Age, sex, and hormone therapy are associated with open-angle glaucoma: a case-only analysis in U.S. veterans.

OBJECTIVE: Open-angle glaucoma (OAG) is a leading cause of blindness, yet the understanding of sex and age on disease diagnosis remains incomplete. In females, the role of age and hormone therapy (HT) in modulating OAG diagnosis is also uncertain. This study evaluated potential sex- and age-related differences in OAG diagnosis. DESIGN: Retrospective cohort study, using the nationwide Veterans Affairs database, of longitudinally followed U.S. veterans with OAG. PARTICIPANTS: Males and females with a previous negative OAG screening and a current OAG diagnosis were included. METHODS: Propensity-score matching was performed for age, body mass index, diabetes, and hypertension between females not taking HT and males (n = 5102 pairs). Patients were stratified by baseline age cohorts (<45, 45-55, >55 years). OAG diagnoses were estimated using Kaplan-Meier analyses, and Cox proportional hazards regression evaluated covariates including age, sex, body mass index, hypertension, diabetes, myopia, diabetic retinopathy, and cataracts. Then, matched females not taking HT to females taking HT (n = 2655 pairs) were analysed. Outcome measures were median time to OAG diagnosis and significance of covariates influencing age of diagnosis across sex and age groups. RESULTS: Females developed OAG earlier than males in younger cohorts (<45, 45-55 years), whereas sex differences diminished after 55 years of age. HT use was associated with delayed diagnosis in females, with the greatest effect in those <45 years. Diabetes, hypertension, myopia, and cataracts were linked to earlier OAG diagnosis similarly in both sexes. CONCLUSIONS: Females experience earlier OAG diagnosis than males, but this difference narrows with age. HT was associated with later diagnosis, particularly in younger women, highlighting potential sex-specific influences in OAG.