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Postmenopausal Estrogen Use, Type of Menopause, and Lens Opacities
The Framingham Studies
Katherine Worzala, MD, MPH;
Rita Hiller, MS;
Robert D. Sperduto, MD;
Karen Mutalik, BS;
Joanne M. Murabito, MD, MPH;
Mark Moskowitz, MD, MPH;
Ralph B. D'Agostino, PhD;
Peter W. F. Wilson, MD
Arch Intern Med. 2001;161:1448-1454.
Background Previous studies of estrogen replacement therapy and lens opacities
have not reported consistent findings.
Objective To investigate whether postmenopausal estrogen use is associated with
the occurrence of age-related lens opacities (nuclear, cortical, and posterior
subcapsular).
Methods Surviving members of the original cohort of the Framingham Heart Study
who also participated in the Framingham Eye Study (1986-1989) were examined
for the absence or presence of lens opacities. Data from the Framingham Heart
Study, including information on menopausal status (collected biennially from
approximately 1948) and use of estrogen replacement therapy (collected biennially
from approximately 1960) were used to examine associations between lens opacities
and duration of postmenopausal estrogen use, type of menopause, and age at
menopause. Five hundred twenty-nine women, aged 66 to 93 years, were included.
Multivariable-adjusted odds ratios of specific types of lens opacities were
calculated for (1) duration of estrogen use (never and 1-2, 3-9, and  10
years), (2) surgical vs natural menopause, and (3) age at menopause.
Results Longer duration of postmenopausal estrogen therapy was inversely associated
with the presence of nuclear lens opacities in an adjusted model. Women who
had taken estrogen for 10 years or longer had a 60% reduction in risk compared
with nonusers (odds ratio, 0.4; 95% confidence interval, 0.2-1.01). Longer
duration of estrogen use was associated with fewer posterior subcapsular opacities
at a borderline level of significance. No association was noted for cortical
opacities. The risk of posterior subcapsular opacities was significantly increased
for women who had undergone surgical menopause compared with women with natural
menopause (odds ratio, 2.2; 95% confidence interval, 1.1-4.3). No association
was noted for lens opacities and age at menopause.
Conclusion Data from our study and other studies suggest that a reduction in the
risk of lens opacities may be an additional benefit of postmenopausal estrogen
use.
From the Section of General Internal Medicine, University of Minnesota
School of Medicine, Minneapolis Veterans Affairs Medical Center, Minneapolis
(Dr Worzala); Division of Epidemiology and Clinical Research, National Eye
Institute, Bethesda, Md (Ms Hiller and Dr Sperduto); National Heart, Lung,
and Blood Institute, Framingham, Mass (Ms Mutalik and Drs Murabito and Wilson);
Sections of General Internal Medicine (Drs Murabito and Moskowitz) and Endocrinology
(Dr Wilson), Boston University School of Medicine, Boston, Mass; and Department
of Mathematics and Statistics, Boston University (Dr D'Agostino).
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