As awareness of menopause-related health concerns grows, Neda Gioia, OD, CNS, IFMCP, FOWNS, says it is time for the eye care industry to recognize how profoundly hormonal shifts can affect vision and ocular comfort.
Dr. Gioia, a certified nutrition specialist, functional medicine provider and owner of Integrative Vision in Shrewsbury, New Jersey, has been developing a focused interest in ocular changes that emerge as women approach perimenopause and menopause.
“The topic is a newer subject matter, but it’s a necessary one,” says Dr. Gioia. “I think this is just the tip of the iceberg in terms of speaking about it.”
Dr. Gioia said women experience hormonal transitions that differ significantly from men, yet health care systems do not consistently account for those biological differences. “Men and women are biologically different. We know this,” she says. “The discussion is why are we not actually navigating this difference with our health care system?”
LACK OF DATA IS A CHALLENGE
A major area of concern is dry eye disease. Dr. Gioia notes the evidence-based trend that women experience dry eye symptoms more frequently and severely than men, especially during perimenopause and menopause.
“Women get this more often, right? We make a blanket statement out of that, and we just keep practicing as if being a woman is just a risk factor. Part of the challenge is how little education exists around the presence of hormone receptors in the eye.”
“We have various estrogen receptors in the retinal tissue,” she says, adding that research is in its early stages. Dr. Gioia says that estrogen, progesterone and androgen receptors have been identified throughout ocular structures, yet many optometrists were never taught this.
ROOM FOR GROWTH
As a practitioner who blends conventional optometry with functional medicine and nutrition, Dr. Gioia says she often finds herself identifying systemic issues that patients have not yet recognized. She describes instances of noticing arcus—a cholesterol-related ring in the cornea—in women in their 40s. “There’s this imbalance of their hormones that is triggering this cholesterol imbalance,” she says, noting that such findings can prompt referrals for lipid profiles or cardiovascular evaluations.
Dr. Gioia believes optometrists can become key members of a patient’s broader care team. “We are in a very good place to start opening up that conversation,” she says. “The eye is not separate from hormone fluctuations.”
She encourages clinicians to ask questions about sleep, menstrual cycles, hot flashes and even vaginal dryness because there are correlations to ocular discomfort with some of these symptoms. “If anything, these patients are so appreciative that somebody’s actually talking to them,” Dr. Gioia says. “There is no negativity. It’s the complete opposite, ‘Wow, this person wants to investigate further.’”
She says even small steps such as earlier dry eye treatment or Omega-3 testing can have a meaningful impact. “Women make less DHA during this transition into menopause,” a fact Dr. Gioia notes that some optometrists may not realize when discussing Omega-3 supplementation.
Dr. Gioia also sees an industry-wide need for greater collaboration. “I think one of the biggest values that optometrists have is not doing everything themselves,” she says. “It’s understanding that we can collaborate with many different disciplines whether it’s rheumatology or cardiology, and this is an opportunity to start connecting gynecology or hormone therapists and nutrition specialists to our patients.”
With more than a million women entering menopause each year, Dr. Gioia believes optometry is in a position to lead a shift in how eye health is addressed during this life stage. “We have a huge opportunity here,” she says. “I’m excited to go into this.”
