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Gender-Medizin in der Augenheilkunde

Der „kleine Unterschied“ zwischen Frauen und Männern

Gender medicine in ophthalmology

The “small difference” between women and men

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Zusammenfassung

Die gender- oder geschlechtsspezifische Medizin ist Teil der „personalisierten“ Medizin. Nachdem seit den 1980er-Jahren zunächst auf dem Gebiet der Kardiologie Unterschiede bei Herzerkrankungen zwischen Frauen und Männern nachgewiesen und verstärkt publiziert wurden, sind auch in anderen Fachbereichen Unterschiede zwischen den Geschlechtern in den Fokus des Interesses gerückt. Immunologische und hormonelle Aspekte lassen auf deutliche Unterschiede z. B. in der Krankheitsausprägung oder der Reaktion auf Therapien schließen. In der Augenheilkunde selbst sind epidemiologische Unterschiede in einigen Erkrankungen bekannt, jedoch führen diese bislang nicht zu einer unterschiedlichen Herangehensweise in der praktischen Behandlung von Patienten. Dieser CME-Beitrag soll das Bewusstsein für die Gender-Medizin auch im Bereich der Augenheilkunde wecken und gleichzeitig auch durch Darstellung der grundlegenden Unterschiede bei den Geschlechtern das Verständnis für ebendiese Unterschiede fördern.

Abstract

Gender-specific or sex-specific medicine is part of “personalized” medicine. After differences in heart diseases between women and men were first identified and increasingly published in the field of cardiology since the 1980s, differences between the sexes have also become the focus of interest in other disciplines. Immunological and hormonal aspects indicate significant differences, e.g. in the severity of the disease or the response to treatment. Even in ophthalmology epidemiological differences in some diseases are known but so far these do not lead to a different approach in the practical treatment of patients. This CME article aims to raise awareness of gender medicine also in the field of ophthalmology and at the same time to promote understanding of these differences by presenting the fundamental differences between the sexes.

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  1. Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Deutschland

    M.-A. Gamulescu

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Berlin

Heidelberg

Bonn

Freiburg

Leipzig

Anatomisch sind männliche Augen in den meisten Strukturen größer als weibliche. Welche Struktur ist bei Frauen größer als bei Männern?

Kornea

Ziliarkörper

Papillendurchmesser

Foveale avaskuläre Zone

Netzhautdicke

Welche Geschlechtshormone sind für eine normale Funktion von Tränen- und Lidkantendrüsen besonders wichtig?

Gestagene

Östrogene

Katecholamine

Androgene

Somatostatin

Für welche Erkrankung des Auges scheint eine verlängerte Östrogenexposition im Laufe des Lebens protektiv zu sein?

Offenwinkelglaukom

Chorioretinopathia centralis serosa (CRCS)

Ablatio retinae

Autoimmunuveitis

Diabetische Retinopathie

Wie erklärt man sich die direkte drucksenkende Wirkung des Östrogens am Auge?

Verminderter Blutfluss im Gewebe

Östrogenrezeptoren im Ziliarkörperepithel

Verstärkte Produktion von Kammerwasser

Verminderter Abfluss des Kammerwassers

Abnahme der Hornhautdicke

Welche Uveitiden sind insbesondere mit dem weiblichen Geschlecht assoziiert?

Infektiöse Uveitiden

Autoimmunuveitiden

HLA-B27-positive Uveitiden

Granulomatöse Uveitiden

Virale Uveitiden

Was wird neben der größeren anterior-posterioren Achsenlänge des männlichen Auges noch als Grund für die höhere Inzidenz einer Ablatio retinae bei Männern angegeben?

Steilere Hornhautkurvatur

Dichtere und axial dickere Linse

Schnellere Glaskörperverflüssigung

Breitere und weiter posterior gelegene Glaskörperbasis

Dünnere Netzhaut und schmälere Glaskörperbasis

Bei der Chorioretinopathia centralis serosa (CRCS) haben Männer eine schlechtere Prognose, da bei ihnen vermehrt welche Merkmale in der Bildgebung zu finden sind?

Subretinale Ablagerungen und hyperreflektive Foci

Ausgedehnte intraretinale Flüssigkeit

Foveoläre Gefäßastverschlüsse

Ausdünnung der inneren Netzhautschichten

Punktuelle Leckagen in der Angiographie

In welcher Bevölkerungsgruppe ist die Inzidenz der AMD bei Männern höher als bei Frauen?

Kaukasier

Hispanier

Schwarzafrikaner

Asiaten

Inuit

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Gamulescu, MA. Gender-Medizin in der Augenheilkunde. Ophthalmologe 117, 831–842 (2020). https://doi.org/10.1007/s00347-020-01174-7

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