Glaucoma and Gender: Decoding the Hormone Connection
"Unveiling the role of sex hormones in ocular blood flow and intraocular pressure for targeted glaucoma prevention."
Primary open-angle glaucoma (POAG) is a complex condition characterized by progressive damage to the optic nerve and vision loss. While elevated intraocular pressure (IOP) is a well-known risk factor, it doesn't fully explain why some individuals develop or progress with glaucoma. Recent research suggests that gender and sex hormones play a significant role in the development and progression of glaucoma. This is due to their influence on factors beyond just IOP, including ocular blood flow and neuroprotection.
Certain demographics and pre-existing health conditions are already known to influence glaucoma risk. But physiological differences between men and women—specifically, the variable effects of sex hormones—may explain some of the discrepancies in who develops POAG and how it progresses. Understanding these hormonal influences could pave the way for more targeted preventative and therapeutic strategies.
This article will explore the emerging link between sex hormones, IOP, and ocular blood flow in POAG. By reviewing the latest findings, we aim to clarify how hormones like estrogen and testosterone may influence glaucoma risk and progression, paving the way for more personalized approaches to prevention and treatment.
Estrogen Exposure and Glaucoma Risk
Epidemiologic studies have examined possible links between estrogen-associated reproductive factors and glaucoma. Earlier menopause and later menarche—both used as surrogate measures of lower lifetime estrogen exposure—have been associated with glaucoma. A study presented at AAO 2024 analyzed sex hormones and glaucoma susceptibility using data from 94 million patients between 2006 and 2024; its report described hormone replacement therapy and long-term estrogen use as potential protective factors. These findings concern potential associations and do not establish that estrogen therapy prevents glaucoma.
Estrogen Signaling: Evidence and Uncertainty
Glaucoma is described as a complex disorder involving retinal ganglion cell loss and optic nerve degeneration, and a meta-analysis has evaluated associations between estrogen-signaling pathways and open-angle glaucoma. A 2023 review reports that some studies found inverse correlations between estrogen levels and glaucoma risk, while variants in estrogen-signaling genes have also been associated with glaucoma. Together, these findings suggest estrogen dysregulation may contribute to disease processes and that estrogen signaling may have a protective role. However, oral contraceptives differ from endogenous estrogen, and research on oral estrogen and glaucoma has reported inconsistent findings, including reduced risk, no significant association, or slightly increased risk.
Sex Differences in Glaucoma: More Than Meets the Eye
The prevalence of POAG appears to differ between men and women, although the data isn't entirely consistent. Some studies indicate a higher prevalence in women, while a large meta-analysis suggests men are more likely to develop POAG. Other research points to age-related differences, with men having higher incidence rates in earlier decades, but rates converging in later life.
- Structural Differences: Men tend to have thicker corneas, while women have more steeply curved corneas. While corneal thickness can affect IOP measurements, the direct link between these anatomical differences and POAG remains unclear.
- Ocular Blood Flow: Studies using Laser Speckle Flowgraphy have revealed differences in ocular blood flow between sexes. Females often exhibit higher blood flow velocity in the optic nerve head, while men may maintain blood flow at a high level for longer periods between heartbeats.
Recent Reviews and Measurement Findings
A 2026 comprehensive review examines medical, laser, and surgical management of glaucoma or ocular hypertension during pregnancy, including outcomes related to intraocular pressure, optic nerve evaluation, and visual fields. A 2025 systematic review and meta-analysis of estrogen and progesterone therapy and intraocular pressure reported high heterogeneity across studies (I² = 97%), likely reflecting differences in hormone types, doses, and treatment durations. Another 2025 study reported that the association between male gender and greater retinal nerve fiber layer loss was not statistically significant, with p-values from 0.054 to 0.105. A 2025 review also surveys how estrogens and androgens relate to ocular function, glaucoma incidence, and intraocular pressure.
A Possible Benefit With an Important Gap
A review discussing estrogen and primary open-angle glaucoma notes that estrogen therapy is often used to alleviate postmenopausal discomfort and can improve quality of life for women experiencing those symptoms. It also points to glaucoma as an often-forgotten condition associated with menopause. The excerpt does not establish that hormone replacement therapy prevents glaucoma or quantify its effect on glaucoma risk, so it supports awareness of the possible connection rather than a firm treatment conclusion.
Pressure Targets and Low-Pressure Glaucoma
One source describes a reduction of 20% from initial intraocular pressure, or a decrease to below 18 mmHg in advanced glaucoma, as a recognized strategy for reaching target pressure. A separate report found low-pressure glaucoma in 33 of 150 patients with primary open-angle glaucoma (22%), with a mean age of 56 ± 9.21 years. These figures illustrate that glaucoma can be discussed in relation both to pressure-reduction targets and to cases occurring below normal intraocular pressure. The sources address different measures and do not provide a direct comparison of treatment outcomes.
Looking Ahead: Personalized Glaucoma Care
The current research strongly suggests that estrogen plays a protective role by increasing ocular blood flow, lowering IOP, and offering neuroprotection. The role of testosterone is less clear and requires further investigation to clarify seemingly contradictory findings.
Hormone Therapy Findings Need Careful Interpretation
A report dated June 23, 2026, states that postmenopausal hormone therapy use was associated with a modest but measurable increase in glaucoma risk, regardless of formulation. It reports that the trend also appeared in subgroup analysis, particularly for primary open-angle glaucoma, where estrogen-only therapy remained significantly associated with increased risk. This finding contrasts with reports elsewhere of possible protective associations, underscoring that the relationship between hormone therapy and glaucoma is not settled by a single study.
Menopause, Estrogen, and POAG
A 2020 review focuses on possible associations between estrogen and primary open-angle glaucoma (POAG). It evaluates the existing literature using a PubMed-based literature search. The review frames estrogen and POAG as a possible connection for examination, rather than establishing a definitive causal relationship.
As we move toward more individualized approaches to medical care, further research into the impact of sex hormones on glaucoma risk is essential. This includes understanding how hormone levels influence ocular blood flow and IOP, and developing targeted preventative and therapeutic strategies based on gender and hormonal status.
Ultimately, a deeper understanding of these hormonal influences in the context of POAG will improve risk assessments, allow for more personalized management plans, and contribute to better patient outcomes in the fight against glaucoma.