Skip to main content

Advertisement

SpringerLink
Log in

Long-term effects of tibolone on ocular functions in postmenopausal women

  • Original Article
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Hormone replacement therapy has been widely used for the prevention of postmenopausal osteoporosis and treatment of climacteric symptoms for many years, but its effect on ocular functions remains unclear. The aim of the study was to evaluate the long-term effects of tibolone on ocular functions in postmenopausal women. A total of 77 healthy women with at least 1 year of spontaneous menopause were enrolled in the study. Forty women were treated with tibolone for 6 months and 37 women were left untreated. All these patients underwent ophthalmic examination including visual acuity, intraocular pressure (IOP), tear functions, blue-on-yellow and white-on-white Humphrey visual field (HVF), visual evoked potentials (VEP) and electroretinography (ERG). There were significant differences in mean deviation of blue-on-yellow HVF, and oscillatory potentials (O1, O2, and O4) in the ERGs of the chronic tibolone users and the control (P < 0.0001, P = 0.001, P < 0.0001 and 0.05, respectively). However, no significant differences were observed in visual acuity, IOP, tear functions, white-on-white HVF and VEP. We concluded that, although tibolone had no effects on visual acuity, IOP, tear functions and VEP, it might cause some early adverse effects on the electrophysiologic and structural characteristics of the retina, which are detected by these sensitive assays. Randomized placebo-controlled studies with larger groups are needed in future research.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Affinito P, Di Spiezio Sardo A, Di Carlo C, Sammartino A, Tommaselli GA, Bifulco G, Loffredo A, Loffredo M, Nappi C (2003) Effects of hormone replacement therapy on ocular function in postmenopause. Menopause 10:482–487

    Article  PubMed  Google Scholar 

  2. Abramov Y, Borik S, Yahalom C, Fatum M, Avgil G, Brzezinski A, Banin E (2005) Does postmenopausal hormone replacement therapy affect intraocular pressure? J Glaucoma 14:271–275

    Article  PubMed  Google Scholar 

  3. Albertazzi P, Di Micco R, Zanardi E (1998) Tibolone: a review. Maturitas 30:295–305

    Article  PubMed  CAS  Google Scholar 

  4. Altintas O, Caglar Y, Yuksel N, Demirci A, Karabas L (2004) The effects of menopause and hormone replacement therapy on quality and quantity of tear, intraocular pressure and ocular blood flow. Ophthalmologica 218:120–129

    Article  PubMed  CAS  Google Scholar 

  5. Bigsby RM, Cardenas H, Caperell-Grant A, Grubbs CJ (1999) Protective effects of estrogen in a rat model of age-related cataracts. Proc Natl Acad Sci USA 96:9328–9332

    Article  PubMed  CAS  Google Scholar 

  6. Bui BV, Fortune B (2004) Ganglion cell contributions to the rat full-field electroretinogram. J Physiol 555:153–173

    Article  PubMed  CAS  Google Scholar 

  7. Christodoulakos GE, Lambrinoudaki IV, Vourtsi AD, Panoulis KP, Kelekis DA, Creatsas GC (2002) Mammographic changes associated with raloxifene and tibolone therapy in postmenopausal women: a prospective study. Menopause 9:110–116

    Article  PubMed  Google Scholar 

  8. Davis VL, Chan CC, Schoen TJ, Couse JF, Chader GJ, Korach KS (2002) An estrogen receptor repressor induces cataract formation in transgenic mice. Proc Natl Acad Sci USA 99:9427–9432

    Article  PubMed  CAS  Google Scholar 

  9. Doren M, Ruebig A, Holzgreve W (2001) Differential effects on the androgen status of postmenopausal women treated with tibolone and continuous combined estradiol and norethindrone acetate replacement therapy. Fertil Steril 75:554–558

    Article  PubMed  CAS  Google Scholar 

  10. Ederveen AG, Kloosterboer HJ (2001) Tibolone exerts its protective effect on trabecular bone loss through the estrogen receptor. J Bone Miner Res 16:1651–1657

    Article  PubMed  CAS  Google Scholar 

  11. Eisner A, Austin DF, Samples JR (2004) Short wavelength automated perimetry and tamoxifen use. Br J Ophthalmol 88:125–130

    Article  PubMed  CAS  Google Scholar 

  12. Fuchsjager-Mayrl G, Nepp J, Schneeberger C, Sator M, Dietrich W, Wedrich A, Huber J, Tschugguel W (2002) Identification of estrogen and progesterone receptor mRNA expression in the conjunctiva of premenopausal women. Invest Ophthalmol Vis Sci 43:2841–2844

    PubMed  Google Scholar 

  13. Genazzani A, Benedek-Jaszmann DM, Andolsek L, Kicovic PM, Tax L (1991) Org OD 14 and the endometrium. Maturitas 13:243–251

    Article  PubMed  CAS  Google Scholar 

  14. Guaschino S, Grimaldi E, Sartore A, Mugittu R, Mangino F, Bortoli P, Pensiero S, Vinciguerra A, Perissutti P (2003) Visual function in menopause: the role of hormone replacement therapy. Menopause 10:53–57

