Female reproductive factors and the risk of exudative age-related macular degeneration: a nationwide cohort study.

PURPOSE To evaluate the association between female reproductive factors and the incidence of exudative age-related macular degeneration (AMD). METHODS A total of 1,297,388 postmenopausal women over 50 years of age who participated in both national health screening and cancer screening in 2009 were identified using the Korea National Health Insurance System database. Data on female reproductive factors were collected using a self-administered questionnaire. Patients were followed up until 2018, and the incident cases of exudative AMD were identified. The hazard ratios and 95% confidence intervals for exudative AMD were estimated using the multivariable-adjusted Cox proportional hazard model. RESULTS During a mean follow-up of 7.27 years, 4,086 patients were newly diagnosed with exudative AMD. The hazard ratio (95% confidence intervals) for exudative AMD was 1.14 (1.01-1.31) for a reproductive period ≥ 40 years compared to a reproductive period < 30 years, and 1.72 (1.48-2.00) for patients with ≥ 5 years of hormone replacement therapy (HRT), and 1.29 (1.09-1.52) for those with 2-5 years of HRT compared to those who never underwent HRT. CONCLUSION Female reproductive factors were associated with the risk of exudative AMD. Greater lifetime exposure to endogenous and exogenous estrogen was associated with a higher incidence of exudative AMD.