A womans visual fields may be affected by her menstrual cycle, according to a study in Ophthalmologica.1

The study included 59 healthy women and 54 men with no systemic or ocular problems other than refractive error. Subjects underwent ocular examination, standard achromatic perimetric (SAP) testing and short-wavelength automated perimetric (SWAP) testing during the follicular phase (seventh to tenth day of the cycle) and luteal phase (three to seven days before menstrual bleeding) of the menstrual cycle.

The SWAP test demonstrated a significant decrease in mean sensitivity during the luteal phase. Both examination duration and the fixation loss rate were significantly more than with the SAP test.

The researchers concluded that the SWAP test may be more sensitive to subtle sex hormone-dependent changes in visual field analysis of healthy women. They recommend that clinicians note a womans menstrual cycle phase when evaluating suspected visual field loss in menstruating women.

In another study, researchers found that the normal fluctuations in serum sex hormone levels during the menstrual cycle of diabetic women seemed to affect the optic nerve head in advanced diabetes.2

This study evaluated 123 normally menstruating women. Of these, 36 had severe nonproliferative diabetic retinopathy (NPDR), 42 had mild NPDR and 45 were healthy. At four phases of the menstrual cycle (early follicular, late follicular, mid-luteal and late luteal), researchers analyzed the optic nerve head and measured the serum levels of estradiol, progesterone and luteinizing hormone.

The researchers found that women with severe NPDR had a significantly increased neuroretinal rim area and a significantly decreased cup-shape measure, linear cup-to-disc ratio, cup-to-disc area ratio and cup area in the late luteal phase compared with other phases of the menstrual cycle.

Patients with mild NPDR or a normal retina did not have any significant topographic changes in the optic nerve head during their menstrual cycle.

These studies seem to confirm what has long been documented: that hormonal fluctuations may affect organ systems, including the eye, says optometrist Andrew Gurwood of Pennsylvania College of Optometry. But, he says, without evidence that hormonal changes cause permanent damage, the findings have little clinical significance.

Experienced physicians are aware of the variability of the SWAP test, as many factors can alter the tests ability to provide accurate data, Dr. Gurwood says. It is likely that most physicians who see an unexpected result will recognize the need for a retest or series of studies before determining a course of action, he says.

1. Akar Y, Yucel I, Akar ME, et al. Menstrual cycle-dependent changes in visual field analysis of healthy women. Ophthalmologica 2005 Jan-Feb;219(1):30-5.
2. Akar ME, Yucel I, Erdem U, et al. Effect of the menstrual cycle on the optic nerve head in diabetes: analysis by confocal scanning laser ophthalmoscopy. Can J Ophthalmol 2005 Apr;40(2):175-82.

Vol. No: 142:11Issue: 11/15/2005