Identification of androgen, estrogen and progesterone receptor mRNAs in the eye

Expression, distribution, and function of sex hormone receptors in the rabbit brain

Sex hormones such as estradiol, progesterone, and testosterone are crucial for vertebrate brain functions by interacting with their specific receptors. In rabbits, these hormones regulate sexual behavior, scent marking, nest building, and nipple searching across different brain regions. However, information on sex hormone receptors in the rabbit brain is limited. We examined intracellular progesterone (PR), estrogen (ER), and androgen receptors (AR) in the rabbit brain. PR activation by progesterone is associated with pregnancy and maternal behaviors like nest building and nipple searching. PR is expressed in female and male rabbits' cerebral cortex, hypothalamus, preoptic area, and hippocampus. In males, it is also found in the olfactory bulb, mesencephalon, and cerebellum. Rabbits express two ER subtypes, ERα and ERβ, with different expression patterns and functions. The former is in the amygdala, bed nucleus of the stria terminalis, hippocampus, hypothalamus, preoptic area, septum, and thalamus of females. In males, ERα is expressed in the hypothalamus, olfactory bulb, prefrontal cortex, preoptic area, mesencephalon, and cerebellum. Both ERs are located in male rabbits' amygdala, claustrum, and hippocampus. ERs influence estrous behavior and chinning. ERα has a role in rabbit hippocampus development and plasticity. AR is expressed in male rabbit hypothalamus, olfactory bulb, prefrontal cortex, hippocampus, preoptic area, mesencephalon, and cerebellum, related to sexual behavior and chinning. Interestingly, sex hormones regulate their own receptor expression and those of other sex hormones. Thus, estradiol regulates PR expression. This review summarizes the expression and distribution of sex hormone receptors in the rabbit brain and their behavioral role.

Exploring the overlooked risk: Ocular health and alterations in women with polycystic ovary syndrome

BackgroundPolycystic Ovary Syndrome is well known to cause various metabolic changes in the body; however, changes in the ocular surface are not fully understood or well-described in the existing literature. Hormonal disturbances resulting from PCOS may affect multiple ocular tissues, including the posterior segment, lacrimal and meibomian glands, cornea, and conjunctiva.ObjectiveThis paper aims to summarize the current knowledge and research regarding ocular alterations related to PCOS.MethodA comprehensive review of the existing literature was conducted by searching multiple databases, including Scopus, PubMed, and Google Scholar. Keywords such as "Polycystic Ovary Syndrome," "PCOS," "ocular surface," "dry eye," "meibomian gland dysfunction," and "ocular changes" were used. Relevant case reports and clinical studies were included to provide a comprehensive understanding of the ocular implications of PCOS.ResultsAmong the ocular changes associated with PCOS, dry eyes are the most common source of irritation and discomfort in affected individuals. Recognizing this association is crucial for eye care practitioners.ConclusionIdentifying the link between PCOS and dry eyes enables practitioners to develop personalized management plans for individuals with PCOS, potentially improving their eye health and comfort in longer run. When necessary, further evaluation or referral may be required for patients with PCOS-related ocular symptoms.

Sex Differences in the Lacrimal Gland: Implications for Dry Eye Disease

Sexual dimorphism significantly impacts the lacrimal gland's structure, function, and ageing processes, playing an important role in dry eye disease (DED) pathophysiology. This multifactorial disorder, characterised by tear film instability, inflammation, and visual impairment, disproportionately affects women, especially after menopause. It highlights the interplay between sex steroid hormones, lacrimal gland function, and environmental factors. Systemic and local androgens are vital for maintaining lacrimal gland health and tear production, while the role of oestrogens remains less clear. Evidence suggests dose and context-dependent effects on inflammation and glandular function. Histopathological and molecular studies reveal significant sex differences in the lacrimal gland, with women exhibiting more pronounced age-related degenerative changes, including fibrosis and acinar atrophy, contributing to their increased susceptibility to DED. Despite these findings, the underlying mechanisms connecting sex steroid hormones, receptor expression, and local tissue regulation to these disparities remain poorly understood, highlighting the need for further research. This review synthesises the current knowledge of sex-specific differences in the lacrimal gland, emphasising the importance of integrating systemic and local biomarkers, histological data, and molecular insights into personalised therapeutic strategies. By tailoring treatments to patients' unique hormonal and molecular profiles, personalised medicine has the potential to transform DED management, addressing unmet clinical needs and improving outcomes.

Bifocal retinal degeneration observed on ultra-widefield autofluorescence in some cases of CRX-associated retinopathy

BACKGROUND

Variants in CRX are associated with dominantly inherited retinopathy with considerable phenotypic variability. Many patients have central retinal degeneration; in some patients, we have observed an additional focus of degeneration in the nasal retina. This study explores this phenotypic association amongst patients with CRX-associated disease.

METHODS

A retrospective review was conducted for all patients with dominant CRX-associated retinopathy at two UK centres. Analysis focused on patients with available ultra-widefield autofluorescence imaging and aimed to identify those with a specific bifocal degeneration pattern involving the nasal retina in both eyes.

RESULTS

Sixty patients were identified, with ultra-widefield fundus imaging available for 50 patients. Of these, six male patients aged 26-74 years displayed a distinct pattern characterised by central retinal degeneration and an additional discrete area of altered autofluorescence in the nasal periphery. Pattern and full-field ERGs indicated macular dysfunction in all 6 cases, with generalised cone (n = 2) or cone and rod (n = 4) system involvement, with a locus that appeared to be post-phototransduction. The CRX variants found in these patients included missense variants (n = 2), frameshifting variants (n = 3), and a CRX whole gene deletion (n = 1), with no clear genotype-phenotype correlation identified.

CONCLUSIONS

We report a distinct pattern of bifocal retinal degeneration in some cases of CRX-associated retinopathy (12% in our cohort), not typically seen in other forms of inherited retinal disease. Recognising such phenotypes can guide genetic investigations or their interpretation, facilitating molecular diagnoses for effective family counselling, given the autosomal dominant inheritance and phenotypic variability of CRX-associated retinopathy.

The Effects of Pregnancy on Disease Progression of Retinitis Pigmentosa

PURPOSE

Retinitis pigmentosa (RP) is the most common diagnosis in the ophthalmic genetics clinic. Women with RP are often diagnosed during their reproductive years, posing significant challenges for family planning. The effects of pregnancy on RP progression is a frequently unanswered concern for these patients.

DESIGN

Retrospective cohort study.

SUBJECTS

Women who attended Moorfields Eye Hospital (London, UK) and met the following inclusion criteria were included in this study: (1) had their most recent visit at 30 years old or more, (2) were diagnosed with RP, (3) had information in their medical records about having had children, and (4) were found to have biallelic rare or likely disease-causing variants in USH2A.

METHODS

The cohort was divided into parous and nulliparous, and multivariate Cox regressions adjusting for multiple confounding effects were performed. A further analysis also included number of children as a variable.

MAIN OUTCOME MEASURES

RP severity criteria based on visual acuity (VA) and ellipsoid zone (EZ) width, and national registration of sight impairment.

RESULTS

A total of 142 women were included in the study, 98 parous (69%) and 44 nulliparous (31%). In the parous group, 21% had cystoid macular edema (CMO) requiring treatment and 46% had cataracts or were pseudophakic, versus 18% with CMO and 59% with cataracts in the nulliparous. Women had a median of 2 children. A significant association was only found in parous women having 3.04 (1.23-7.48) times increased risk of having VA worse than LogMAR 0.7 than nulliparous (P = .016), after adjusting for baseline age, phenotype, lens status, and CMO.

CONCLUSIONS

This is the first large-scale objective study analyzing the effects of pregnancy in genetically-confirmed women with RP. Women with USH2A-associated RP who had children appeared to have 3.04 times the risk of reaching VA below 20/100 than those who did not have children. It is possible that other factors besides retinal degeneration are affecting central vision and causing this increased risk. A significant association between faster or slower EZ loss and pregnancy was not present in our cohort. We believe these findings will be relevant to all women with RP considering starting a family; although further studies are needed.

Macular, choroidal and disc associations across women's reproductive life stages: a scoping review from menarche to post-menopause

Oestrogen and progesterone fluctuate cyclically in women throughout their adult lives. Although these hormones cross the blood-retinal barrier and bind to intraocular receptors, their effects remain unclear. We present the first review to date on associations between posterior pole structures-specifically the macula, choroid, and optic disc-and both the menstrual cycle and post-menopausal period, utilising multimodal imaging techniques in healthy adult non-pregnant women. We excluded studies on contraception and hormonal replacement therapy, focusing solely on physiological associations. Despite the comprehensive scope of our review, limited data and inconsistent reporting among studies prevented the establishment of meaningful trends. Across menstrual cycle phases, choroidal thickness (CHT) was the most consistently reported parameter, with thinning during the luteal phase compared to the follicular phase. Conversely, no significant differences were observed in macular or disc morphology across the cycle, likely reflecting a preserved structure despite potential fluctuations in blood flow and perfusion. Studies comparing pre- and post-menopausal associations, after adjusting for age or body mass index (BMI), failed to reveal meaningful trends, highlighting the difficulty in separating the effect of age from hormonal declines in older women. Understanding how hormonal cycles impact the posterior pole in women is crucial for addressing sex differences in various ocular pathologies. Research on female-specific factors is still sparse, and interestingly, the majority of affiliations in the reviewed articles did not originate from regions with the highest biomedical research funding and publication rates. We encourage further studies focusing on female-specific variables and provide recommendations for future designs.

