Glaucoma in women: What do we know so far - A systematic review

Abstract

Purpose

To review the existing literature regarding on the topic of sex differences in the glaucoma.

Design

Systematic review of the available data on sex and gender differences in the glaucoma population.

Methods

A PubMed search was conducted using the words “glaucoma”, “gender”, “sex”, “female”, “women”, “hormone”, “estrogen”, “menopause”, “dry eye”, “socio-economic”, and “vascular”. Inclusion criteria were papers studying female risk factors for glaucoma. A total of 42 studies met the study criteria and were included in this study. 15 studies refer to female sex, and 14 studies refer to woman gender. 13 studies do not clearly differentiate between gender and sex and include information on both female sex and woman gender. We discuss 6 main topics: the effect of female reproductive factors from reproductive age until menopause on glaucoma, the effect of pregnancy on glaucoma, the particularities of acute angle closure glaucoma in women, dry eye disease in women and its impact on glaucoma, the vascular theory behind susceptibility to glaucoma, and finally socio-economic status and gender disparity in glaucoma. When the type of glaucoma is not specified, the section included data on all the types of glaucoma.

Results

Glaucoma is more prevalent in post-menopausal women compared to pre-menopausal women, which suggests the protective effect of estrogen in women before menopause. Pregnancy can induce changes in intraocular pressure and glaucoma should be well monitored before during and after pregnancy. Special consideration should be given during pregnancy and lactation phase as many eyedrops used in glaucoma can reach the fetal circulation. Acute angle closure glaucoma is more prevalent in women due to proven differences in anterior chamber measurements in the female population. Dry eye disease is more prevalent in women and increases the sensitivity of the ocular surface to anti-glaucoma eye drops. Primary vascular dysregulation is more common in women than in men and leads to changes in vascular autoregulation that may decrease blood flow to the optic nerve, leading to glaucomatous optic neuropathy. Finally, the socioeconomic status of a country and the sex disparities within this country correlates with the burden of glaucoma.

Conclusions

Glaucoma in women has unique particularities encompassing various aspects. By deepening our understanding of these associations and the pathogenesis of glaucoma, we may potentially uncover novel preventative measures and therapeutic interventions.