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    Managing glaucoma in women

    Gender and hormones may play a bigger role than previously thought

    It has been estimated that by the year 2020, there will be an increase in the number of Americans living with glaucoma from 60 to 80 million. Given that women outnumber and outlive men, this will result in a vast number of patients who will require optometric care. As we review risk factors for this blinding disease, perhaps gender and hormonal factors should be factored in to the decision-making process.1

    As glaucoma is a disease of the aged optic nerve, it makes sense that those who live longer will have an increased risk. With glaucoma being a disease of progression, it is more essential to diagnose and treat earlier, especially those who may have silent risk factors, such as exposure to endogenous estrogen.1

    More from this issue: Understanding drainage in glaucoma

    There have been a number of epidemiologic studies conducted to determine if there is a gender difference in the incidence of glaucoma. Due to variances in study designs and populations, there are no conclusive findings for primary open-angle glaucoma. The Baltimore and Beaver Dam Studies showed no difference, the Blue Mountain Study showed an increased incidence for women and the Framingham, Barbados, and Rotterdam Studies showed an increased incidence for men.2-5


    Secondary glaucomas

    When looking at the less common forms, women are more likely to be susceptible to narrow-angle glaucoma. There has been a long-standing theory that shorter axial length was the physical difference; however, new evidence from Wang using anterior segment tomography reveals that it may also be related to iris thickening and curvature variations.6,7 Many studies in the U.S. and Scandinavia agree that women are more at risk for pseudoexfoliation syndrome8 and less at risk for pigmentary dispersion glaucoma.2,8

    However, because these forms can be more aggressive, so should their management.  Of greatest concern is low tension glaucoma because it is the most underdiagnosed form—yet according to the Collaborative Normal Tension Glaucoma Study (CNTGS), women have a higher risk. This is likely due to the multifactorial causes for glaucoma, such as vasospasm disorders that women develop which include low blood pressure, migraine headaches, and reduced circulation to hands and feet which may contribute to loss of blood flow to the optic nerve.8-10

    Next: Effects on pregnancy

    Louise Sclafani, OD, FAAO
    Dr. Sclafani is clinical associate of ophthalmology and visual science and director of optometric services The University of Chicago ...


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