Corneal thickness, contrast sensitivity and binocular vision in menopausal and non-menopausal women

OBJECTIVE

This study aimed to investigate the effects of menopause on ocular health and visual function.

METHOD

Sixty-two women (31 premenopausal and 31 postmenopausal) who visited Rasht Health Center were selected and matched based on their ages and compared in terms of their hormonal status, central corneal thickness (CCT), contrast sensitivity (CS), binocular vision variables and refractive error.

RESULTS

CCT and corneal curvature were significantly thinner in postmenopausal women. However, menopause had no significant impact on CS, binocular vision or refractive error.

CONCLUSION

Age-related hormonal abnormalities play a significant role in corneal thinning, highlighting the intricate relationship between systemic hormonal changes and ocular health. In contrast, binocular vision functions remain unaffected by menopause.

Physiological and pathological changes to the eye and vision during and after pregnancy

Pregnancy introduces a multitude of changes in the body, including hormonal fluctuations and metabolic changes, which can lead to atypical ocular signs and symptoms. Ocular manifestations range from fluctuations in vision, to microstructural changes in the retina and choroid, to dry eye disease. This narrative review highlights the range of pregnancy-related effects on the eye and vision that are likely to present in the context of routine eyecare. Specifically, physiological ocular changes and pathological ocular changes that manifest for the first time, or are exacerbated, in uncomplicated pregnancy are discussed. The literature has evolved from simply noting differences in the eye between pregnant and non-pregnant groups, to refining knowledge of the proposed underlying pathophysiology with the advent of newer technologies in eyecare. A particular focus of this review is navigating when pregnancy changes in the eye occur or peak during the gestational period, and whether the changes are short-lived or might extend past pregnancy. While many pregnancy-associated changes are temporary and resolve post-partum, it is also recognised that some changes persist after pregnancy, with a notable absence of literature on ocular changes with loss or termination of pregnancy. Currently or previously pregnant women (or those planning to become pregnant), and other health professionals, should be educated about the importance of seeking eyecare before, during and after pregnancy.

Retinal morphology across the menstrual cycle: insights from the UK Biobank

Oestradiol and progesterone levels are higher in menstruating women than men of the same age, and their receptors are present in their neurosensory retina and retinal pigment epithelium. However, the impact of this hormonal environment on retinal physiology in women remains unclear. Using self-reported menstrual cycle phases as a surrogate for fluctuating hormonal levels, we investigated associations with retinovascular indices on colour fundus photograph and retinal thickness in optical coherence tomography across regularly menstruating women in the UK Biobank. We found no differences in retinal thickness across the cycle; however, vessel density, arteriolar and venular, and fractal dimension were higher in the luteal phase than follicular. The calibre of the central retinal vessels did not differ. This study suggests that the menstrual cycle phase might be associated with retinal microvasculature density in non-invasive imaging. It raises awareness for this understudied area, providing insights into neuroscience fields and epidemiological studies.

Role of Gonadal Steroid Hormones in the Eye: Therapeutic Implications

Gonadal steroid hormones are critical regulatory substances involved in various developmental and physiological processes from fetal development through adulthood. These hormones, derived from cholesterol, are synthesized primarily by the gonads, adrenal cortex, and placenta. The synthesis of these hormones involves a series of enzymatic steps starting in the mitochondria and includes enzymes such as cytochrome P450 and aromatase. Beyond their genomic actions, which involve altering gene transcription over hours, gonadal steroids also exhibit rapid, nongenomic effects through receptors located on the cell membrane. Additionally, recent research has highlighted the role of these hormones in the central nervous system (CNS). However, the interactions between gonadal steroid hormones and the retina have received limited attention, though it has been suggested that they may play a protective role in retinal diseases. This review explores the synthesis of gonadal hormones, their mechanisms of action, and their potential implications in various retinal and optic nerve diseases, such as glaucoma, age-related macular degeneration (AMD), diabetic retinopathy (DR), or retinitis pigmentosa (RP), discussing both protective and risk factors associated with hormone levels and their therapeutic potential.

Variations in anterior segment parameters among different phenotypes of polycystic ovary syndrome

PURPOSE

The objective of this study was to evaluate anterior segment parameters across various phenotypes of polycystic ovary syndrome (PCOS), considering body mass index (BMI), serum estradiol and testosterone levels.

MATERIALS AND METHODS

This prospective study included 116 women with PCOS, with each of the four distinct phenotype comprising 29 women. Additionally, 29 healthy women were included in the control group. All participants underwent comprehensive ophthalmologic examinations, including intraocular pressure (IOP) measurements. Anterior segment parameters, such as central corneal thickness (CCT), axial length (AL), aqueous depth (AD), anterior chamber depth (ACD), and lens thickness (LT) were measured using optic biometry. Endothelial cell density (ECD) was assessed using non-contact specular microscopy. The BMI was calculated, and serum levels of estradiol and testosterone were noted.

RESULTS

IOP was found to be significantly higher (p = 0.003) and CCT was significantly thicker (p = 0.004) in all phenotypes of PCOS compared to the control group. BMI, serum estradiol and free testosterone were found to correlate with both IOP and CCT. AL, AD, ACD and LT values showed no significant differences compared to the control group. Although ECD tend to be higher in the PCOS phenotypes, this difference was not statistically significant (p > 0.05).

CONCLUSION

Given our findings that CCT and IOP are significantly elevated in PCOS phenotypes. PCOS should be considered as an important factor when evaluating female patients for anterior segment diseases and glaucoma.

Differential Expression of Sex-Steroid Receptors in the Choroid Aligns With Central Serous Chorioretinopathy Sex Prevalence Across Different Ages

Purpose

The purpose of this study was to investigate the presence of sex-steroid receptors in human choroidal tissue across different ages and sex, aiming to better understand the pronounced sex difference in central serous chorioretinopathy (CSC) occurrence.

Methods

Paraffin-embedded enucleated eyes of 14 premenopausal women, 15 postmenopausal women, 10 young men (<45 years), and 10 older men (>60 years) were used. A clinically certified immunostaining was performed to detect the presence of the androgen receptor (AR), progesterone receptor (PR; isoform A and B), and estrogen receptor (ERα). The stained slides were scored in a blinded manner for positive endothelial cells and stromal cells in consecutive sections of the same choroidal region.

Results

Our analysis revealed the presence of AR, PR, and ERα in endothelial cells and stromal cells of choroidal tissue. The mean proportion of AR-positive endothelial cells was higher in young men (46% ± 0.15) compared to aged-matched women (29% ± 0.12; P < 0.05, 95% confidence interval [CI]). Premenopausal women showed markedly lower mean proportion of ERα (5% ± 0.02) and PR-positive endothelial cells (2% ± 0.01) compared to postmenopausal women (15% ± 0.07 and 19% ± 0.13; both P < 0.05, 95% CI), young men (13% ± 0.04 and 21% ± 0.10; both P < 0.05, 95% CI), and older men (18% ± 0.09 and 27% ± 0.14; both P < 0.05, 95% CI). Mean PR-positive stromal cells were also less present in premenopausal women (12% ± 0.07) than in other groups.

Conclusions

The number of sex-steroid receptors in the choroidal tissue differs between men and women across different ages, which aligns with the prevalence patterns of CSC in men and postmenopausal women.

Evaluation of anterior segment parameters between pregnancy trimesters and postpartum with pentacam scheimflug ımaging: a prospective study

PURPOSE

To evaluate the effect of pregnancy on the anterior chamber, corneal parameter, and intraocular pressure measurements; and compare the results between trimesters, postpartum and non-pregnant healthy age-matched women.

METHODS

This prospective study included 41 pregnant women and 53 non-pregnant women. Four measurements were taken from the pregnant women, in each trimester and postpartum third month, and once from the control group. Of the individuals included in the study, anterior chamber depth (ACD), anterior chamber volume (ACV), K1 (flat keratometry), K2 (steep keratometry), Kmean (mean value of K1 and K2), anterior chamber angle (ACA), central corneal thickness (CCT), thinnest corneal thickness (TCT), astigmatism value (AST), corneal volume (CV), biometry, axial length (AL), spherical equivalent (SFEQ), intraocular lens power (ILP), VA (visual acuity) datas were recorded.

