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Dr. JAI KISHORE BANSAL

INTRODUCTION 

  • Nowadays, there is an increasing trend of visual problems in teenagers, especially among girls (3).
  • Hormonal changes across menstrual cycle have been shown to influence optical function and vision (1,2).
  • During clinical practice, the authors have observed that a large number of adolescent girls with visual problems concomitantly report of menstrual irregularities.
  • Incidentally, there is little or no attention being paid on the association between menstrual irregularities and visual problems among adolescent girls.

The present study is an attempt to record the prevalence of menstrual irregularities and their association with different types of visual problems in a specialty clinic of North India.

AIMS AND OBJECTIVES

AIM

  • To assess prevalence of menstrual irregularities among adolescent girls visiting a specialty eye care facility in North India.

OBJECTIVES

  • To describe spectrum of visual problems among adolescent girls.
  • To assess prevalence and type of menstrual irregularities in study population.

To find out association between menstrual irregularities and different types of visual problems 

METHODOLOGY 

  • Study Area:Sumitra Eye and Maternity Hospital, Lucknow, a specialty care facility providing specialized services in Ophthalmology and Obstetrics/Gynecology.
  • Study Population: Adolescent girls visiting Sumitra Eye and Maternity Hospital, Lucknow for evaluation of refractive error.
  • Study Design: Cross-sectional Exploratory study.
  • Study Period: 1st September 2014 to 31st March, 2018
  • Sample Size: 3620
  • Inclusion Criteria
    • Subjects aged 13 to 19 years.
    • Diagnosed to have >50 D refractive error (+0.50D were considered to have refractive error on examination.)
    • Free from congenital visual defects
  • Exclusion Criteria
    • Non-consenting adolescents.
    • juvenile diabetics.
  • Any other congenital or hereditary endocrinal disorder

METHOD

  • Screening with 6 metres distance, on Snellen’s chart.
  • Refraction test (for those with VA<6/9).
  • Objective refraction was performed with retinoscopy which was followed by subjective refraction performed by achieving best corrected visual acuity (BCVA).
  • Cycloplegic refraction was advised when best corrected visual acuity could not be achieved

Definitions:

Myopia:

when the measured refraction was more than or equal to −0.5 spherical equivalent diopters in one or both eyes.

Hypermetropia:

when the measured objective refraction was greater than or equal to +0.5D spherical equivalent diopters in one or both eyes.

Astigmatism:

was considered to be visually significant if ≥0.5D.

  • After diagnosis for refractive errors, respondents were interviewed by using a pre-designed, pre-tested questionnaire consisting of socio-demographic variable, menstrual pattern and complaints and also pre/post menstrual symptoms/complaints (if any) or during ovulation.
  • Menstrual irregularities, if any were classified as per FIGO classification.
  • Investigations
    • Hormonal assay (Thyroid profile, LH, FSH, Testosterone)
    • USG Abdomen (wherever indicated)

DATA ANALYSIS;

The data was analyzed using Statistical Package for Social Sciences, version 21.0. Chi-square test was used for comparing the data. The confidence level of the study was kept at 95%. A ‘p’ value less than 0.05 was considered significant

RESULTS

All the adolescent girls reporting menstrual irregularities (n=1183) were invited to participate in detailed diagnostic work up. However, only 795 finally agreed to participate in the detailed work up. Subsequent results are shown for these 795 patients only

SN Hormone No. (%) Affected
1. S. FSH

<4 mIU/ml

>4 mIU/ml

 127 (13.8%)

668 (86.2%)
2. Serum testosterone

>6.8 nmol/L

<6.8 nmol/L

 146 (23.6%)

649 (76.4%)
3. LH/FSH

>2

<2

 131 (15.9%)

664 (84.1%)
4. Prolactin

>24 ng/ml

<24 ng/ml

 115 (7.7%)

680 (92.3%)
5. Thyroid abnormalities 89 (11.3%)

 Association between type of refractive error and hormonal abnormalities 

  • DISCUSSION
  • In different community surveys (4,5,6,7) prevalence of menstrual problems in adolescent Indian girls has been reported to vary from 18.3% to 87.7%.
  • Prevalence of reported menstrual irregularities (32.55%) in this study was thus within this reported range.
SN Hormone Myopia Astigmatism Hyper-metropia ‘p’ value
1. S. FSH < 4 mIU/ml 14 (9.7%) 3 (7.3%) 0 (0%) 0.538
2. S. Testosterone > 6.8 nmol/L 37 (25.7%) 6 (14.6%) 3 (30%) 0.300
3. LH/FSH >2 26 (18.1%) 4 (9.8%) 1 (10%) 0.383
4. S. Prolactin >24 ng/ml 11 (7.6%) 2 (4.9%) 2 (20%) 0.274
5. Thyroid abnormalities 18 (12.5%) 4 (9.8%) 0 (0%) 0.454

The etiology of menstrual irregularities could be dependent on nutritional, hormonal and pathological abnormalities, which in turn might have a deterministic role on the overall physiology as a result affecting vision.

ON THE ORIGIN OF THIS STUDY

  • This study was done for the first time in India.
  • Both menstrual pattern and visual problems (refractive error) are affected by lifestyle and nutritional deficiencies.

