The Effect of Hormone Therapy on the Ocular Surface and Intraocular Pressure for Postmenopausal Women

The effect of hormone therapy on the ocular surface and intraocular pressure for postmenopausal women

A systematic review and meta-analysis of randomized controlled trials


The aim of the study was to investigate the impact of hormone therapy (HT)
on the ocular surface and intraocular pressure in postmenopausal women.


This systematic review and meta-analysis was conducted according
to the Preferred Reporting Items for Systematic Reviews and Metaanalyses Statement. PubMed, EMBASE, Cochrane Library of Systematic
Reviews, Cochrane Central Register of Controlled Trials,,
Chinese Biomedical Literature Database, and China National Knowledge
Infrastructure were searched from inception to November 2019 without
language restrictions. Only randomized controlled trials that evaluated
the impact of HT on the ocular surface and intraocular pressure in
postmenopausal women were eligible. The trials had to report at least one
of the following outcomes: break-up time, Schirmer test, corneal staining,
ocular surface symptom score, and intraocular pressure. Two investigators
independently extracted the information, assessed the risk of bias, and
evaluated the publication bias. All data were analyzed by Review Manager
V.5.3. Sensitivity analysis and subgroup analysis were performed to find
the source of heterogeneity and evaluate the different effects among


Nine randomized controlled trials (N = 612) were included. The HT group
showed significant improvements compared with the control group in
break-up time (mean difference [MD] = 2.09, 95% confidence interval [CI]
1.00-3.19, P = 0.0002), Schirmer test without anesthesia (MD = 4.17, 95%
CI 1.55-6.80, P = 0.002), Schirmer test with anesthesia (MD = 1.44, 95%
CI 0.71-2.18, P = 0.0001), and corneal staining scores (standardized mean
difference [SMD] = −0.85, 95% CI −1.39 to −0.30, P = 0.002). Moreover,
significant beneficial effects were observed on all four symptoms, including
dryness (SMD = −1.21, 95% CI −1.99 to −0.44, P = 0.002), foreign body
sensation (SMD = −1.02, 95% CI −1.29 to −0.76, P < 0.00001), ocular fatigue
(SMD = −1.74, 95% CI −2.12 to −1.36, P < 0.00001), and burning (SMD
= −0.53, 95% CI −0.78 to −0.29, P < 0.0001) after HT. Subgroup analysis
revealed that, in terms of break-up time, postmenopausal women younger
than 55 years achieved more improvements (MD = 0.88, 95% CI 0.16-1.59,
P = 0.02) than women older than 55 years old (MD = 2.60, 95% CI −1.34
to 6.55, P = 0.20), and the estrogen subgroup received more benefits (MD
= 3.11, 95% CI 0.93-5.30, P = 0.005) than the estrogen plus progestogen
subgroup (MD = 0.42, 95% CI −0.02 to 0.85, P = 0.06). Sensitivity analysis
and subgroup analysis suggested that the heterogeneity might derive from
the methodological quality, the age of participants, and the intervention of
the control group. Intraocular pressure (MD = −1.54, 95% CI −3.39 to 0.32,
P = 0.10) was not evidently decreased after HT. No more specific adverse
events (relative risk = 1.66, 95% CI 0.41-6.77, P = 0.48) were found in the
HT group.


Our study revealed that HT could improve ocular surface function in
postmenopausal women effectively and safely, especially for those who
were younger than 55 years, and estrogen-only showed more improvements
than estrogen plus progestogen. The effectiveness of HT in treating dry
eye in postmenopausal women is, however, still a controversial topic. In
addition, we did not find HT led to a significant reduction of intraocular


1 Department of Ophthalmology, Peking University Third Hospital, Beijing, China
2 Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China.
Address correspondence to: Li Xuemin, MD, Department of Ophthalmology, Peking University Third Hospital, No 49 Huayuan North Road, Haidian District, Beijing 100191, People’s Republic of China. 

Received 24 December, 2019
Revised 9 March, 2020
Accepted 9 March, 2020
Y.H. and J.X. contributed equally as first authors.

This abstract was presented in the 24th Congress of Chinese Ophthalmological Society.

This project was supported by National Science and Technology Major Project (numbers 2018ZX10101004) from Ministry of Science and Technology of the People’s Republic of China.

The sponsor of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
Financial disclosure/conflicts of interest: None reported.

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Menopause: June 08, 2020 – Volume Publish Ahead of Print – Issue – doi: 10.1097/GME.0000000000001559


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