RESULTS

We observed a statistically significant decrease in K2, CCT, ACD, AL and CV in the postpartum period (p = 0.025, p < 0.001, p = 0.029, p = 0.005, p = 0.004 respectively) and a statistically significant increase in ACV, CCT, and TCT as the gestational week progressed in the pregnant group (p = 0.007, p < 0.001, p = 0.025, respectively). A statistically significant decrease in IOP towards to the third trimester, and an increase in the postpartum period was observed (p < 0.001). We did not observe statistically significant changes in K1, Kmean, AST, ACA, VA, ILP, and SFEQ values.

CONCLUSION

It is important to investigate the physiological changes that may occur during pregnancy, distinguish them from pathological changes, and avoid unnecessary treatment. We consider that it's also important to guide the timing of anterior segment surgeries such as cataract and refractive surgery and to prescribe glasses/contact lenses.

Influence of sex on chronic steroid-induced glaucoma: 24-Weeks follow-up study in rats

The objective was to evaluate ocular changes based on sex in steroid-induced glaucoma models in rats comparing healthy controls, over 24 weeks follow-up. Eighty-nine Long-Evans rats (38 males and 51 females) with steroid-induced glaucoma were analysed. Two steroid-induced glaucoma models were generated by injecting poly-co-lactic-glycolic acid microspheres loaded with dexamethasone (MMDEX model) and dexamethasone-fibronectin (MMDEXAFIBRO model) into the ocular anterior chamber. Intraocular pressure was measured by rebound tonometer Tonolab®. Neuroretinal function was analysed using dark- and light-adapted electroretinography (Roland consult® RETIanimal ERG), and structure was analysed using optical coherence tomography (OCT Spectralis, Heidelberg® Engineering) using Retina Posterior Pole, Retinal Nerve Fibre Layer and Ganglion Cell Layer protocols over 24 weeks. Males showed statistically (p < 0.05) higher intraocular pressure measurements. In both sexes and models neuroretinal thickness tended to decrease over time. In the MMDEX model, males showed higher IOP values and greatest percentage thickness loss in the Ganglion Cell Layer (p = 0.015). Females receiving MMDEXAFIBRO experienced large fluctuations in thickness, a higher percentage loss (on average) in Retina Posterior Pole (p = 0.035), Retinal Nerve Fibre Layer and Ganglion Cell Layer than aged-matched males, and the highest thickness loss rate by mmHg. Although no difference was found by sex in dark- and light-adapted electroretinography, increased amplitude in photopic negative response was found in MMDEX males and MMDEXAFIBRO females at 12 weeks. Although both glaucoma models used dexamethasone, different intraocular pressure and neuroretinal changes were observed depending on sex and other influential cofactors (fibronectin). Both sex and the induced glaucoma model influenced neuroretinal degeneration.

Sex-related difference in the retinal structure of young adults: a machine learning approach

Purpose

To compare the accuracy of machine learning (ML) algorithms to classify the sex of the participant from retinal thickness datasets in different retinal layers.

Methods

This cross-sectional study involved 26 male and 38 female subjects. Data were acquired using HRA + OCT Spectralis, and the thickness and volume of 10 retinal layers were quantified. A total of 10 features were extracted from each retinal layer. The accuracy of various algorithms, including k-nearest-neighbor, support vector classifier, logistic regression, linear discriminant analysis, random forest, decision tree, and Gaussian Naïve Bayes, was quantified. A two-way ANOVA was conducted to assess the ML accuracy, considering both the classifier type and the retinal layer as factors.

Results

A comparison of the accuracies achieved by various algorithms in classifying participant sex revealed superior results in datasets related to total retinal thickness and the retinal nerve fiber layer. In these instances, no significant differences in algorithm performance were observed (p > 0.05). Conversely, in other layers, a decrease in classification accuracy was noted as the layer moved outward in the retina. Here, the random forest (RF) algorithm demonstrated superior performance compared to the others (p < 0.05).

Conclusion

The current research highlights the distinctive potential of various retinal layers in sex classification. Different layers and ML algorithms yield distinct accuracies. The RF algorithm's consistent superiority suggests its effectiveness in identifying sex-related features from a range of retinal layers.

Estrogen dysregulation, intraocular pressure, and glaucoma risk

Characterized by optic nerve atrophy due to retinal ganglion cell (RGC) death, glaucoma is the leading cause of irreversible blindness worldwide. Of the major risk factors for glaucoma (age, ocular hypertension, and genetics), only elevated intraocular pressure (IOP) is modifiable, which is largely regulated by aqueous humor outflow through the trabecular meshwork. Glucocorticoids such as dexamethasone have long been known to elevate IOP and lead to glaucoma. However, several recent studies have reported that steroid hormone estrogen levels inversely correlate with glaucoma risk, and that variants in estrogen signaling genes have been associated with glaucoma. As a result, estrogen dysregulation may contribute to glaucoma pathogenesis, and estrogen signaling may protect against glaucoma. The mechanism for estrogen-related protection against glaucoma is not completely understood but likely involves both regulation of IOP homeostasis and neuroprotection of RGCs. Based upon its known activities, estrogen signaling may promote IOP homeostasis by affecting extracellular matrix turnover, focal adhesion assembly, actin stress fiber formation, mechanosensation, and nitric oxide production. In addition, estrogen receptors in the RGCs may mediate neuroprotective functions. As a result, the estrogen signaling pathway may offer a therapeutic target for both IOP control and neuroprotection. This review examines the evidence for a relationship between estrogen and IOP and explores the possible mechanisms by which estrogen maintains IOP homeostasis.

Unexpected recurrence and rapid progression of lacrimal gland adenoid cystic carcinoma during pregnancy: a case report

Adenoid cystic carcinoma (ACC) is the most common malignant neoplasm involving the lacrimal glands, with high rates of recurrence and metastasis. During the pregnancy, reports of recurrence of ACC of the salivary glands and trachea have previously been published, but no lacrimal gland ACC recurrence has been reported. We present a 35-year-old woman with lacrimal gland ACC who was initially treated by surgical resection and adjunctive radiotherapy, but her cancer recurred during pregnancy, with rapid progression to cavernous sinuses and brain. Estrogen and progesterone receptors have been detected on lacrimal glands and ACCs of salivary glands. Thus, hormonal changes during pregnancy might contribute to the recurrence of ACC. However, the inherent invasive and recurrent nature of ACC could also account for the regrowth in this patient and further molecular studies can provide more accurate explanations.

Pathohistological features of the aging human lacrimal gland

AIM

To assess sex-related differences in the pathohistological features of the human lacrimal gland and to investigate age-related and sex-related differences in stereologically measured volume density of the secretory tissue, connective tissue, and fat.

METHODS

We performed an observational analysis of acinar atrophy, periacinar fibrosis, periductal fibrosis, ductal dilation, ductal proliferation, fatty infiltration, and lymphocyte infiltration of hematoxylin and eosin-stained lacrimal gland samples from 81 cornea donors. Stereological analysis of the volume density of the secretory tissue, connective tissue, and fat was performed on samples from 66 donors.

RESULTS

Up to 69% of all samples showed degenerative changes. Female samples had a higher frequency of all observed degenerative changes, except ductal dilation. While acinar atrophy was significantly more prevalent in women, ductal dilation was significantly more prevalent in men. Stereological analysis indicated lower portions of acini and higher portions of connective tissue and fat, as well as a more pronounced age-related progression of degenerative changes in female samples.

CONCLUSION

Female lacrimal glands are more susceptible to degeneration, and this susceptibility could play an important role in the higher incidence of dry eye disease in older women. A further stereological analysis using more samples from younger age groups is needed to elucidate age-related and sex-related differences in the structure of the human lacrimal gland and their impact on dry eye disease.

Hysterectomy for Benign Indications and Risk of Cataract Formation in South Korean Women

Background and Objectives: Few studies have investigated the relationship between female reproductive hormones, especially estrogen, and the incidence of cataracts. This study sought to evaluate the effects of hysterectomy on the risk of lens opacity in Korean women. Materials and Methods: This retrospective cohort study utilized data collected from 2007 to 2020 for 255,576 postmenopausal women in the Korean National Health Insurance database. Participants were divided into those who did and did not undergo hysterectomy. The hysterectomy group was further divided into two subgroups according to the type of adnexal surgery performed. The prevalence of cataracts was then compared among the control, hysterectomy alone, and hysterectomy with adnexal surgery groups. Results: The control group included 137,999 participants who did not undergo hysterectomy, while the treatment group included 93,719 women who underwent hysterectomy alone or in combination with adnexal surgery. The incidence of cataracts was higher in the control group than in the treatment group, as demonstrated in a 1:1 propensity score-matching analysis adjusted for potential confounding variables. Conclusions: The incidence of cataracts was significantly lower in the group with hysterectomy than in the control group, but the difference was subtle. The current findings may aid in identifying the role of female reproductive hormones in cataract development.

