The role of sex hormones and aging in dry eye disease

A scarcity of research on women’s eye health and a passion to improve women’s quality of life inspired the recipient of the 2024 AOA Investigator Initiated Research Award.

That winning entry for a pilot study on the role of sex  hormones in the development of dry eye disease was submitted by Anna Tichenor, O.D., Ph.D., an assistant professor at Indiana University School of Optometry (IUSO) and director of the IUSO Dry Eye Clinic at Atwater Eye Care Center. The award’s recipient receives a $50,000 grant to pursue their research.

“This award is designed to stimulate future investigator-initiated awards from the National Institutes of Health (NIH) and other major funding agencies by supporting AOA members pursuing innovative, independent, investigator-initiated research with a strong potential for future, large-scale, multi-year project funding,” Dr. Tichenor says.

“Receiving this research grant is also very exciting for me,” she adds. “I am especially grateful because it provides me an opportunity to explore women’s ocular health as a research area, and it feels like an endorsement from the vision community that we need more research in this area, especially in understanding the development and progression of dry eye disease in women. Ultimately, I am thankful for the opportunity to advance my research in this area.”

An estimated 3.25 million women compared to 1.68 million men are affected by dry eye disease. Further, the prevalence of dry eye disease in women increases with aging.

Below, Dr. Tichenor explains the goals of her research.

What drew you to optometric research?

I am an assistant professor and director of the dry eye clinic at Indiana University School of Optometry. I earned my OD from Southern College of Optometry and Ph.D. from the University of Alabama at Birmingham. I grew interested in research as an optometry student and decided to pursue a Ph.D. in order to learn more about dry eye disease and learn how to conduct clinical research. I am passionate about teaching students in the clinic about evidence-based practices for diagnosing and treating patients with ocular surface disease and dedicated to conducting clinical research to improve patient quality of life.

As a researcher, what about dry eye disease intrigues you?

Dry eye disease is a common condition that is both chronic and progressive in most cases. It can significantly reduce a patient’s quality of life and is highly associated with depression. I am passionate about seeing dry eye patients and conducting research in this area because these patients need clinicians who are compassionate, empathetic and are capable of guiding patients through an evidence-based treatment care plan that will likely need modifications along the way due to the multifactorial nature of the disease. Moreover, dry eye disproportionately affects women more than men, yet we still have a paucity of research in truly understanding the hormonal and aging effects experienced by women on the development of dry eye disease. Thus, after seeing so many female patients struggling with dry eye, even young patients, I decided I wanted to start focusing my research on understanding the role of hormones in dry eye disease. So, this grant will fund a pilot study to detect sex hormones in the tear film, to see if concentrations of sex hormones in the tears change with age much like they do in the blood, and to begin understanding the role they play on the ocular surface.

How will the results help patients, women in particular, with dry eye?

This pilot study will lay the groundwork for a larger study to understand the role of sex hormones in the tear film and see if hormones in the tears are a good therapeutic target. If sex hormones play a role in maintaining ocular surface homeostasis, i.e., a balance of tears and its constituents needed to keep the cornea healthy, then we can focus future research studies to target specific signaling pathways that control homeostasis, understand whether these pathways become dysfunctional in dry eye, and attempt to restore these homeostatic pathways via therapeutic treatments.

Why is women’s eye health a particular area of interest of yours?

Women’s health research historically is very underrepresented, and we need more focused studies on sex and gender differences in prevalence, etiology and treatment of conditions such as dry eye disease. There are many unique physiological and psychosocial factors that affect women’s health, so we need more research to elucidate mechanisms underlying these associations to ultimately improve quality of care and outcomes for women suffering from these conditions.

AOA Investigator Initiated Research Award

This year, the AOA will again sponsor the Investigator-Initiated Research Award. Submissions will open in spring 2025. Stay tuned to aoa.org/news for more information.