Impact of Hormone Therapy on Ocular Disease Risk in Postmenopausal Women: Evidence from the Korean National Health Insurance Service Database

Abstract

Objectives: This study aimed to evaluate the relationship between menopausal hormone therapy (MHT) and the development of major ocular diseases, including cataract, glaucoma, and retinal disorders. Methods: This retrospective cohort study used data from the Korean National Health Insurance Service database (2005–2015) comprising 23,333 women diagnosed with menopause, International Classification of Diseases, 10th Revision code N95. Participants were categorized into MHT and non-MHT groups. Incidence rate ratios (IRRs) of ophthalmologic diseases were analyzed, with subgroup analyses by age at menopause, time to MHT initiation, and duration of therapy. Results: A total of 18,228 women were included. The MHT group had a significantly lower incidence of glaucoma than the non-MHT group (IRR 0.921, 95% confidence interval [CI] [0.869, 0.975]). The protective effect was most evident in women who experienced menopause at 40–49 years (IRR 0.851, 95% CI [0.762, 0.951]). Initiating MHT within 1 year of menopause was linked to a reduced glaucoma risk (IRR 0.896, 95% CI [0.844, 0.951]), while delayed initiation increased the risk (IRR 1.161, 95% CI [1.024, 1.316]). MHT use for ≥ 365 days was associated with lower risks of glaucoma (IRR 0.888, 95% CI [0.816, 0.967]) and retinal disorders (IRR 0.886, 95% CI [0.789, 0.995]) compared to shorter use. Conclusions: MHT use is associated with reduced glaucoma risk in postmenopausal women, especially those aged 40–49 years. These findings highlight the potential ocular benefits of MHT and the importance of early initiation in younger menopausal women.