Novel Correlation between TGF-β1/-β3 and Hormone Receptors in the Human Corneal Stroma

This study investigated the interplay between transforming growth factor beta (TGF-β1/T1 and TGF-β3/T3), and sex hormone receptors using our 3D in vitro cornea stroma model. Primary human corneal fibroblasts (HCFs) from healthy donors were plated in transwells at 106 cells/well and cultured for four weeks. HCFs were supplemented with stable vitamin C (VitC) and stimulated with T1 or T3. 3D construct proteins were analyzed for the androgen receptor (AR), progesterone receptor (PR), estrogen receptor alpha (ERα) and beta (ERβ), luteinizing hormone receptor (LHR), follicle-stimulating hormone receptor (FSHR), gonadotropin-releasing hormone receptor (GnRHR), KiSS1-derived peptide receptor (KiSS1R/GPR54), and follicle-stimulating hormone subunit beta (FSH-B). In female constructs, T1 significantly upregulated AR, PR, ERα, FSHR, GnRHR, and KiSS1R. In male constructs, T1 significantly downregulated FSHR and FSH-B and significantly upregulated ERα, ERβ, and GnRHR. T3 caused significant upregulation in expressions PR, ERα, ERβ, LHR, FSHR, and GNRHR in female constructs, and significant downregulation of AR, ERα, and FSHR in male constructs. Semi-quantitative Western blot findings present the interplay between sex hormone receptors and TGF-β isoforms in the corneal stroma, which is influenced by sex as a biological variable (SABV). Additional studies are warranted to fully delineate their interactions and signaling mechanisms.

Tamoxifen related chorioretinal structural changes

PURPOSE

To evaluate the vascular structure of the choroid and each retinal layer in patients with breast cancer on tamoxifen therapy and compare them with healthy subjects.

MATERIALS AND METHODS

124 eyes of 62 patients with breast cancer who were on tamoxifen therapy (group 1) and 80 eyes of 40 healthy controls (group 2) were included in this prospective cohort study. The structure of the choroid was evaluated using enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT) and choroidal binarisation. Spectral-domain OCT (SD-OCT) was performed to analyse the peripapillary nerve fibre layer thickness (pRNFL) and each retinal layer thickness. A subgroup analysis was performed based on chemotherapy history in Group 1. All parameters were compared between Group 1 and the healthy controls and between the subgroups of Group 1.

RESULTS

The subfoveal choroidal thickness and temporal and nasal directions were increased in Group 1 when compared with Group 2 (p < 0.05, each comparison). Choroidal vascularity index was significantly decreased in Group 1 compared with Group 2 (63.15 ± 3.11% and 65.37 ± 4.63%, p < 0.001). There were no significant differences in each retinal layer, pRNFL thickness, and choroid structural parameters between the subgroups of Group 1.

CONCLUSIONS

Increased choroidal thickness may be the initial finding of subclinical tamoxifen-induced retinopathy. Patients with breast cancer undergoing tamoxifen therapy may be screened prior to tamoxifen therapy and followed during treatment by SD-OCT.

Effects of Androgens on the Thickness of Retinal Layers in Transgender Men and in Women with Polycystic Ovarian Syndrome

Purpose

This study aimed to evaluate the relationship between androgens and the retinal thickness by comparing the macular thickness (MT), retinal nerve fiber layer (RNFL), and ganglion cell complex (GCC) thickness of female-to-male transgender men (TGM), women with polycystic ovary syndrome (PCOS), and cisgender women (CW).

Methods

Thirty-four eyes of 34 TGM, 34 eyes of 34 women with PCOS, and 45 eyes of 45 CW were evaluated by optical coherence tomography. One-way analysis of variance and body mass index (BMI)-adjusted one-way analysis of covariance were conducted to test the differences between groups for statistical evaluation.

Results

The parafoveal MT in TGM was significantly higher than women with PCOS and CW (p<0.001 and p=0.022, respectively). After adjusting for BMI, the perifoveal MT in TGM was significantly higher than women with PCOS and CW (p=0.041 and p=0.021, respectively). The nasal RNFL thickness in TGM was significantly higher than women with PCOS and CW (p=0.021 and p=0.009, respectively). The means of average and inferior RNFL, fovea, and the mean of all GCC values were higher in the TGM group than women with PCOS and CW, but these results were not statistically significant.

Conclusions

In this study, there was a significant difference between the TGM group and the CW group for the thickness of the nasal RNFL and parafoveal and perifoveal macular area. Androgens may have the potential to increase retinal thickness in TGM; however, there is a need for validation in larger study groups. Clinical Trial Registration Number: HNEAH-KAEK 2021/4.

Sex-related differences in retinal function in Wistar rats: implications for toxicity and safety studies

Introduction: Wistar Han rats are a preferred strain of rodents for general toxicology and safety pharmacology studies in drug development. In some of these studies, visual functional tests that assess for retinal toxicity are included as an additional endpoint. Although the influence of gender on human retinal function has been documented for more than 6 decades, preclinically it is still uncertain if there are differences in retinal function between naïve male and female Wistar Han rats. Methods: In this study, sex-related differences in the retinal function were quantified by analyzing electroretinography (ERG) in 7-9-week-old (n = 52 males and 51 females) and 21-23-week-old Wistar Han rats (n = 48 males and 51 females). Optokinetic tracking response, brainstem auditory evoked potential, ultrasonic vocalization and histology were tested and evaluated in a subset of animals to investigate the potential compensation mechanisms of spontaneous blindness. Results/Discussion: Absence of scotopic and photopic ERG responses was found in 13% of 7-9-week-old (7/52) and 19% of 21-23-week-old males (9/48), but none of female rats (0/51). The averaged amplitudes of rod- and cone-mediated ERG b-wave responses obtained from males were significantly smaller than the amplitudes of the same responses from age-matched females (-43% and -26%, respectively) at 7-9 weeks of age. There was no difference in the retinal and brain morphology, brainstem auditory responses, or ultrasonic vocalizations between the animals with normal and abnormal ERGs at 21-23 weeks of age. In summary, male Wistar Han rats had altered retinal responses, including a complete lack of responses to test flash stimuli (i.e., blindness), when compared with female rats at 7-9 and 21-23 weeks of age. Therefore, sex differences should be considered when using Wistar Han rats in toxicity and safety pharmacology studies with regards to data interpretation of retinal functional assessments.

Expression of Androgen and Estrogen Receptors in the Human Lacrimal Gland

Lacrimal gland dysfunction causes dry eye disease (DED) due to decreased tear production. Aqueous-deficient DED is more prevalent in women, suggesting that sexual dimorphism of the human lacrimal gland could be a potential cause. Sex steroid hormones are a key factor in the development of sexual dimorphism. This study aimed to quantify estrogen receptor (ER) and androgen receptor (AR) expression in the human lacrimal gland and compare it between sexes. RNA was isolated from 35 human lacrimal gland tissue samples collected from 19 cornea donors. AR, ERα, and ERβ mRNA was identified in all samples, and their expression was quantified using qPCR. Immunohistochemical staining was performed on selected samples to evaluate protein expression of the receptors. ERα mRNA expression was significantly higher than the expression of AR and ERβ. No difference in sex steroid hormone (SSH) receptor mRNA expression was observed between sexes, and no correlation was observed with age. If ERα protein expression is found to be concordant with mRNA expression, it should be investigated further as a potential target for hormone therapy of DED. Further research is needed to elucidate the role of sex steroid hormone receptors in sex-related differences of lacrimal gland structure and disease.

Menopausal hormone therapy and the risk of cataracts in postmenopausal women in South Korea

PURPOSE

Postmenopausal women have a higher prevalence of cataracts than men of a similar age. This study aimed to evaluate the effects of menopausal hormone therapy (MHT) on lens opacities in postmenopausal women.

METHODS

This retrospective cohort study analysed population-based health insurance data in South Korea collected from 2002 to 2019. To determine the risk factors associated with cataract, postmenopausal women (N = 2,506,271) were grouped according to post-MHT use. The treatment group was further divided into the following subgroups: tibolone, combined oestrogen plus progestin by manufacturer, oral oestrogen, combined oestrogen plus progestin by physician and topical oestrogen groups. The main outcome measure was the prevalence of cataracts.

RESULTS

The control group comprised 463,151 postmenopausal women who had never used MHT after menopause, while the treatment group included 228,033 postmenopausal women who had used MHT continuously for at least 6 months. The treatment group had a higher incidence of cataracts than the control group based on Cox proportional hazards ratio analysis. Low socioeconomic status and high parity were identified as risk factors for cataracts, and reduced risk of cataracts was associated with living in rural areas and drinking alcohol.

CONCLUSIONS

Women undergoing post-MHT, including tibolone, had a higher incidence of cataracts. Cataract development should be a concern when examining postmenopausal patients using MHT.

