SYSTEMIC RISK-FACTORS FOR IDIOPATHIC MACULAR HOLES - A CASE-CONTROL STUDY

Purpose/background The idiopathic full-thickness macular hole (IFTMH) is an important cause of poor vision in the elderly affecting predomin antly women over the age of 60 years. While it is accepted that vitreo retinal traction is an important local factor in the development of IF TMH, the underlying cause is not known. The aim of this study was to i dentify possible systemic risk factors for the development of IFTMH. M ethods Two hundred and thirty-seven patients with IFTMH (cases) attend ing the Macular Hole Clinic at Moorfields Eye Hospital were identified . These were compared with 172 patients without macular holes (control s) attending other clinics in the same hospital. Cases and controls we re frequency-matched by sex. The prevalence of the following factors i n both groups was ascertained by interview: ethnic origin, place of bi rth, housing tenure, any systemic diseases, current and lifetime consu mption of medication, severe dehydrational episodes, menstrual and obs tetric history, onset and severity of menopause and use of exogenous o estrogens (in women only), osteoporosis, vegetarianism, use of vitamin supplementation, and smoking and alcohol consumption. Height and weig ht were measured for all participants. Results Cases of IFTMH macular holes were predominantly women (67%) and aged 65 years and older (74%) . We found very few systemic risk factors that were significantly asso ciated with IFTMH. There was a higher prevalence of diabetes in contro ls (12% vs 5%). There was no association between the majority of indic ators of oestrogen exposure in women and macular holes, but cases had a more difficult menopause as judged by the severity of hot flushes at menopause: odds ratio 2.6 (1.4-4.6). Conclusions In common with other studies, we found only a few systemic factors associated with IFTMH. The study did confirm, however, that IFTMH is a strongly gender-relate d disease. There is some evidence for the role of sudden changes in ho rmonal balance, as seen by the increased reporting of severity of symp toms around the menopause along with (statistically non-significant) i ncreased risks associated with hysterectomy and oophorectomy. The part icular aetiological factor which puts women at increased risk of macul ar holes requires further studies.