Several studies have provided evidence of a link between glaucoma and combined oral contraceptive use. Until recently, however, risk factors for glaucoma went largely unexplored in younger women. 

Exploring the risk for this demographic is critical. Nearly 400 million non-pregnant women of reproductive age worldwide use hormonal contraceptives, and this class of medication is the most widely-prescribed for women of childbearing age in the U.S. 

In order to close this knowledge gap, a new study investigated the roles of sex hormones and gender in the risk of glaucoma development in younger women. 

What They Did

The research team conducted a retrospective case-control analysis of 4,781,504 electronic medical records dated from 2008 to 2018 for women aged 15 to 45 years old.

Participants were either:

• Non-users of any type of hormonal contraceptives 
• Users of oral contraceptives
• Users of non-oral contraceptives, such as:
  • An intrauterine device (IUD)
  • Vaginal rings
  • Intramuscular injections

The primary outcome of interest was a first diagnosis of glaucoma (or ocular hypertension), and each participant case was matched to four controls by age, body mass index (BMI), and follow-up time.

Of the patient cohort, 2,366 (0.05%; average age 34.9 years) glaucoma cases were identified. These were then matched with 9,464 controls (average age 34.8 years). More cases than controls were Black and had hypertension, both risk factors for glaucoma.

What They Found

According to the study findings:

• Regular users of hormonal contraceptives had a higher risk of developing glaucoma than non-users. 
• Current users were at greatest risk – more than two times greater than past users.
• Glaucoma risk increased as more prescriptions were combined:
  • Participants who used >4 prescriptions were at higher risk than those with ≤2. 
• Past users did not experience an increased risk compared with non-users.

What It Means

Hormonal contraceptive use among women of reproductive age–especially combined contraceptive use–was associated with a more than two-fold higher risk of developing glaucoma.

“Women on hormonal contraceptives who experience visual changes should have these symptoms examined by an ophthalmologist,” warned senior study author Mahyar Etminan, PharmD, MSc, of The University of British Columbia.

That said, Etminan added, the risk is relatively low and should not cause most women to avoid such medications. 

*Gavidia, M. (2021, July 10). Hormonal Contraceptive Use Associated With Increased Risk of Glaucoma in Women. American Journal of Managed Care.  https://www.ajmc.com/view/hormonal-contraceptive-use-associated-with-increased-risk-of-glaucoma-in-women