Aging female patients present new clinical challenges and opportunities has a role in detecting of the eye – and the rest of the body

Howard Larkin weight of babies, age of onset of ■ Use of hormone replacement “Ocular suggests McDonald MD, clinical professor in Chicago menopause and the use of therapy – oestrogen may play a risk for a wide range of of ophthalmology at Tulane hormone replacement therapy role in perfusion of the optic conditions,” she stressed. University, New Orleans. AS the French say:“Vive la have also been shown to be nerve, putting patients “LASIK causes dry eye, but the Différence.” significant predictors for receiving HRT at higher risk. Ocular signs of neurological outcomes are much worse if you Yet, as obvious as are the and other eye diseases, go in with dry eye.” ■ biological differences between she points out. Birth weights of babies – Often, older patients experience Dr McDonald theorises that female and male, until recently In addition, diseases such as women who have delivered vague visual distortions and post-LASIK dry eye may result they were often, even (RA), which high birth-weight babies, those other visual impairments that from severing corneal nerve systematically, ignored in medical are more common among over 3.6 kg, are at higher risk may be early signs of endings when the flap is cut, and research. For example, from 1977 women, may present as for diabetes and may be at neurological disease, Dr Gordon destroying nerve bases during to 1986 women of childbearing ophthalmic complaints, says Janine higher risk for the progression notes. ablation. Dr McDonald’s research age were actually banned from A. Smith, MD Deputy Clinical of glaucoma. “Don’t assume it is because of suggests that conductive Phase 1 clinical trials in the Director of the National Eye a or mild AMD.Ask if it keratoplasty may be a better United States. Institute in Bethesda, Maryland, In addition, female sex by itself option for treating hyperopia and is a significant factor in the could be a subtle double vision, “Men and women were seen to US. an , or a visual . LASEK may be better be biologically equivalent,” says “Perforation, corneal progression of low-tension for treating because it glaucoma, Dr Higginbotham says. perceptual problem secondary to Eve J. Higginbotham MD, involvement, , glaucoma, a greater neurological problem.” eliminates damage induced by professor and chair at the disease and detached cutting a flap, Dr McDonald says. Ocular inflammation and Sudden or transient loss of Department of Ophthalmology, are complications that can vision could be a sign of a University of Maryland School of result from RA.They require systemic autoimmune disease transient ischemic attack. Medicine Baltimore, addressing a systemic immune therapy to Identifying and promptly treating “We must study session at the annual meeting of treat.” Inflammatory conditions such as TIA is key to preventing strokes, the American Academy of Visual disturbances may also be , episcleritis, nodular which are the third leading cause sex at the cellular Ophthalmology dedicated to early signs of broader episcleritis and , and of mortality among women, and women’s health issues. neurological problems, including peripheral ulcerative are the risk increases with age. level. We have a not only more common in Nonetheless, about 1/3 of “Perforation, corneal involvement, women, they may be signs of an patients with TIA symptoms are long way to go in underlying rheumatoid arthritis not referred for neurological cataracts, glaucoma, optic nerve or other systemic condition, Dr testing, Dr Gordon says. our commitment Smith says. If so, systemic Alzheimer’s disease, HIV- disease and detached retina are autoimmune treatment is related dementia and other to discover when required. She recommends degenerative neurological complications that can result from RA. looking for the following: conditions may present as visual our differences disturbances resulting from a They require systemic immune ■ Scleritis with severe pain – loss of the ability to manipulate make a while pain and tenderness are visual information. Other therapy to treat.” hallmarks of scleritis, RA- symptoms of dementia include difference.” related scleritis tends to be memory loss, language more severe and painful. deterioration, poor judgment, That’s a problem because it just degenerative, cerebrovascular, restlessness and mood swings. These comments reflect just ■ Dry eye and mouth – may be isn’t true. Childbearing, hormone inflammatory and neoplastic The incidence of dementia is how far ophthalmology has come caused by Sjogren’s syndrome, changes and other unique disease. Early diagnosis is critical increasing, with the risk of in recognising and an autoimmune disorder that features of female biology have to reduce morbidity and Alzheimer’s doubling every five accommodating the needs of attacks the lachrymal and profound medical implications for mortality.As age increases, the years past age 65, Gordon says. females, particularly aging saliva glands. Sjogren’s may also everything from disease rates to risk of all these conditions rises, Double vision could indicate women. However, much remains appear in conjunction with RA pathology progression to emphasised Lynn K. Gordon MD, neoplastic brain cancers. to be discovered about how or other autoimmune treatment response.And since PhD, assistant professor of Impaired vision, visual female biology affects the eye, Dr disorders. women on average live longer ophthalmology at the University hallucinations and difficulty Higginbotham says. than men, as the population ages of California at Los Angeles “We must study sex at the ■ reading can also be associated it also becomes increasingly School of Medicine. Presence of arthritis – arthritis cellular level.We have a long way in conjunction with with neurological problems, Dr female. Dry eye is also more prevalent Gordon notes. to go in our commitment to The bottom line: understanding in older women than men, with inflammation of the eye and discover when our differences surrounding tissues could “, HIV, and how female biology affects the implications for treatment of the vasculitis are all very important make a difference.” eyes is increasingly important for disease itself and for choosing indicate RA or even Wegener's granulomatosis. and their prevalence increases ophthalmologists to effectively refractive surgery techniques, she with age.” Eve J Higginbotham MD notes. [email protected] treat patients. It can help ■ Uveitis – may be associated physicians detect, diagnose and with a variety of autoimmune Dry eye and refractive Janine Smith, MD Taking the older female [email protected] treat not only eye diseases, but diseases including HLA-B surgery also systemic diseases that patient history related arthritis, even though Dry eye is about three times Marguerite McDonald present with visual symptoms. Many female-specific risk factors this condition is more more common in women than [email protected] Even though the study of for can be identified common in men. men and its incidence increases female ophthalmology was while taking the patient history, at menopause. Refractive delayed by wrong-headed Dr Higginbotham says. She Systemic erythematosus surgeons operating on women research assumptions in the past, suggests exploring the following and sarcoidosis are also now over the age of 40 should also be much valuable research has been questions: being seen in older women, aware that LASIK surgery can done, Dr Higginbotham told the though both are more commonly provoke dry-eye, and it is much session. ■ Age of onset of menopause – seen in younger populations, Dr more likely to last longer in Nuclear and cortical cataracts women who undergo Smith says. older women already prone to and vascular AMD are more menopause before age 45 are the condition, says Marguerite common in women.The birth at higher risk for glaucoma.

EuroTimes March 2006