Background: Data suggest a possible protective effect against lens opacity with use of hormone replacement therapy (HRT). However, no agreement exists on which opacity type is affected, and more exploration of the additional role of endogenous estrogen exposure is warranted. Objective: To determine whether HRT and the prevalence of different lens opacity types are associated after controlling for endogenous estrogen exposure. Design and Setting: Salisbury Eye Evaluation population-based prevalence survey of residents in an eastern US city. Participants: One thousand two hundred thirty-nine women aged 65 through 84 years. Main Outcome Measures: Nuclear, cortical, and posterior subcapsular opacity. Results: We found a protective association between nuclear opacity and current (odds ratio [OR], 0.5; 95% confidence interval [CI], 0.3-0.7) and recent (OR, 0.4; 95% CI, 0.3-0.7) HRT use. Increasing number of births in younger women was also protective (test of trend, P=.05). Past HRT use protected against nuclear opacity only in women who had never been pregnant (OR, 0.2; 95% CI, 0.1-0.7). Past (OR, 0.2; 95% CI, 0.1-0.7) and current (OR, 0.3; 95% CI, 0.1-0.9) HRT use were associated with a lower prevalence of posterior subcapsular opacity. Conclusion: A protective association between the use of HRT and nuclear and posterior subcapsular opacities is reported, which should be confirmed in prospective studies.
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