Background: To investigate the association between endogenous estrogen exposure and intraocular pressure (IOP) in postmenopausal women stratified by glaucoma status. Methods: This population-based, cross-sectional study analyzed 1,823 postmenopausal women aged ≥50 years from the Korea National Health and Nutrition Examination Survey (2010–2011). Age at menarche, and menopause, reproductive span, and time since menopause were used as surrogate markers of lifetime estrogen exposure. Multivariate linear regression analyses were performed for the non-glaucoma and glaucoma groups, adjusting for confounders. Results: Among women without glaucoma, indicators of longer estrogen exposure were significantly associated with higher IOP. Menopause at the age of ≥49 years and reproductive span of ≥33 years were associated with IOP increases of 0.79 mmHg and 0.88 mmHg, respectively. Conversely, in women with glaucoma, longer estimated estrogen exposure was associated with lower IOP. Menopause at ≥48 years of age and reproductive span at ≥31 years were not associated with IOP reduction. These findings demonstrate distinct associations between endogenous estrogen exposure proxies and IOP in women with and without glaucoma. Conclusions: Our results suggest a context-dependent role of estrogen in ocular physiology, with potential implications for glaucoma risk assessment and the development of preventive strategies in aging women.

Background/Objectives: To describe the study protocol and baseline characteristics of participants in the Myopic Normal-Tension Glaucoma Treatment Study (MYNT-GTS), which is a randomized controlled trial evaluating the effect of intraocular pressure (IOP)-lowering treatment on glaucoma progression in eyes with myopic normal-tension glaucoma (NTG). Methods: A prospective, multicenter, randomized controlled clinical trial and baseline cross-sectional analysis. The study enrolled 473 treatment-naïve NTG eyes with myopia (spherical equivalent ≤ −1.0 diopters or axial length [AXL] > 24.0 mm) aged 20–60 years from 9 tertiary referral centers in South Korea. Participants were randomized at a 1:1 ratio into a treated group and an untreated group managed by active surveillance, and stratified by age, baseline IOP, AXL, and visual field (VF) mean deviation (MD). Treatment was initiated or intensified when predefined structural or functional progression was detected. Comprehensive examinations including quantitative assessments of the optic nerve head structure and microvasculature, medication adherence, and quality of life were performed every 4 months during the first year and every 6 months thereafter. Glaucoma progression was assessed from the rate of circumpapillary retinal nerve fiber layer (RNFL) thinning, and the rate of VF deterioration was assessed from the MD or visual field index (VFI). Results: The 473 enrolled participants comprised 239 assigned to the treated group and 234 to the untreated group. Most of the baseline variables did not differ significantly between the groups, including age (43.1 ± 9.1 vs. 43.9 ± 9.1 years [mean ± standard deviation], p = 0.33), baseline IOP (14.9 ± 2.6 vs. 14.7 ± 2.5 mmHg, p = 0.26), AXL (26.31 ± 1.37 vs. 26.32 ± 1.34 mm, p = 0.94), global RNFL thickness (79.5 ± 11.4 vs. 80.5 ± 13.2 μm, p = 0.38), and VF MD (−2.71 ± 2.58 vs. −2.32 ± 2.52 dB, p = 0.10). Conclusions: The vast majority of the analyzed variables did not differ significantly between the treated and untreated groups at baseline, supporting the validity of the subsequent comparisons. As the first prospective, multicenter randomized controlled trial dedicated to myopic NTG, the MYNT-GTS should clarify the efficacy of IOP-lowering treatment and inform the individualized management of myopic NTG. Trial Registration: Clinical Research Information Service (CRIS), Republic of Korea, KCT0005225.

Background: To investigate the structural and clinical factors linked to visual field (VF) progression in glaucomatous eyes after the initial detection of optic disc haemorrhage (DH) in patients with primary open-angle glaucoma (POAG). Methods: This study included 92 eyes of 92 patients who presented with at least one optic DH on stereoscopic optic disc and red-free photography. The included patients had a minimum follow-up of 3 years after initial detection of DH and at least 5 reliable standard automated perimetry investigations. VF progression was assessed using event-based guided progression analysis (GPA). Baseline demographic, clinical, and ocular parameters were examined using Cox proportional hazards regression to identify the independent predictors of functional deterioration. Results: Among the patients, 32 (34.8%) showed VF progression and 60 (65.2%) remained stable. In univariate analysis, recurrent DH, longer axial length, thinner central corneal thickness (CCT), and intraocular pressure (IOP) fluctuation were significantly associated with VF progression. In multivariate analysis, recurrent DH (HR 4.008, p < 0.001), longer axial length (HR 1.287, p = 0.005), thinner CCT (HR 0.865, p = 0.005), and greater IOP fluctuation (HR 1.997, p = 0.032) remained independently associated with VF progression. Conclusions: Recurrent DH, longer axial length, thinner CCT, and greater IOP fluctuation were independently associated with VF progression following optic DH. These factors may help identify glaucomatous eyes at higher risk of progression and support closer clinical monitoring after the initial detection of DH.