Glaucoma is the leading global cause of irreversible blindness, and is often called the “silent thief of sight” because it can gradually steal your vision without noticeable symptoms until it’s quite advanced. Glaucoma is actually a group of diseases that damage the optic nerve, the route by which visual information is transported from your eyes to your brain. Scientists are investigating a possible connection between menopause and the risk of developing glaucoma. Here’s what they’ve found so far.* 

About glaucoma

Glaucoma can develop over the course of years, even decades. It affects peripheral (side) vision first, slowly encroaching on your central vision, leading to blindness if not caught and treated early enough. Right now, the only approved treatment is to lower your internal eye pressure (IOP). 

IOP can increase when your eye’s natural fluids can’t drain properly, either because the drainage system is blocked or your eye is producing too much fluid. Over time, high IOP damages the optic nerve, killing off cells that you need in order to see.

Glaucoma and the sexes

Women make up 59% of the global glaucoma population. They report a higher rate of visual impairment, yet are 24% less likely than men to seek treatment. In addition, write the study authors, preclinical (animal) studies often focus exclusively on male animals, making it “nearly impossible to identify underlying causes of a disease or responsiveness to drug treatments that may differ between sexes.”

Fortunately, the need to focus on women’s health issues is being recognized in proposals for research funding. Recent reports from the National Eye Institute state that:

• More women have glaucoma compared to men (2.21% vs. 1.67%). 
• Women have been shown to have a higher prevalence of glaucoma between the ages of 40 and 59, and after age 80. 

What does this have to do with menopause? The age range of 40 to 59 (and more narrowly ages 45-51) is the standard range during which most women enter perimenopause and reach menopause.

Menopause and health risks

Menopause is associated with a range of health concerns, including:

• Diabetes,
• Heart disease,
• Stroke, and
• Osteoporosis. 

This is mostly due to the declining levels of the hormone estrogen, which is linked to the proper function of many body systems. 

Recent research also links estrogen loss to risks associated with glaucoma, along with dry eye and age-related macular degeneration. Estrogen is produced by both men and women, but is generally more abundant in women. 

Estrogen, eye health, and glaucoma

Estrogen also plays a protective role in eye health. Though scientists haven’t established a direct cause-and-effect relationship, research suggests that the decline in estrogen levels during menopause may negatively influence eye health factors related to glaucoma, no matter your age at the time of menopause.

Several studies have demonstrated that:

• Women who experienced surgical menopause through the removal of both ovaries (OVX) were at an increased risk of developing glaucoma later in life. 
• Postmenopausal women had higher IOP than age-matched premenopausal women. 
• Postmenopausal women on estrogen hormone replacement therapy (HRT) had lower IOP compared to postmenopausal women not receiving HRT. 
• Using topical eye drops containing estradiol after OVX preserved visual contrast sensitivity.

What it could mean for you

Knowledge of your menopausal status (i.e., pre, peri, or post) could influence your doctor’s recommendations about what treatment(s) to start and when. 

More detailed information on how menopause and estrogen affect glaucoma could also lead to new treatment targets and therapies, including more personalized glaucoma treatment plans, particularly for postmenopausal women. Since estrogen is known to be neuroprotective, it may potentially have a role in treating other eye diseases and disorders, and nurturing long-term eye health, as well.  

Whether you’re perimenopausal or postmenopausal, it’s a good idea to pay attention to your vision and get regular eye exams. This is especially important if your doctor has identified you as a glaucoma suspect.

*Douglass, A., Dattilo, M., and Feola, A. J. (2023, January). 

Evidence for Menopause as a Sex-Specific Risk Factor for Glaucoma. Cell Mol Neurobiol, 43(1). doi: 10.1007/s10571-021-01179-z 79–97. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9250947/ 

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