Menopausal Hormone Therapy and Conversion from Intermediate to Advanced Age-Related Macular Degeneration

Purpose: To evaluate the relationship between self-reported menopausal hormone replacement therapy use and conversion to an advanced form of AMD among female patients with intermediate AMD (iAMD). Methods: Female patients with iAMD enrolled in the University of Colorado AMD Registry between July 2014 and July 2024 were included in this prospective cohort study, with follow-up through November 2024. Conversion to an advanced form of AMD, either advanced non-neovascular AMD or neovascular AMD, was assessed by review of patients' multimodal imaging. Kaplan-Meier curves and Cox proportional hazards modeling were used to assess time to conversion. Hazard ratios (HRs) with 95% CIs are presented for multivariable models. Results: Among 285 female patients with iAMD, the mean (±SD) follow-up time was 36.3 ± 26.7 months. In a total of 82 patients (28.8%), conversion to advanced AMD occurred during follow-up. In univariate analysis, a history of ever having used hormone replacement therapy (55.4%), compared with never having used hormone replacement therapy (44.6%), was not associated with conversion to either of the advanced forms of AMD. In multivariable analysis, patients who had ever used hormone replacement therapy did not have significantly elevated risks of conversion to advanced non-neovascular AMD (HR, 1.03, 95% CI, 0.54-1.96; P = .94) or neovascular AMD (HR, 2.10, 95% CI, 0.86-5.02; P = .10). Conclusions: Among female patients with iAMD, self-reported use of hormone replacement therapy was not associated with an increased risk of conversion to either of the advanced forms of AMD.