    PubMed  Google Scholar 

  15. Gupta PD, Johar K, Nagpal K, Vasavada AR (2005) Sex hormone receptors in the human eye. Surv Ophthalmol 50:274–284

    Article  PubMed  CAS  Google Scholar 

  16. Hales AM, Chamberlain CG, Murphy CR, McAvoy JW (1997) Estrogen protects lenses against cataract induced by transforming growth factor-beta (TGFbeta). J Exp Med 185:273–280

    Article  PubMed  CAS  Google Scholar 

  17. Hammar M, Christau J, Rud T, Garre K (1998) A double-blind, randomised trial comparing the effects of tibolone and continuous combined hormone replacement therapy in postmenopausal women with menopausal symptoms. Br J Obstet Gynaecol 105:904–911

    PubMed  CAS  Google Scholar 

  18. Hankins MW, Jones RJM, Ruddock KH (1998) Diurnal variation in the b-wave implicit time of the human electroretinogram. Vis Neurosci 15:55–67

    Article  PubMed  CAS  Google Scholar 

  19. International Standardization Committee (1989) Standard for clinical electroretinography. Arch Ophthalmol 107:816–819

    Google Scholar 

  20. Johnson CA, Adams AJ, Casson EJ, Brandt JD (1993) Blue-onyellow perimetry can predict the development of glaucomatous visual field loss. Arch Ophthalmol 111:645–650

    PubMed  CAS  Google Scholar 

  21. Johnson CA, Adams AJ, Casson EJ, Brandt JD (1993) Progression of early glaucomatous visual field loss as detected by blue on-yellow and standard white-on-white automated perimetry. Arch Ophthalmol 111:651–656

    PubMed  CAS  Google Scholar 

  22. Kloosterboer HJ (2001) Tibolone: a steroid with a tissue-specific mode of action. Steroid Biochem Mol Biol 76:231–238

    Article  CAS  Google Scholar 

  23. Kuscu NK, Toprak AB, Vatansever S, Koyuncu FM, Guler C (2003) Tear function changes of postmenopausal women in response to hormone replacement therapy. Maturitas 44:63–68

    Article  PubMed  CAS  Google Scholar 

  24. Lacin S, Oruc S, Karaca S, Kuscu K, Koyuncu F, Uyar Y, Caglar H (2001) Assessment of the effectiveness of postmenopausal tibolone therapy on neural functions by measuring visual evoked potentials: a placebo-controlled study. Eur J Obstet Gynecol Reprod Biol 98:72–76

    Article  PubMed  CAS  Google Scholar 

  25. Lange C, Fernandez J, Shim D, Spurr-Michaud S, Tisdale A, Gipson IK (2003) Mucin gene expression is not regulated by estrogen and/or progesterone in the ocular surface epithelia of mice. Exp Eye Res 77:59–68

    Article  PubMed  CAS  Google Scholar 

  26. Lee SM, Tseng LM, Li AF, Liu HC, Liu TY, Chi CW (2004) Polymorphism of estrogen metabolism genes and cataract. Med Hypotheses 63:494–497

    Article  PubMed  CAS  Google Scholar 

  27. Lundstrom E, Christow A, Kersemaekers W, Svane G, Azavedo E, Soderqvist G, Mol-Arts M, Barkfeldt J, von Schoultz B (2002) Effects of tibolone and continuous combined hormone replacement therapy on mammographic breast density. Am J Obstet Gynecol 186:717–722

    Article  PubMed  CAS  Google Scholar 

  28. McCarty CA, Bansal AK, Livingston PM, Stanislavsky YL, Taylor HR (1998) The epidemiology of dry eye in Melbourne, Australia. Ophthalmology 105:1114–1119

    Article  PubMed  CAS  Google Scholar 

  29. Modelska K, Cummings S (2002) Tibolone for postmenopausal women: systematic review of randomized trials. J Clin Endocrinol Metab 87:16–23

    Article  PubMed  CAS  Google Scholar 

  30. Moore RA (1999) Livial: a review of clinical studies. Br J Obstet Gynaecol 106:1–21

    PubMed  CAS  Google Scholar 

  31. Moss SE, Klein R, Klein BE (2000) Prevalence of and risk factors for dry eye syndrome. Arch Ophthalmol 118:1264–1268

    PubMed  CAS  Google Scholar 

  32. Nathorst-Boos J, Hammar M (1997) Effect on sexual life—a comparison between tibolone and a continuous estradiol-norethisterone acetate regimen. Maturitas 26:15–20

    Article  PubMed  CAS  Google Scholar 

  33. Nonaka A, Kiryu J, Tsujikawa A, Yamashiro K, Miyamoto K, Nishiwaki H, Mandai M, Honda Y, Ogura Y (2000) Administration of 17beta-estradiol attenuates retinal ischemia-reperfusion injury in rats. Invest Ophthalmol Vis Sci 41:2689–2696