Embryo developmental toxicity in marine medaka (Oryzias melastigma) due to parental and embryonic 17α-ethinylestradiol exposure

The synthetic estrogen 17α-ethinylestradiol (EE2) is a common component of hormone therapy and oral contraceptives and has been widely used for nearly 60 years. Numerous studies have shown that exposure to EE2 can affect embryonic development in a number of fish species. The effects of parental and embryonic EE2 exposure on embryo developmental toxicity and the underlying molecular mechanisms, however, have rarely been examined. In this study, embryos collected from parental EE2-exposed adult fish were examined to assess EE2-induecd toxicity during embryo development. The rate of embryo development including heart rate, hatching rate, and larval locomotion were measured to assess embryo developmental toxicity. The embryonic transcriptome was used to delineate the related developmental toxicity pathways. Our results suggest that parental and embryonic EE2 exposure resulted in growth retardation including a reduction in embryo heart rate, a delay in the appearance eye pigmentation, decreased hatching rate and impaired larval locomotion. In addition, gene ontology (GO) enrichment analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis, and Ingenuity Pathway Analysis (IPA) of transcriptome revealed that these impairments are controlled by estrogen receptor and related to eye structure, neuronal and synaptic structure, and behaviour. The key factors identified, including PRKAA2, APOB, EPHB2, OXTR, NR2E3, and POU4F2, could serve as biomarkers for assessing EE2-induced embryo developmental toxicity. For the first time, our results show that eye pigmentation is a potentially sensitive marker of EE2-induced embryo developmental toxicity.

Does Menopausal Status Affect Dry Eye Disease Treatment Outcomes with OC-01 (Varenicline Solution) Nasal Spray? A Post Hoc Analysis of ONSET-1 and ONSET-2 Clinical Trials

INTRODUCTION

This study sought to compare the efficacy of OC-01 (varenicline solution) nasal spray for treatment of dry eye disease (DED) in postmenopausal women (PM+) versus women who were not postmenopausal (PM-).

METHODS

This was a post hoc subgroup analysis of data integrated from two prior randomized controlled clinical trials, ONSET-1 and ONSET-2. Women randomized to treatment with OC-01 (varenicline solution) nasal spray 0.03 mg or vehicle control (VC) whose self-reported menopausal status (PM+ versus PM-) was known were included. Outcomes included the treatment difference (the OC-01 [varenicline solution] nasal spray change from baseline [CFB] minus VC CFB) in Schirmer test score (STS, mm) with anesthesia and the eye dryness score (EDS) measured on a 100-mm visual analog scale (0 = no discomfort, 100 = maximal discomfort). Least-squares mean treatment differences were derived from analysis of covariance (ANCOVA) models.

RESULTS

Overall, 449 female participants in the ONSET-1 and ONSET-2 trials randomized to the OC-01 (varenicline solution) nasal spray 0.03 mg or VC groups were included in this analysis. The treatment-menopausal status interaction terms in the STS and EDS ANCOVA and logistic regression models were not statistically significant (p > 0.05), indicating consistency of treatment effect between the PM- and PM+ groups. The treatment difference in STS was similar in the PM- and PM+ groups (6.7 and 5.5 mm, respectively). The treatment difference in EDS was similar in the PM- and PM+ groups (- 5.5 and - 4.1, respectively).

CONCLUSIONS

OC-01 (varenicline solution) nasal spray demonstrated similar efficacy in promoting natural tear production and improving symptoms in both PM- and PM+ groups. As menopausal-related hormonal changes may be associated with more severe DED, these results may support OC-01 (varenicline solution) nasal spray as an effective treatment for DED in women regardless of presenting menopausal status.

TRIAL REGISTRATION

Post hoc subgroup analysis of data integrated from ONSET-1 (ClinicalTrials.gov identifier NCT03636061) and ONSET-2 (ClinicalTrials.gov identifier NCT04036292).

Effects of Progesterone and Other Gonadal Hormones on Glutamatergic Circuits in the Retina

BACKGROUND

Gonadal hormones function in the retina; however, their targets have not yet been identified. Therefore, the present study examined the effects of progesterone and other gonadal hormones on glutamatergic circuits in the retina.

METHODS

Extracellular glutamate concentrations, which correspond to the amount of glutamate released, were examined using an enzyme-linked fluorescent assay system. The activity of glutamatergic synapses between bipolar cells and ganglion cells was investigated using a patch clamp technique. Changes in retinal thickness during pregnancy were assessed using optical coherence tomography (OCT) images.

RESULTS

Progesterone and pregnenolone sulfate increased extracellular glutamate concentrations, whereas estrogen and testosterone did not. Progesterone increased the activity of glutamatergic synapses between bipolar cells and ganglion cells. A temporal decrease in the thickness of the peripheral retina was observed in the 1st trimester.

CONCLUSIONS

Progesterone, but not estrogen or testosterone, activated glutamate release in the mouse retina. Increases in the concentration of progesterone during pregnancy did not induce any detectable change in retinal thickness.

The effect of pregnancy on meibomian gland, tear film, cornea and anterior segment parameters

AIM

In this prospective study, we aimed to examine the effect of physiological and pathological changes that occur during pregnancy in regard to Meibomian Gland (MG) structure, tear film, cornea and anterior segment parameters.

METHODS

The following groups were compared: 49 eyes of 49 pregnant women at 16-20 weeks of pregnancy (P16 Group), 46 eyes of 46 pregnant women at 32-36 weeks of pregnancy (P32 Group) and 51 eyes of 51 participants who were not pregnant (P0 Group). The groups were compared in terms of the first break-up time (NIF-BUT) and average break-up time (NIAvg-BUT) values. Non-contact meibography and MG loss rates were also compared.

RESULTS

The groups were found to be compatible in terms of age (P=0.052). The mean NIF-BUT values in the P16, P32 and P0 groups were 4.7 ±2.7, 6 ±3 and 6.7 ±3.1 seconds, respectively (P=0.055). The mean MG loss rates for the upper lid in the P16, P32 and P0 groups were 35.3%±12.6, 33.4%±11.4 and 15.5%±5.4, respectively. The loss rates for the lower lid in the P16, P32 and P0 groups were found to be 40.5%±18.6, 40.5%± 14.4 and 20.1%±8.1, respectively (P=0.000, p=0.000). The mean anterior chamber value (ACV) was found in the P16, P32 and P0 groups with 160.8 ±31.8, 150.9 ±26.5 and 165.9 ±26.5 µm³, respectively (P=0.035).

CONCLUSION

MG loss was found to be higher in pregnant groups compared to the non-pregnant groups. We found minimal instability in the tear film of the pregnant groups. We believe that pregnant women should be followed closely in terms of ocular surface diseases.

Ocular findings in central precocious puberty

PURPOSE

To evaluate ocular findings in central precocious puberty (PP).

METHODS

This prospective study included 38 children with PP and 34 healthy control children. All participants were evaluated in terms of refractive error, axial length (AL), and anterior segment parameters, including keratometry (K), corneal volume (CV), anterior chamber depth (ACD), anterior chamber volume (ACV), and iridocorneal angle (ICA). Central macular thickness (CMT), retinal nerve fiber layer (RNFL) thickness and central subfoveal choroidal thickness (ChT) were also analyzed. The correlation of these parameters with Tanner stage was also investigated in the PP group.

RESULTS

Compared with the control group, spherical refraction was less hyperopic (P = 0.017) and AL was significantly higher (P = 0.001) in the PP group. Spherical value and AL were significantly associated with the Tanner stage. None of the anterior segment parameters obtained by Pentacam was different in the PP group compared with controls. In PP cases, CMT and RNFL thicknesses in all sectors did not differ from controls. Subfoveal ChT was significantly higher in the PP group, regardless of Tanner stage (P < 0.001).

CONCLUSIONS

In our cohort of children with central PP, AL and ChT were higher than in children without PP.

Sex Steroid Hormone Analysis in Human Tear Fluid Using a Liquid Chromatography-Mass Spectrometry Method

The marked sexual dimorphism prevalent in inflammatory/autoimmune diseases is mostly due to sex hormone actions. One common eye disease that disproportionately affects women is dry eye. Thus, our aim was to optimise our highly sensitive liquid chromatography-tandem mass spectrometry method for steroid hormone quantification in tear fluid (TF). We used tears and matched serum samples from 10 heathy individuals. Estrone, estradiol testosterone, progesterone, androstenedione, and dehydroepiandrosterone, were quantified with an HPLC coupled with a Triple Quad 5500 MS. Estrone was measured in 80% of female and 20% of male TF samples (mean ± SD, 68.9 ± 62.2 pmol/L), whereas estradiol was undetectable in tears. Progesterone was identified in half of the female tear samples (2.91 ± 3.47 nmol/L) but in none of the male samples, whereas testosterone was quantifiable only in male tears (0.24 ± 0.1 nmol/L). TF hormone levels were, on average, from 1.4% to 55% of systemic values. Estrone, progesterone, and testosterone levels in tears correlated with the matching serum samples (r = 0.82, 0.79, and 0.85, respectively), but androstenedione and dehydroepiandrosterone showed no correlations. Our LC-MS/MS method could detect five out of the six steroid hormones studied in individual human TF samples and could therefore be used to analyse the role of sex steroids in eye diseases.

