Abstract
Aim: This review article presents a comprehensive overview of the literature on sex hormones (estrogens, androgens, progesterone) and optic nerve disorders, with a discussion of the implications for therapy and prevention.Methods: Epidemiological, pre-clinical and clinical studies were reviewed.Results: Analysis of the biological basis for a relationship between eye diseases and sex hormones showed that some types of hormones can exert a protective effect either directly on the retina and optic nerve or indirectly by modulating ocular blood flow. For example, it seems that estrogen exposure has a protective effect against glaucoma, whereas its deficit may lead to early onset of the disease. If further studies confirm the data in the literature, estrogen therapy, because of its antioxidant action, may be effective in the treatment of Leber's hereditary optic neuropathy, whereas, in the light of current studies, there does not seem to be an influence of estrogen on non-arteritic anterior ischemic optic neuritis (NAION).Conclusions: Although there is some evidence that in some optic nerve pathologies the sex hormones seem to play an important role there are still too few studies providing evidence for its wider use in clinical practice.
Highlights
There is growing evidence for interaction between gonadal hormones and diseases involving body systems other than the reproductive organs (Rosner et al, 2013; Eisner, 2015)
The findings provide an explanation for a hormone-correlated metabolic basis for the prevalence of Leber’s hereditary optic neuropathy (LHON) in males, and open horizons for designing treatments with estrogens or their analogs
The aim of the study was to determine whether use of ERβ as a target for potential estrogen therapy could prevent or delay LHON in carriers of the genetic mutations associated with its development: findings provide evidence that phytoestrogen can correct in vitro the cellular pathologic phenotype associated with LHON mutations, in both cybrids and patient derived fibroblasts
Summary
There is growing evidence for interaction between gonadal hormones and diseases involving body systems other than the reproductive organs (Rosner et al, 2013; Eisner, 2015). Seem to exert a neuroprotective effect (Azcoitia et al, 2011; Melcangi et al, 2011), a vascular effect (Toker et al, 2003a; Faria et al, 2011; Schmidl et al, 2015), an intraocular pressure (IOP) regulation effect (Weinreb and Khaw, 2004; Tehrani, 2015) and a support action against lamina cribrosa These evidences support the hypothesis that sex hormones may be involved in the pathogenesis of eye diseases, such neuropathies as glaucoma, and retinic diseases, as age-related macular degeneration (AMD), and diseases of the lens, as cataracts. It may be speculated that hormone replacement therapy (HRT) in postmenopausal women can influence the course of these disorders and be useful in the treatment of eye diseases (Hutchinson et al, 2014; Nuzzi et al, 2018; Table 1).
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