    PubMed  CAS  Google Scholar 

  34. Paganini-Hill A, Clark LJ (2000) Eye problems in breast cancer patients treated with tamoxifen. Breast Cancer Res Treat 60:167–172

    Article  PubMed  CAS  Google Scholar 

  35. Parisi P, Tommasini P, Piazza G, Manfredi M (2004) Scotopic threshold response changes after vigabatrin therapy in a child without visual field defects: a new electroretinographic marker of early damage? Neurobiol Dis 15(3):573–579

    Article  PubMed  CAS  Google Scholar 

  36. Sample PA, Weinreb RN (1990) Color perimetry for assessment of primary open-angle glaucoma. Invest Ophthalmol Vis Sci 31:1869–1875

    PubMed  CAS  Google Scholar 

  37. Sator MO, Akramian J, Joura EA, Nessmann A, Wedrich A, Gruber D, Metka M, Huber JC (1998) Reduction of intraocular pressure in a glaucoma patient undergoing hormone replacement therapy. Maturitas 29:93–95

    Article  PubMed  CAS  Google Scholar 

  38. Sauve Y, Lu B, Lund RD (2004) The relationship between full field electroretinogram and perimetry-like visual thresholds in RCS rats during photoreceptor degeneration and rescue by cell transplants. Vis Res 44(1):9–18

    Article  PubMed  CAS  Google Scholar 

  39. Schaumberg DA, Buring JE, Sullivan DA, Dana MR (2001) Hormone replacement therapy and dry eye syndrome. JAMA 286:2114–2119

    Article  PubMed  CAS  Google Scholar 

  40. Schwarz M, Block F (1994) Visual and somatosensory evoked potentials are mediated by excitatory amino acid receptors in the thalamus. Electroencephalogr Clin Neurophysiol 91:392–398

    Article  PubMed  CAS  Google Scholar 

  41. Sendag F, Terek MC, Ozsener S, Oztekin K (2001) Mammographic density changes in postmenopausal women using tibolone therapy. Int J Gynaecol Obstet 74:63–64

    Article  PubMed  CAS  Google Scholar 

  42. Sullivan DA, Wickham LA, Rocha EM, Kelleher RS, da Silveira LA, Toda I (1998) Influence of gender, sex steroid hormones, and the hypothalamic-pituitary axis on the structure and function of the lacrimal gland. Adv Exp Med Biol 438:11–42

    PubMed  CAS  Google Scholar 

  43. Taner P, Akarsu C, Atasoy P, Bayram M, Ergin A (2004) The effects of hormone replacement therapy on ocular surface and tear function tests in postmenopausal women. Ophthalmologica 218:257–259

    Article  PubMed  CAS  Google Scholar 

  44. Toker E, Yenice O, Temel A (2003) Influence of serum levels of sex hormones on intraocular pressure in menopausal women. J Glaucoma 12:436–440

    Article  PubMed  Google Scholar 

  45. Ugurlu S, Hoffman D, Garway-Heath DF, Caprioli J (2000) Relationship between structural abnormalities and short-wavelength perimetric defects in eyes at risk of glaucoma. Am J Ophthalmol 129:592–598

    Article  PubMed  CAS  Google Scholar 

  46. Wachtmeister L (1998) Oscillatory potentials in the retina: what do they reveal. Prog Retin Eye Res 17:485–521

    Article  PubMed  CAS  Google Scholar 

  47. Yilmaz H, Erkin EF, Mavioglu H, Sungurtekin U (1998) Changes in pattern reversal evoked potentials during menstrual cycle. Int Ophthalmol 22(1):27–30

    Article  PubMed  CAS  Google Scholar 

  48. Yilmaz H, Erkin E, Mavioglu H, Lacin S (2000) Effects of oestrogen replacement therapy on pattern reversal visual evoked potentials. Eur J Neurol 7:217–221

    Article  PubMed  CAS  Google Scholar 

  49. Yucel I, Akar ME, Dora B, Akar Y, Taskin O, Ozer HO (2005) Effect of the menstrual cycle on standard achromatic and blue-on-yellow visual field analysis of women with migraine. Can J Ophthalmol 40:51–57

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Faculty of Medicine, Harran University, 63100, Sanliurfa, Turkey

    Fatma Ferda Verit

  2. Department of Ophthalmology, Faculty of Medicine, Harran University, Sanliurfa, Turkey

    Halit Oguz & Omer Bozkurt

  3. Department of Neurology, Faculty of Medicine, Harran University, Sanliurfa, Turkey

    Yasar Ozkul

Authors
  1. Fatma Ferda Verit
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Halit Oguz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yasar Ozkul
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Omer Bozkurt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fatma Ferda Verit.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Verit, F.F., Oguz, H., Ozkul, Y. et al. Long-term effects of tibolone on ocular functions in postmenopausal women. Arch Gynecol Obstet 275, 255–261 (2007). https://doi.org/10.1007/s00404-006-0251-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-006-0251-y

Keywords

Search

Navigation