The Association of Female Reproductive Factors with Glaucoma and Related Traits: A Systematic Review

TOPIC

This systematic review summarizes evidence for associations between female reproductive factors (age at menarche, parity, oral contraceptive [OC] use, age at menopause, and postmenopausal hormone [PMH] use) and intraocular pressure (IOP) or open-angle glaucoma (OAG).

CLINICAL RELEVANCE

Understanding the associations between female reproductive factors and glaucoma may shed light on the disease pathogenesis and aid clinical prediction and personalized treatment strategies. Importantly, some factors are modifiable, which may lead to new therapies.

METHODS

Two reviewers independently extracted articles in MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials databases to identify relevant studies. Eligibility criteria included studies with human subjects aged > 18 years; a measured outcome of either IOP or OAG; a cohort, case-control, cross-sectional, or randomized controlled trial design; a reported measure of association, such as the hazard ratio, relative risk, odds ratio, or mean difference, with an associated confidence interval; and a measured exposure of at least 1 of the following variables: age at menarche, parity, OC use, age at menopause, or PMH use.

RESULTS

We included a total of 27 studies. Substantial differences in study designs, exposure and treatment levels, treatment durations, and variable reporting precluded a meaningful quantitative synthesis of the identified studies. Overall, relatively consistent associations between PMH use and a lower IOP were identified. Estrogen-only PMH use may be associated with lower OAG risk, which may be modified by race. No significant associations were found with combined estrogen-and-progesterone PMH use. No strong associations between parity or age at menarche and glaucoma were found, but a younger age at menopause was associated with an increased glaucoma risk, and adverse associations were identified with a longer duration of OC use, though no overall association with OC use was found.

CONCLUSIONS

The association between PMH use and lower IOP or OAG risk is a potentially clinically relevant and modifiable risk factor and should be investigated further, although this needs to be interpreted in the context of a high risk of bias across included studies. Future research should examine associations with IOP specifically and how the relationship between genetic factors and OAG risks may be influenced by female reproductive factors.

Differential distribution of steroid hormone signaling networks in the human choroid-retinal pigment epithelial complex

Background

The retinal pigment epithelium (RPE), a layer of pigmented cells that lies between the neurosensory retina and the underlying choroid, plays a critical role in maintaining the functional integrity of photoreceptor cells and in mediating communication between the neurosensory retina and choroid. Prior studies have demonstrated neurotrophic effects of select steroids that mitigate the development and progression of retinal degenerative diseases via an array of distinct mechanisms of action.

Methods

Here, we identified major steroid hormone signaling pathways and their key functional protein constituents controlling steroid hormone signaling, which are potentially involved in the mitigation or propagation of retinal degenerative processes, from human proteome datasets with respect to their relative abundances in the retinal periphery, macula, and fovea.

Results

Androgen, glucocorticoid, and progesterone signaling networks were identified and displayed differential distribution patterns within these three anatomically distinct regions of the choroid-retinal pigment epithelial complex. Classical and non-classical estrogen and mineralocorticoid receptors were not identified.

Conclusion

Identified differential distribution patterns suggest both selective susceptibility to chronic neurodegenerative disease processes, as well as potential substrates for drug target discovery and novel drug development focused on steroid signaling pathways in the choroid-RPE.

Differential response to topical lubrication in patient with dry eye disease, based on age

BACKGROUND

To compare the Ocular surface disease index (OSDI) score, Schirmer I test (SIT), fluorescein break up time (FBUT) and fluorescence staining (FLCS) score of dry eye patients at different ages.

METHODS

90 eyes of 90 patients with mild to moderate dry eye from September 2020 to September 2021 were retrospectively included and were divided into young group (20-39 years, n = 29), middle-age group (40-59 years, n = 30), and elder group (> 60 years, n = 31). Patients were given a 28-day topical lubricating ocular surface and repair-promoting drugs combined with local physical therapy. Patients were followed up at 7, 14 and 28 days. The OSDI score, SIT, FBUT and FLCS score were examined.

RESULTS

There were differences between the OSDI score in three groups at each time point (all P < 0.001). SIT were different among the three groups (F = 350.61, P < 0.001), and a time effect was found (F = 80.87, P < 0.001). SIT at 14 and 28 days after treatment in middle-age and elder groups were lower than young group (all P < 0.001). SIT at 7, 14 and 28 days in elder group were lower than middle-age group (all P < 0.001). FLCS score was lower at 28 days than other time points (all P < 0.001).

CONCLUSION

Dry eye patients are given a 28-day topical lubricating ocular surface and repair-promoting drugs combined with local physical therapy, which can promote tear secretion, film stability, and the recovery of corneal integrity. Age affects the treatment effect of mild to moderate dry eye, among which tear secretion is the most significant.

Sex-based differences in conjunctival goblet cell responses to pro-inflammatory and pro-resolving mediators

Many conjunctival inflammatory diseases differ between the sexes and altered conjunctival goblet cells (CGCs) response is often involved. Inflammation is initiated by the release of pro-inflammatory mediators and terminated by the biosynthesis of specialized pro-resolution mediators (SPMs). Herein, we determined the sex-based difference in the responses of CGCs to inflammatory stimuli or pro-resolving lipid SPMs and their interaction with sex hormones. GCs were cultured from pieces of human conjunctiva in RPMI media. CGCs were transferred 24 h before the start of experiments to phenol red-free and FBS-free media to minimize exogenous hormones. RT-PCR, immunofluorescence microscopy (IF), and Western Blot (WB) were performed to determine the presence of sex hormone receptors. Cellular response to pro-inflammatory stimuli or SPMs was studied by measuring the increase in intracellular [Ca²⁺] ([Ca²⁺]_i) using fura 2/AM microscopy. Use of RT-PCR demonstrated estrogen receptor (ER) α in 4/5 males and 3/3 females; ERβ in 2/4 males and 2/3 females; and androgen receptors (AR) in 3/3 male and 3/3 female CGCs. Positive immunoreactivity by IF and protein expression by WB was detected using antibodies for the ERα and ERβ in 3/3 males and 3/3 females, while AR were only present in males. Significantly different Ca²⁺ responses between sexes were found with carbachol only at 10^–3 M, but not with histamine or leukotriene (LT) B₄ at any concentration used. Incubation with dihydrotestosterone (DHT), estrone (E1), or estradiol (E2) at 10^–7 M for 30 min significantly inhibited the LTB₄-stimulated [Ca²⁺]_i increase in male and female CGCs. Incubation with DHT, E1, and E2 overnight significantly inhibited the LTB₄ response in females, while DHT and E2 significantly inhibited the LTB₄ response in males. The SPM lipoxin A₄ (LXA₄) (10^–9–10⁻⁸ M), but not the resolvins D1 or D2, induced an [Ca²⁺]_i increase that was significantly higher in males compared to females. We conclude that male and female CGCs showed differences in the expression of sex hormone receptors. Treatment with sex hormones altered pro-inflammatory mediator LTB₄-induced response. Males compared to females have a higher response to the ω-6-fatty acid derived SPM LXA₄, indicating males may terminate inflammation in conjunctival goblet cells faster than females.

Assessment of choroidal vascularity index during the menstrual cycle

PURPOSE

To explore the effect of menstrual cycle on choroidal vascularity index (CVI).

METHODS

Thirty six eyes of 36 healthy women were included in this prospective study. The menstrual cycles were regular and ranged from 28 to 30 days in length. Optical coherence tomography images were obtained in 3 different phases of the menstrual cycle. The choroidal thickness (CT), total choroidal area, luminal area, stromal area, and CVI were quantified.

RESULTS

Mean subfoveal, nasal and temporal CT were significantly changed in mid-luteal phase in comparison to early follicular (p = 0.018, p = 0.006 and p = 0.001, respectively) and ovulatory phases (p = 0.037, p = 0.037, and p = 0.035, respectively). Mean CVI showed a significant change in mid-luteal phase when compared with early follicular (p = 0.001) and ovulatory phases (p = 0.036).

CONCLUSION

CVI seemed to be affected in mid-luteal phase of menstrual cycle. This should be considered while analyzing choroidal structure in otherwise healthy women.

Sex Differences in Circadian Rhythms

Sex as a biological variable is the focus of much literature and has been emphasized by the National Institutes of Health, in part, to remedy a long history of male-dominated studies in preclinical and clinical research. We propose that time-of-day is also a crucial biological variable in biomedical research. In common with sex differences, time-of-day should be considered in analyses and reported to improve reproducibility of studies and to provide the appropriate context to the conclusions. Endogenous circadian rhythms are present in virtually all living organisms, including bacteria, plants, invertebrates, and vertebrates. Virtually all physiological and behavioral processes display daily fluctuations in optimal performance that are driven by these endogenous circadian clocks; importantly, many of those circadian rhythms also show sex differences. In this review, we describe some of the documented sex differences in circadian rhythms.

