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The Women's Health Initiative Sight Exam Study

Mary N. Haan, MPH, DrPH; Ronald Klein, MD, MPH; Barbara E. Klein, MD, MPH; Yingzi Deng, MS, MD; Lynn K. Blythe, BS; Johanna M. Seddon, MD, SM; David C. Musch, MPH, PhD; Lewis H. Kuller, DrPH, MD; Leslie G. Hyman, PhD; Robert B. Wallace, MD

Arch Ophthalmol. 2006;124:988-992.

Objective  To determine the effectiveness of treatment with conjugated equine estrogens (CEE) or with CEE combined with progestin (CEE + P) on age-related macular degeneration (AMD).

Methods  In an ancillary study to the Women's Health Initiative clinical trial of hormone therapy, 4262 women 65 years and older underwent fundus photography for the determination of AMD. Participants were recruited from April 2000 to June 2002 at 21 clinical sites an average of 5 years after randomization. Participants were randomized to treatment with CEE, CEE + P, or placebo. Participants had been treated for an average of 5 years at the ophthalmic evaluation for AMD.

Results  The overall prevalence of any AMD was 21.0%. No association was found between CEE + P (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.75-1.11) or CEE alone (OR, 0.98; 95% CI, 0.78-1.25) and early-stage AMD. The CEE + P was associated with a reduced risk of soft drusen (OR, 0.83; 95% CI, 0.68-1.00) after adjustment for covariates and with a reduced risk of neovascular AMD (OR, 0.29; 95% CI, 0.09-0.92).

Conclusions  Treatment with CEE alone or CEE + P does not affect early- or late-stage AMD. Treatment with CEE + P may reduce the risk of soft drusen or neovascular AMD.

Author Affiliations: Departments of Epidemiology (Drs Haan, Deng, and Musch and Ms Blythe) and Ophthalmology and Visual Sciences (Dr Musch), University of Michigan, Ann Arbor; Department of Ophthalmology, University of Wisconsin–Madison (Drs R. Klein and B. E. Klein); Department of Epidemiology, Harvard Medical School, Massachusetts Eye & Ear Infirmary, Boston (Dr Seddon), Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pa (Dr Kuller); Department of Preventive Medicine, State University of New York at Stony Brook (Dr Hyman); and Department of Epidemiology, University of Iowa, Iowa City (Dr Wallace).