以下のリンクから全文が見られます。
http://www.aao.org/newsroom/release/oral-contraceptives-increase-glaucoma-risk.cfm
Abstractを転載しておきます。
Research shows birth control use over three years could be a risk factor for glaucoma
NEW ORLEANS — Research presented today, at the 117th Annual Meeting of the American Academy of Ophthalmology in New Orleans, has found that women who have taken oral contraceptives for three or more years are twice as likely to suffer from glaucoma, one of the leading causes of blindness which affects nearly 60 million worldwide.[i] The researchers caution gynecologists and ophthalmologists to be aware that oral contraceptives might play a role in glaucomatous diseases, and inform patients to have their eyes screened for glaucoma if they also have other risk factors.
The study – conducted by researchers at University of California, San Francisco, Duke University School of Medicine and Third Affiliated Hospital of Nanchang University, Nanchang, China – is the first to establish an increased risk of glaucoma in women who have used oral contraceptives for three or more years. The researchers utilized 2005-2008 data from the National Health and Nutrition Examination Survey (NHANES), administered by the Centers for Disease Control, which included 3,406 female participants aged 40 years or older from across the United States who completed the survey's vision and reproductive health questionnaire and underwent eye exams. It found that females who had used oral contraceptives, no matter which kind, for longer than three years are 2.05 times more likely to also report that they have the diagnosis of glaucoma.
Although the results of the study do not speak directly to the causative effect of oral contraceptives on the development of glaucoma, it indicates that long-term use of oral contraceptives might be a potential risk factor for glaucoma, and may be considered as part of the risk profile for a patient together with other existing risk factors. These include factors such as African American- ethnicity, family history of glaucoma, history of increased eye pressure or existing visual field defects. Previous studies in the field have shown that estrogen may play a significant role in the pathogenesis of glaucoma.
"This study should be an impetus for future research to prove the cause and effect of oral contraceptives and glaucoma," said Shan Lin, M.D., researcher and professor of clinical ophthalmology at the University of California San Francisco. "At this point, women who have taken oral contraceptives for three or more years should be screened for glaucoma and followed closely by an ophthalmologist, especially if they have any other existing risk factors."
Association Between Oral Contraceptive Use and Glaucoma in the United States (PO339) was presented at the 117th Annual Meeting of the American Academy of Ophthalmology which is in session November 15-19 at Ernest N. Morial Convention Center in New Orleans. More than 25,000 attendees and 500 companies from 123 countries gather each year to showcase the latest in ophthalmic education, research, clinical developments, technology, products and services. To learn more about the place Where All of Ophthalmology Meets, visit http://www.aao.org/2013.
Note to media: Contact Media Relations to request full text of the study and arrange interviews with experts. From Nov. 15-19, the Media Relations staff can be reached on site at (504) 670-6527.
About the American Academy of Ophthalmology
Eye M.D.s — with more than 32,000 members worldwide. Eye health care is provided by the three "O's" – ophthalmologists, optometrists, and opticians. It is the ophthalmologist, or Eye M.D., who has the education and training to treat it all: eye diseases, infections and injuries, and perform eye surgery. For more information, visit www.aao.org. The Academy's EyeSmart® program educates the public about the importance of eye health and empowers them to preserve healthy vision. EyeSmart provides the most trusted and medically accurate information about eye diseases, conditions and injuries. OjosSanos™ is the Spanish-language version of the program. Visit www.geteyesmart.org or www.ojossanos.org to learn more.
英語が苦手な方のために日本語で要約しておきます。
研究グループは、産婦人科医や眼科医に対し、経口避妊薬が緑内障性疾患の一端を担うことがあると認識し、患者さんに対して緑内障検査を行い他にも危険因子があるかを確認するよう指導するべきであることを警告しています。
本試験は、University of California(サンフランシスコ)、Duke University School of MedicineおよびThird Affiliated Hospital of Nanchang University(中国南昌)の研究者らにより実施されました。研究グループは、2005～2008年に実施された国民健康栄養調査(NHANES)に登録された参加者、すなわち視力とリプロダクティブヘルスに関するアンケートを完成させ眼科検診を受けた40歳以上の全米女性3406人に関するデータを用いています。
その結果、経口避妊薬を3年以上服用した女性は薬剤の種類にかかわらず、緑内障と診断される可能性が2.05倍高かったという結果となりました。なお、緑内障発症の原因となる経口避妊薬の作用は直接示されありませんでしたが、緑内障に関する他の既存の危険因子(アフリカ系アメリカ人、緑内障の家族歴、眼圧上昇歴、または視野の欠けがある等)とともに患者のリスクプロフィールと考えられることが判明しました。
University of Californiaの眼科教授であるShan Lin氏は次のように述べています。｢本試験によって、将来、経口避妊薬と緑内障の因果関係を得るための研究が促進されるであろう。現段階で経口避妊薬を3年以上に渡り服用している女性は、緑内障検査を受け、他に危険因子がある場合は特に、眼科医による注意深い経過観察を受けるべきである｣。
以下は私のコメントです。
経口避妊薬と緑内障の関係なんて意識したことがありませんでした。本当に意外な関連でしたね。経口避妊薬は避妊目的は当然ですが、機能性月経困難症や月経前緊張症の治療としても用いられますし、子宮内膜症の薬物療法のひとつとしても用いられます。いずれの場合においても数年単位での長期連用になる場合が多くなると予想されます。
経口避妊薬の内服において血栓症の既往や家族歴の確認、喫煙の有無、禁煙の指導などはかなり周知されてきていると思われるのですが、緑内障に関しては産婦人科医はあまり認識がないというのが実情でしょう。
今回の論文を受けて、経口避妊薬の長期服用は緑内障のリスクを高めると言い切るのは時期尚早でしょうが、少なくとも経口避妊薬と緑内障に何らかの関連がありそうであることは確かであり、われわれ産婦人科医もそうした認識を持っていくことが必要になりそうですね。
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