Research is also providing a clearer understanding of how menopause affects eye health. Sex hormone receptors have been found in various parts of the eye, and while the exact functions of estrogen and androgen receptors in these areas are still being studied, evidence suggests that sex hormones play a role in maintaining equilibrium in the eye — so hormonal changes in menopause are bound to have an impact.

It’s a bit tricky because aging in general causes eyesight to deteriorate. Is a patient’s condition due to menopause or simply natural ocular aging? Staying up to date on the potential effects of menopause is the first step in providing better care to patients in this transitional time.

A proactive approach, with regular eye exams and open communication about symptoms is the best way to go. Here’s a quick rundown of the latest findings and practical protocols for managing menopause-related eye changes.

Tackling Dry Eyes

The hormonal changes during menopause, especially the drop in estrogen, are major drivers of dry eye syndrome, one of the most common eye problems during this time. Recent studies show that menopausal women often struggle with visual discomforts, from eye strain and photophobia to a gritty sensation or unnatural awareness of their eyeballs.

There isn’t one product or strategy that works for everyone, but given the impact on daily life, finding a way to treat DED in your menopausal patients should be a priority.

• Regular use of quality artificial tears can temporarily relieve dryness.
• Prescription eye drops can reduce inflammation and increase tear production.
• Intense pulsed light therapy (IPL) may help.
• Small lifestyle changes, like using humidifiers at home and cutting back on screen time, can go a long way in reducing symptoms.
• Omega-3 supplements can potentially help, although current research actually presents mixed results:
  • The Dry Eye Assessment and Management (DREAM) study, a large-scale, multicenter, double-masked randomized controlled trial, evaluated omega-3 fatty acid supplements for DES. The study found no significant difference in symptom improvement between participants taking omega-3 supplements and those receiving a placebo.
  • But a more recent systematic review and meta-analysis in 2023 analyzed data from randomized clinical trials over the past decade. The analysis concluded that omega-3 fatty acid supplementation does effectively reduce DED symptoms, especially when administered in high doses, over a long duration, and with increased levels of eicosapentaenoic acid.

Navigating Corneal Changes

Menopause doesn’t just bring hot flashes and mood swings — it can subtly reshape the cornea. Changes in eye shape can affect focus, cause eyes to tire more easily, and make contact lenses uncomfortable. Patients might notice their usual lenses feeling off or their vision slightly blurred. Here’s research that suggests a link between menopause and a steepened curvature of the cornea.

• If patients experience discomfort with their current contacts, consider refitting them with a different brand or lenses designed for altered corneal shapes.
• Regular eye exams are key to monitoring corneal changes in order to make appropriate adjustments to any vision correction methods.

Monitoring for Glaucoma

Menopause might be a factor for increased glaucoma risk. New research suggests that women who enter menopause earlier may have a higher chance of developing open-angle glaucoma due to reduced estrogen levels. In fact, this 2023 research article suggests that late menarche (13+y), early menopause (prior to 45y), and delivering 5 or more children are all possible risk factors for OAG.

• Keeping an eye on intraocular pressure and performing optic nerve assessments can help catch changes early.
• Some evidence indicates that HRT might help stabilize IOP, though it’s something to discuss on a case-by-case basis with patients because the relationship between HRT and IOP is complex, and individual responses can vary. (HRT carries a risk of cardiovascular issues, breast cancer, blood clots, and gallbladder disease.)

Cataract Awareness

Hormone fluctuations can trigger or accelerate cataract formation in mid-life. It’s important to note that we aren’t entirely clear on the relationship between estrogen and lens health, only that they are linked. For example, HRT has been shown to increase the risk of cataract surgery in women, but hormonal contraception may be associated with a lower prevalence of cataracts (source).

• Not to be repetitive, but again, scheduling regular exams for menopausal and postmenopausal patients helps catch early signs of cataracts.
• For those with impaired vision, cataract surgery remains an effective solution when symptoms start to interfere with daily life.

Protecting Retinal Health

The retina also takes a hit during menopause, with lower estrogen levels possibly raising the risk for conditions like age-related macular degeneration. Menopausal women, especially those with lifestyle risk factors, can benefit from proactive steps.

• Encourage patients to quit smoking and eat a diet high in leafy greens and omega-rich fish, which have been shown to support retinal health.
• Vitamins C, E, zinc, lutein, and zeaxanthin are also recommended to keep the retina healthy:
  • The Age-Related Eye Disease Study and its follow-up, AREDS2, conducted by the National Eye Institute, have provided substantial evidence supporting the use of specific vitamins and minerals in reducing the progression of AMD.

As with most things, managing menopause-related eye issues benefits from a holistic approach. Healthy eating will support more than just the retina. Addressing DED can help with contact lense comfort. Coordinating with other health professionals will help you stay abreast of things like hormone levels and treatments that might influence a patient’s eye health.

And don’t underestimate the power of informing your patients about how menopause can affect their eyes. Hot flashes, mood swings, and brain fog are essentially common knowledge these days, but many people have no idea that menopause can impact eye health. Empowering your patients to take proactive steps makes a big difference.

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