that guidance in eye care.

Looking at the field of cardiology – the American Heart Association and American College of Cardiology guidelines now state that early menopause is a risk-enhancing factor for developing cardiovascular disease and view the menopause transition as a treatment window. So, for example, if a patient has borderline cholesterol markers for cardiovascular disease and experienced early menopause, they might intervene earlier.

Previous work by Dr. Louis Pasquale and others found that menopause had a significant effect on eye pressure, or IOP, with an increase seen in postmenopausal women. IOP is the #1 risk factor for developing glaucoma, and additional studies have shown that hormonal therapy after menopause lowers IOP.

So, there is evidence around menopause and factors associated with glaucoma, but finding people who say this is something we should really study rigorously is difficult. Some people say it’s only one factor, but our work has also shown that menopause affects how IOP is regulated and accelerates vision loss after injury. So, we need to study how menopause affects the eye to better understand glaucoma.

Consider as well that 100% of aging women will eventually become postmenopausal, and that these women will live at least one-third of their lives after menopause. There are many unknowns about how menopause affects the eye, and that is what our group is trying to tackle. The field is gaining traction, but we still need more support.

Women’s health is underfunded generally. If you look at global research dollars, only five percent goes to research specifically for women’s health. And for every research dollar that goes to women’s health, 80 cents goes to cancer research, five cents goes to fertility issues, leaving the remaining 15 cents for every other issue relating to women’s health throughout the entire body. So, menopause is not an area heavily invested in for research, even though it affects every post-menopausal woman.

We need people to realize there is a lot to learn and that menopause is a significant issue worth investing in that will benefit everyone’s health. The history of work to include women is still relatively young, considering that women were only first included in cardiovascular studies in 1948. About 30 years later, they found that the rate of cardiovascular disease increased after menopause, and they acknowledged that correlation. Then in the ‘90s, following the initial results from the Women’s Health Initiative study, there were years of debate about the risks and benefits of hormonal therapy. Only more recently, in the last 5 years, after numerous follow-up studies and re-examining the data, have the guidelines changed to state that menopause is a risk-enhancing factor for cardiovascular conditions, and the concept of hormone therapy has been revisited, either as a window of treatment or long-term option.

I do not think we have to take over 50 years to understand how menopause is related to glaucoma. I think we can do better in glaucoma and eye care, better for women, and better for society.