Hormone Replacement Therapy and Retinal Disease

Hormone replacement therapy (HRT) is used in a variety of systemic disorders including menopause, pituitary disease and thyroid dysfunction. In select cases, this may affect the retina and in some instances may lead to potentially blinding complications.  Here we review the more common forms of HRT and how you need to counsel and monitor your patients receiving these treatments.

Estrogen and Progesterone Replacement Therapy

Estrogen and Progesterone are produced by the ovaries and their levels fall in midlife leading to menopause (absence of menses).  Replacing these hormones in menopausal women can reduce osteoporosis, hot flashes, mood swings, and the risk of colon cancer and can increase sex drive.  Complications of HRT include blood clots, strokes, and an increased risk of endometrial, ovarian and breast cancers.  If a patient presents with transient blurred vision prompt evaluation of retinal vessel caliber for evidence of venous stasis or a frank vein occlusion is in order.  In the setting of a vein occlusion, the hormones should be discontinues and an anti-platelet medication such as aspirin started.  In mild cases, the retinal occlusions will resolve with observation and topical anti-inflammatory agents that help reduce macular edema.  For more severe cases, reversal of vascular occlusion with anti-VEGF injections (Avastin, Macugen and Lucentis) is usually effective.  Close monitoring and repeat injections may be required.

Cortisol Replacement Therapy

Cortisol is produced by the adrenal glands and cortisol insufficiency may be the result of damage to the adrenal glands or the pituitary glad which control s the adrenals.  Cortisol inefficiency is life threatening and may lead to death.  Cortisol replacement therapy (CRT) requires treatment with glucocorticoids which can cause a variety of ocular problems including cataract, glaucoma and central serous retinopathy.  Some patients have developed chronic CSR and blindness as a result.  In patients with blurred vision receiving CRT macular elevation from sub-retinal fluid secondary to CSR may be the case.  Treatment is reduction in steroid consumption and for more chronic cases intravitreal anti-VEGF therapy and/or photodynamic therapy may be effective.  NSAID drops can stimulate fluid transport across the RPE and may facilitate resolution of the CSR as well.

Growth Hormone

Human growth hormone is produced by the pituitary gland and regulates growth and cell division.  It is used to treat growth disorders in children and for replacement of pituitary deificiances in adults.  More recently, it is used as an anti-aging treatment increasing bone mass, reducing body fat and improving skin tone and energy levels.  AS a stimulator of cellular growth there are reports of proliferative retinopathy in non-diabetic patients.  Treatment is reduction in the hormone supplementation and possible treatment of macular edema and proliferative retinal neovascularization by conventional means. 

Hormone replacement therapy can cause complex effects on retinal function and patients require close monitoring by the eye doctor.  If you note changes in vision loss or retina appearance, prompt referrals warranted to reduce the risk of long term permanent vision loss. 

Ron P. Gallemore, M.D, Ph.D.

Founder and Director

Retina Macula Institute and the

Retina Macula Research Center

South Bay 310-944-9393

Los Angeles 310-466-9393