The effects of systemic aromatase inhibitors on meibomian glands and corneal structure

OBJECTIVES

To evaluate the ocular surface, meibomian glands and corneal structural changes using in vivo confocal microscopy (IVCM) in patients receiving aromatase inhibitor (AI) therapy due to the breast cancer.

METHODS

This prospective observational study included 13 patients undergoing AI therapy. The patients were evaluated before the treatment, at 3- and 6-month timepoints of AI therapy. To examine the ocular surface and tear film, corneal sensitivity (CS) measurement with Cochet-Bonnet Aesthesiometer, tear film break-up time (TBUT), lissamine green (LG) staining, Schirmer I test with anaesthesia (ST) and the ocular-surface disease index (OSDI) questionnaire were performed consecutively. Corneal cell densities and sub-basal nerve plexus were evaluated with IVCM (ConfoScan 4, Nidek, Japan). Finally, quantitative MG drop-out assessment was made using infrared meibography. Shapiro Wilk, Friedman's and Post-hoc Dunn tests were used for the statistical analysis.

RESULTS

TBUT, ST scores, basal epithelium, anterior and posterior keratocytes and endothelial cell densities, long and total sub-basal nerve densities were found to be decreased (p < 0.001, p = 0.023, p < 0.001, p = 0.01, p = 0.002, p = 0.004, p < 0.001, p < 0.001), and meiboscore, CS, OSDI scores and sub-basal nerve tortuosity values were increased (p < 0.001, p = 0.015, p = 0.001, p = 0.004) during the treatment. Endothelial pleomorphism rates were lower at the 3- and 6-month timepoints compared to before the treatment (p = 0.04).

CONCLUSION

This study showed that aromatase inhibitor therapy causes deteriorations in many of the ocular-surface parameters and corneal structural changes in relation with the duration of treatment. These patients should be observed during the therapy in terms of the ocular-surface side effects.

Menopause and the Risk of Developing Age-Related Macular Degeneration in Korean Women

Previous studies have shown that menopausal hormone therapy in postmenopausal women results in a higher prevalence of age-related macular degeneration. This study aimed to evaluate the effects of menopause and patient factors on the development of age-related macular degeneration in Korean women. Data between 2011 and 2014 were collected from the Korean National Health Insurance database. In this retrospective cohort study, 97,651 participants were premenopausal and 33,598 were menopausal. Participants were divided into menopausal and premenopausal groups to analyze the risk factors associated with the development of age-related macular degeneration. The prevalence of age-related macular degeneration was compared between the two groups. Other patient factors were also analyzed. Using a 1:1 propensity score matching method and adjusting for variables, the incidence of age-related macular degeneration was not significantly different between the two groups. Age and diabetes mellitus were associated with an increased risk of developing age-related macular degeneration, regardless of menopause. Menopause was not a risk factor for age-related macular degeneration. These findings may help physicians identify women with diabetes who are at a greater risk of developing age-related macular degeneration.

The Role of Estriol and Estrone in Keratoconic Stromal Sex Hormone Receptors

Keratoconus (KC) is a progressive corneal thinning disease that manifests in puberty and worsens during pregnancy. KC onset and progression are attributed to diverse factors that include: environmental, genetics, and hormonal imbalances; however, the pathobiology remains elusive. This study aims to determine the role of corneal stroma sex hormone receptors in KC and their interplay with estrone (E1) and estriol (E3) using our established 3D in vitro model. Healthy cornea stromal cells (HCFs) and KC cornea stromal cells (HKCs), both male and female, were stimulated with various concentrations of E1 and E3. Significant changes were observed between cell types, as well as between males and females in the sex hormone receptors tested; androgen receptor (AR), progesterone receptor (PR), estrogen receptor alpha (ERα), and estrogen receptor beta (ERβ) using Western blot analysis. E1 and E3 stimulations in HCF females showed AR, PR, and ERβ were significantly upregulated compared to HCF males. In contrast, ERα and ERβ had significantly higher expression in HKC's females than HKC's males. Our data suggest that the human cornea is a sex-dependent, hormone-responsive tissue that is significantly influenced by E1 and E3. Therefore, it is plausible that E1, E3, and sex hormone receptors are involved in the KC pathobiology, warranting further investigation.

Sex Hormones, Growth Hormone, and the Cornea

The growth and maintenance of nearly every tissue in the body is influenced by systemic hormones during embryonic development through puberty and into adulthood. Of the ~130 different hormones expressed in the human body, steroid hormones and peptide hormones are highly abundant in circulation and are known to regulate anabolic processes and wound healing in a tissue-dependent manner. Of interest, differential levels of sex hormones have been associated with ocular pathologies, including dry eye disease and keratoconus. In this review, we discuss key studies that have revealed a role for androgens and estrogens in the cornea with focus on ocular surface homeostasis, wound healing, and stromal thickness. We also review studies of human growth hormone and insulin growth factor-1 in influencing ocular growth and epithelial regeneration. While it is unclear if endogenous hormones contribute to differential corneal wound healing in common animal models, the abundance of evidence suggests that systemic hormone levels, as a function of age, should be considered as an experimental variable in studies of corneal health and disease.

Association Between Sex Hormones and Visual Field Progression in Women With Primary Open Angle Glaucoma: A Cross-Sectional and Prospective Cohort Study

Purpose: We evaluated the level of sex hormones in female patients with primary open angle glaucoma (POAG) to determine whether they are associated with the onset and/or progression of POAG.

Methods: The cross-sectional study enrolled 63 women with POAG and 56 healthy women as normal control subjects. Furthermore, 57 women with POAG were included and followed-up for at least 2 years in the cohort study. All subjects were evaluated for serum concentration of sex hormones [prolactin (PRL), luteinizing hormone (LH), testosterone (TESTO), follicle-stimulating hormone (FSH), progesterone (PROG), and estrogen (E2)] and underwent visual field (VF) examination. In the cross-sectional study, Spearman analysis, linear regression analysis, and logistic regression analysis were performed to assess risk factors for POAG in women. In the cohort study, Cox regression analyses and Kaplan–Meier survival analysis were performed to identify factors associated with VF progression in women with POAG.

Results: In the cross-sectional study, the level of E2 was significantly lower in the POAG group than in the normal group (p < 0.05). Multiple logistic regression showed that the decreased level of E2 was a risk factor of POAG (OR = 0.27, 95% CI = 0.09–0.78, p < 0.05), especially in premenopausal subjects. In the cohort study, there were 29 non-progression subjects and 28 progression subjects. Patients in the progression group had significantly lower levels of E2 than those in the no progression group (p < 0.01). The decreased level of E2 at baseline was associated with POAG progression (HR = 0.08, 95% CI = 0.02–0.46, p < 0.05), especially in premenopausal subjects. Patients with POAG and with lower baseline E2 levels had significantly lower VF non-progression rates than patients with higher E2 levels (log-rank test p < 0.001), especially premenopausal subjects (log-rank test p < 0.05). Additionally, logistic regression analyses, Cox regression analyses, and Kaplan–Meier survival analysis showed that PROG, LH, FSH, and TESTO were risk factors of POAG and/or significantly associated with POAG progression.

Conclusion: A decreased E2 level is a POAG risk factor and is associated with VF progression in women with POAG, especially in premenopausal subjects. Additionally, other sex hormones (PROG, LH, FSH, and TESTO) might also play a role in POAG pathogenesis.

Girl Power in Glaucoma: The Role of Estrogen in Primary Open Angle Glaucoma

Estrogen is essential in maintaining various physiological features in women, and a decline in estrogen levels are known to give rise to numerous unfortunate symptoms associated with menopause. To alleviate these symptoms hormone replacement therapy with estrogen is often used, and has been shown to be fruitful in improving quality of life in women suffering from postmenopausal discomforts. An often forgotten condition associated with menopause is the optic nerve disorder, glaucoma. Thus, estrogen may also have an impact in maintaining the retinal ganglion cells (RGCs), which make up the optic nerve, thereby preventing glaucomatous neurodegeneration. This review aims to provide an overview of possible associations of estrogen and the glaucoma subtype, primary open-angle glaucoma (POAG), by evaluating the current literature through a PubMed-based literature search. Multiple in vitro and in vivo studies of RGC protection, as well as clinical and epidemiological data concerning the well-defined retinal neurodegenerative disorder POAG have been reviewed. Over all, deficiencies in retinal estrogen may potentially instigate RGC loss, visual disability, and eventual blindness. Estrogen replacement therapy may therefore be a beneficial future treatment. However, more studies are needed to confirm the relevance of estrogen in glaucoma prevention.

