Shariffudin, Nor Syahira
(2021)
Evaluation of macula and retinal nerve fiber layer thickness in postmenopausal women with hormone replacement therapy.
Masters thesis, Universiti Sains Malaysia.
Abstract
Introduction
Menopause is a state of natural ovarian senescence with accompanying estrogen deficiency. It
is associated with various systemic manifestations due to estrogen deficiency including
vasomotor, genitourinary, sleep disturbance and others. Besides, menopause is also associated
with ocular changes. Declination of estrogen causing impaired ocular blood flow as estrogen
have the ability to influence the vascular tone and blood flow in organs and tissues; the impaired
ocular blood flow is contributing factor in aetiology and progression of glaucoma and age
related macular degeneration (ARMD). Hormone therapy is used as the most effective
treatment for menopausal symptoms because it reduces the frequency and discomfort causing
by declination of estrogen in the body. In the meantime, it also has the advantages towards eyes
structures itself.
Objective
To evaluate macula and retinal nerve fiber layer thickness in postmenopausal women with and
without oral hormone replacement therapy (HRT) and to correlate between duration of oral
HRT treatment and macula and RNFL thickness.
Methods
This is a cross sectional study conducted at Hospital Universiti Sains Malaysia and Hospital
Raja Perempuan Zainab II between July 2019 until November 2020. A total of 100 menopause
women who fulfilled selection criteria were selected using non-probability sampling method.
They were divided into two groups: Group 1: postmenopausal women with oral HRT treatment and Group 2: postmenopausal women without HRT treatment. The macula and retinal nerve
fiber layer thickness were taken using Hiedelberg Spectralis OCT machine for both groups by
blinded trained personnel. The participants came only once during the study period. Statistical
analysis was performed using SPSS version 26.0.
Results
There were no significant mean differences of mean macula thickness between postmenopausal
women with and without oral HRT except for superior outer macula (p=0.042) and temporal
outer macula (p=0.007). Meanwhile, for RNFL thickness, there were no significant mean
differences of mean RNFL thickness between postmenopausal women with and without oral
HRT except for total temporal (p=0.044), temporal superior (p=0.002) and temporal inferior
(p=0.033). There was no significant correlation between macular thickness and RNFL
thickness with duration of oral HRT treatment (all p>0.050).
Conclusion
HRT usage demonstrated positive structural changes on the macula thickness (specifically on
superior outer macula and temporal outer macula) and RNFL thickness (over the temporal,
temporal superior and temporal inferior). Hence, the usage of HRT is benefited to the ocular
structures of postmenopausal women.
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