Though In some previous work a link between menstrual abnormalities and vision has already been reported (1-3,8),but,there is no systematic previous work evaluating the relationship between menstrual irregularities and visual problems in adolescents. However, a high prevalence of menstrual irregularities among girls, and as such a high prevalence of refractive errors in girls as compared to boys as reported in previous studies (9,10,11) has prompted us to enquire whether menstrual irregularities influence visual function too.

  • Although, we made a sincere attempt to investigate this problem, however, owing to limited participation by the girls, owing to financial burden for carrying out advanced investigations, this enquiry has certain limited impact.

In present study, in the absence of a control group, it is difficult to state that menstrual irregularities have a detrimental effect on the vision. Hence, further cross-sectional or case control studies are recommended to evaluate this impact further.

LACUNAS 

  • Though we could not establish a significant association between type of hormonal abnormality and type of refractive error. And, right now there is no physiological basis to prove this hypothesis.
  • The present study despite failing to establish a significant association between menstrual irregularities and vision in adolescent girls highlighted the commonality of lifestyle and nutritional issues as the underlying etiology affecting both vision and menstrual health. 

 CONCLUSION 

  • Prevalence of menstrual irregularities was 32.55% in adolescent girls having been diagnosed for refractive errors.
  • Most of the girls had Myopia (89.83%) followed by astigmatism (8.71%) and hypermetropia (1.46%).
  • Detailed diagnostic work-up could be carried out in 795 girls only.
  • Maximum girls had hypomenorrhoea (37.4%) followed by menorrhagia (26.7%), menometrorrhagia (15.9%), oligomenorrhea (12.3%) and amenorrhoea( 7.7%) .
  • Serum FSH , testosterone , LH/FSH ratio and Prolactin levels were found outside the normal range in many girls.
  • Thyroid abnormalities were observed in 11.3% girls.
  • No significant association was observed between ref. error type and hormonal profile.
  • Owing to limitations of study,  it could not be established whether menstrual irregularities influence the visual acuity and result in refractive error problems.

However, a high prevalence of menstrual problems among this set of adolescent girls, probably influenced by growing lifestyle changes, indicates the need forlifestyle changes and a further enquiry to explore as to how does menstrual irregularities affect the vision.

RECOMENDATIONS

  • Adolescents should be encouraged to take healthy diet and adopt a healthy lifestyle.
  • Nutritional, lifestyle and activity profile of adolescent girls with menstrual irregularities and visual problems should be investigated and commonality of etiology be established.
  • Further case-control studies to investigate the relationship between menstrual irregularities and refractive error problems must be instituted.

TAKE HOME MESSAGE

  • Whenever you see a female adolescent patient with vague, unexplainable & irrelevant complaints of headache, visual disturbances etc. with no apparent cause for that, take a brief menstrual history.
  • Refer to a Gynecologist with a note requesting a hormonal profile if the patient remains unrelieved of her symptoms.

I assure you that the patient will return with a big smile on herface.

REFRENCES

  1. Hutchinson CV, Walker JA, Davidson C. Oestrogen, ocular function and low-vision: A review. J. Endocrinol. 2014; 223(2): R9-R18.
  2. Eisner A, Burke SN, Toomey MD. Visual sensitivity across the menstrual cycle. Vis Neurosci. 2004 Jul-Aug;21(4):513-31.
  3. Adegbehingbe B, Oladehinde M, Majemgbasan T, Onakpoya H, Osagiede E. Screening of Adolescents for Eye Diseases in Nigerian High Schools. Ghana Medical Journal. 2005;39(4):138-142.
  4. Sachan B, Idris MZ, Jain S, Kumari R, Singh A. Age at menarche and Menstrual Problems among school going adolescent girls of a North Indian District. J. Basic Clin. Rep. Sc. 2012; 1(1&2): 56-59.
  5. Ravi R, Shah P, Palani G, Edward S, Sathiyasekaran BW. Prevalence of Menstrual Problems among Adolescent School Girls in Rural Tamil Nadu. J. Pediatr. Adolesc. Gynecol. 2016; 29(6): 571-576.
  6. Kanotra SK, Bangal VK, Bhavthankar DP. Menstrual pattern and problems among rural adolescent girls. Int. J. Biomed. Adv. Res. 2013; 4(8): 551-554.
  7. Beevi P N, L Manju, Bindhu S A, C Haran Jeesha, Jose R. Menstrual problems among adolescent girls in Thiruvananthapuram district. Int. J. Comm. Med. Pub. Health 2017; 4(8): 2995-2998.
  8. Katz L, Lambert W. A new look at myopia development: Possible links with childhood stress and diet. Journal of Behavioral Optometry 2011; 22(3): 69-73.
  9. Sharma A, Congdon N, Yag G, Jing W, Lam SC, Tse YK, et al. Height, Nutrition and Refractive Error Among Rural Chinese School Children: The See Well to Learn Well Project. Investigative Ophthalmology & Visual Science  2009; 50: 2566.
  10. ChellavelGanapathi K., Arun Vijay Paul R, Kokila K., Bharath Kumar S. A study on prevalence of myopia and its associated factors in school children of Salem, Tamil Nadu. . Int J Community Med Public Health. 2017 Aug;4(8):2741-2744.
  11. Kotabal R, Belur MN, Nandini C, Nagendra K. A study on prevalence of myopia among high school children in an urban area of Shivamogga: a cross sectional study. Int J Community Med Public Health. 2017 Jul;4(7):2373-2376.

 

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