Effects of hormone replacement therapy on lens opacity, serum inflammatory cytokines, and antioxidant levels

PURPOSE

To evaluate the effect of hormone replacement therapy (HRT) on lens opacity as measured by Scheimpflug densitometry, serum inflammatory cytokines, and antioxidant levels.

METHODS

A total of 264 women who were at least five years beyond menopause were included. The control group of 128 patients (Group 1) did not use HRT at any time after menopause. The treatment group of 136 patients (Group 2) used HRT for5 years or more after menopause. Cortical, nuclear, and posterior subcapsular density; pentacam nucleus staging (PNS); pentacam densitometry of zone (PDZ) as measured using a Scheimpflug imaging system (Pentacam); and antioxidant and inflammatory cytokines activities in serum using multiplex bead analysiswere examined.

RESULTS

Uncorrected visual acuity (logMAR) of group1 was significantly worse than those of group 2 (p < .05). Group1 was significantly more myopic than group 2 (p < .05). Nuclear and posterior subcapsular density, PNS, and percentage of PDZ in group 1 were significantly higher than those of group 2 (p < .05). The serum IL-1m. IL-6, IL-8, and TGF-, concentrations of group 1 were significantly higher than those of group 2, and the serum catalase, superoxide dismutase 1 (SOD 1), and superoxide dismutase 2 (SOD 2) fluorescence intensities of group 1 were significantly lower than those of group 2 (p < .05).

CONCLUSIONS

Long-term use of HRT may have a protective effect against cataract formation. HRT seems to be effective in decreasing inflammation and increasing antioxidant contents in the serum of postmenopausal women.KEY MESSAGESHormone replacement therapy (HRT) decrease lens opacity in postmenopausal women as measured by Scheimpflug densitometry.HRT decrease serum inflammatory cytokines and increase antioxidant levelsin the serum of postmenopausal women.Long-term use of HRT may have a protective effect against cataract formationin postmenopausal women.

Retrospective evaluation of the curative effect of traditional Chinese medicine on dry eye disease

Dry eye disease (DED) is a multifactorial illness with an increasingly high global prevalence and multiple risk factors that widely influences patients’ daily lives. It is essential to identify treatments with few or no side effects for patients with DED. We have reviewed studies published from 2001 to 2020 that investigated traditional Chinese medicine (TCM) and integrated Chinese and Western medicine for DED treatment. Current Chinese medicines used in DED therapy were categorized into four types, namely anti-oxidants, anti-inflammatory agents, hormone-like agents, and cell-repairing agents. Compound herbs, including Chi-Ju-Di-Huang-Wan and Qiming granule, can effectively alleviate dry eye symptoms. Moreover, patients with DED who were treated with Western medicine combined with TCM experienced significantly magnified therapeutic effects and reasonable costs of treatment. In conclusion, TCM can be a promising approach for treating DED, and combined treatment with TCM and Western drugs may represent a new strategy for improving the curative effect.

Anterior pituitary, sex hormones, and keratoconus: Beyond traditional targets

"The Diseases of the Horny-coat of The Eye", known today as keratoconus, is a progressive, multifactorial, non-inflammatory ectatic corneal disorder that is characterized by steepening (bulging) and thinning of the cornea, irregular astigmatism, myopia, and scarring that can cause devastating vision loss. The significant socioeconomic impact of the disease is immeasurable, as patients with keratoconus can have difficulties securing certain jobs or even joining the military. Despite the introduction of corneal crosslinking and improvements in scleral contact lens designs, corneal transplants remain the main surgical intervention for treating keratoconus refractory to medical therapy and visual rehabilitation. To-date, the etiology and pathogenesis of keratoconus remains unclear. Research studies have increased exponentially over the years, highlighting the clinical significance and international interest in this disease. Hormonal imbalances have been linked to keratoconus, both clinically and experimentally, with both sexes affected. However, it is unclear how (molecular/cellular signaling) or when (age/disease stage(s)) those hormones affect the keratoconic cornea. Previous studies have categorized the human cornea as an extragonadal tissue, showing modulation of the gonadotropins, specifically luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Studies herein provide new data (both in vitro and in vivo) to further delineate the role of hormones/gonadotropins in the keratoconus pathobiology, and propose the existence of a new axis named the Hypothalamic-Pituitary-Adrenal-Corneal (HPAC) axis.

Anti-inflammatory and neuroprotective properties of the corticosteroid fludrocortisone in retinal degeneration

The pathogenesis of outer retinal degenerations has been linked to the elevation of cytokines that orchestrate pro-inflammatory responses within the retinal milieu, and which are thought to play a role in diseases such as geographic atrophy (GA), an advanced form of AMD. Here we sought investigate the anti-inflammatory and mechanistic properties of fludrocortisone (FA), as well as triamcinolone acetonide (TA), on Müller cell-mediated cytokine expression in response to inflammatory challenge. In addition, we investigated the neuroprotective efficacy of FA and TA in a photo-oxidative damage (PD), a model of outer retinal degeneration. Expression of CCL2, IL-6, and IL-8 with respect to FA and TA were assessed in Müller cells in vitro, following simulation with IL-1β or TNF-α. The dependency of this effect on mineralocorticoid and glucocorticoid signaling was also interrogated for both TA and TA via co-incubation with steroid receptor antagonists. For the PD model, C57BL/6 mice were intravitreally injected with FA or TA, and changes in retinal pathology were assessed via electroretinogram (ERG) and optical coherence tomography (OCT). FA and TA were found to dramatically reduce the expression of CCL2, IL-6, and IL-8 in Müller glia in vitro after inflammatory challenge with IL-1β or TNF-α (P < 0.05). Though FA acts as both a mineralocorticoid and glucocorticoid receptor agonist, co-incubation with selective steroid antagonists revealed that the suppressive effect of FA on CCL2, IL-6, and IL-8 expression is mediated by glucocorticoid signaling (P < 0.05). In PD, intravitreal FA was found to ameliorate outer-retinal atrophy as measured by ERG and OCT (P < 0.05), while TA had no significant effect (P > 0.05). Our data indicate potent anti-inflammatory and mechanistic properties of corticosteroids, specifically FA, in suppressing inflammation and neurodegeneration degeneration associated with outer retinal atrophy. Taken together, our findings indicate that corticosteroids such as FA may have value as a potential therapeutic for outer retinal degenerations where such pro-inflammatory factors are implicated, including AMD.

The thickness changes of retina in high myopia patients during the third trimester of pregnancy: a pilot study

Objectives

To observe and compare the difference in retinal thickness using optical coherence tomography (OCT) between patients with high myopia (HM) during the third trimester of pregnancy and age-matched HM non-pregnant women.

Methods

A case-control study. A total of 39 eyes from 39 HM women in the third trimester (study group) and 50 eyes of 50 age-matched non-pregnant women with HM (control group) were included. All subjects underwent SD-OCT examination. The built-in software was used to measure the retinal thickness in macular region. The data from two groups were compared using independent-samples t test.

Results

Among the 89 subjects in this study, the mean gestational age of the study group was 35.09 ± 2.44 weeks, and the average age was 32.24 ± 3.75 years. The average age of the control group was 34.04 ± 7.19 years old. Compared with the control group, the average thickness of parafoveal area, and the average thickness of parafoveal superior, inferior, temporal quadrants of the superficial retina and the average thickness of the foveal and parafoveal of the superficial retina were significantly decreased in the study group (P < 0.05). Compared with the control group, the average thickness of all quadrants of the retina in the parafoveal area except the nasal quadrant were significantly decreased in the study group (P < 0.05).

Conclusions

In this observational study, the retinal thickness of patients with high myopia during the third trimester of pregnancy was thinner than that of non-pregnant women with age-matched high myopia.

Review of the Literature on Ocular Complications Associated With Aromatase Inhibitor Use

Aromatase inhibitors (AIs), such as anastrozole, letrozole, and exemestane, are commonly used as adjuvant endocrine therapy in hormone-receptive breast cancer in postmenopausal women. Their adverse effects are well documented, except for visual disturbances. The purpose of this study was to review the current literature on ocular disease linked to AI use. Due to the scarcity of published data, any suggested ophthalmic adverse events were included to increase awareness of these drugs. The ocular side effects of tamoxifen use are well documented and were not included. Cases of rare side effects such as papilloedema, macular oedema, and uveitis associated with anastrozole and letrozole have been reported. Studies demonstrating retinopathy, in the form of crystalline retinopathy, hemicentral retinal artery occlusion, and retinal haemorrhages, are also noted. All three third-generation AIs can also lead to ocular surface diseases such as corneal epithelial changes, blepharitis, and keratitis. There is slightly more literature available regarding anastrozole-related ocular diseases. Although these are likely rare side effects, we recommend a high level of clinical suspicion when assessing patients with visual symptoms and on AIs. Larger prospective studies are necessary to further investigate these complications.