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  • Retinal Vascular Occlusion and Hormone Therapy in Women

    By Jean Shaw
    Selected and Reviewed By: Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, January 2021

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    Does taking an oral contraceptive or estrogen replacement therapy raise a woman’s risk of retinal vascular oc­clusion (RVO)? Song et al. set out to determine whether filling a prescrip­tion of female hormone therapy (FHT) is associated with an increased risk of RVO or retinal artery occlusion (RAO) in women. They found no increase in risk.

    For this study, the authors used an administrative claims insurance database. Multiple cohorts were created based on whether a FHT prescription was filled for all women 18 years or older. Patients were excluded if they had less than two years in the plan, had not undergone a previous ophthalmic exam, or had a history of RAO or RVO. They also were excluded if they had a systemic disease or took medications that affected their estrogen levels or if they had a disease associated with an increased risk for thromboembolism.

    A total of 205,304 women who filled a prescription for FHT were matched to 755,462 control patients. The primary outcome was the incidence of a new diagnosis of RAO or RVO. Cox pro­portional hazard regression modeling with inverse probability of treatment weight (IPTW) was used to assess the hazard ratio (HR) for a new diagnosis of RAO or RVO relative to filling an FHT prescription. The researchers also conducted subanalyses to stratify by age, race/ethnicity, and the presence of diabetes and hypertension.

    All told, there were 41 cases of RAO (.01%), 68 cases of RVO (.02%), and 111 combined RAO/RVO outcomes (.03%) in the FHT prescription group, versus 373 RAO cases (.05%), 617 RVO cases (.08%), and 1,003 combined cases (.13%) in the control cohort. With IPTW analysis, no difference was seen in the likelihood of developing RAO (HR, 1.17; 95% confidence interval [CI], 0.83-1.65; p = .36), RVO (HR, 1.07; 95% CI, 0.82-1.39; p = .65), or the combined outcome (HR, 1.10; 95% CI, 0.89-1.36; p = .37) when those who took FHT were compared with con­trols. Moreover, after stratification by age, diabetes, and hypertension, no sig­nificant difference was found between those who took FHT and controls with regard to incidence of RAO, RVO, or RAO/RVO.

    The authors pointed out that this study has several limitations, including the inability to confirm that patients consistently took their FHT after filling their prescriptions.

    The original article can be found here.