• Written By: Jennifer Doyle, MD

    This review article found that many neuro-ophthalmic disorders have an equal sex prevalence prior to puberty and after menopause and are also influenced by pregnancy, suggesting that hormonal changes play a role in the female predominance of many of these diseases.

    Nuclear modifying genes, specifically on the X chromosome, also affect the sex disparity of some diseases. External factors that are female specific, such as oral contraceptives and postmenopausal hormonal therapy, likely contribute to the skewed sex differences as well. 

    The authors reviewed the most common neuro-ophthalmic diseases with a sex predilection. In post-pubertal patients, they found an overall female predominance for idiopathic intracranial hypertension, cerebral venous thrombosis, meningiomas, multiple sclerosis, neuromyelitis optica, migraines, Adie's tonic pupil, breast cancer ocular manifestations and sarcoidosis.

    In pre-pubertal patients, they found equal male and female incidence of idiopathic intracranial hypertension, cerebral venous thrombosis and meningiomas; a female predominance in neuromyelitis optica; and a male predominance in Leber hereditary optic neuropathy.

    They conclude that external factors, such as pregnancy, oral contraceptives and hormonal treatment, likely contribute to the disparities between sexes but there is still much to be learned about the pathophysiology of these diseases. This insight may aid in disease diagnosis and modification of external factors.