Dr. Neda Gioia aims to make connections between hormonal changes and eyecare, as well as nutrition and ocular impact. She recently lectured at Optometry’s Meeting on the topic. Photo Credit: Dr. Gioia.
How midlife hormonal changes are reshaping eyecare opportunities
By Neda Gioia, OD, CNS, IFMCP, FOWNS
July 13, 2026
Quick summary:
- Midlife hormonal changes can contribute to dry eye, blurred vision and other aging eye symptoms.
- There’s a business opportunity to differentiate the practice and build stronger referral relationships.
- Optometrists can capture a clinical opportunity by screening for menopause, medications, sleep and nutrition.
- Five simple action steps can help practices start now, including adding a hormone-health intake question, learning HRT basics and building referral ties.
I received my first referral from gynecology about a decade ago. It opened my eyes to an important connection.
Women in their late 30s, 40s and 50s were arriving in my office with a familiar story. Their gynecologist had been managing hot flashes, irregular cycles, vaginal dryness, bladder leakage and pelvic floor changes. Now those same women were sitting in my chair with burning eyes, new-onset dry eye and visual complaints they could not quite put their finger on. Different complaints, different specialties, same patient, same potential root cause.
What started as an occasional cross-referral opened a new way of thinking about collaborative care.
I began viewing these cases through a more holistic, whole-body perspective.
Here’s what I wish someone had told me earlier: There is a significant healthcare communication gap surrounding women’s hormonal health and eye health. As optometrists, we are uniquely positioned to help bridge that gap. The opportunity is hiding in plain sight.
THE DEMOGRAPHICS ARE TOO BIG TO IGNORE
Consider this: An estimated 1 billion women worldwide are now living beyond menopause, including more than 60 million women over age 45 in the United States. Approximately 6,000 American women are entering menopause each day; this life stage represents a significant and growing area of healthcare relevance.
For example, dry eye disease is upwards of two times more prevalent in women, especially during hormonal decline. Hormonal changes during perimenopause and menopause are increasingly recognized as important contributors to ocular surface dysfunction, dry eye symptoms and visual discomfort.
The problem is that the intersection of hormonal health and ocular disease is almost entirely absent from medical and optometric training. Despite affecting millions of women, menopause remains underrepresented in biomedical research, creating significant gaps in our understanding of how hormonal changes influence long-term health, including ocular health.
THE BUSINESS CASE: WHY THIS IS GOOD FOR YOUR PRACTICE
First, women who feel truly heard don’t leave your practice. They refer their friends, their sisters, their colleagues.
Second, once you understand that hormonal decline is a root cause, your treatment conversations change. You’re recommending a more comprehensive approach: supplements, targeted nutrition counseling and possibly a co-management conversation with her gynecologist about hormone therapy and its impact on the ocular surface. That’s a differentiated service.
Dr. Gioia’s practice, Integrative Vision, has evolved to help bridge a gap between optometry and women’s health.
Third, my referral network grew. Gynecologists, health coaches and integrative internists who are managing perimenopausal women are actively looking for other clinicians who understand this intersection. I became that person in my community. Those relationships send patients in both directions.
WHAT YOU NEED TO KNOW CLINICALLY
You don’t need a fellowship in endocrinology or gynecology to start these conversations. You need a working understanding of how hormonal changes affect the eye. I was happy to present much of this at the recent AOA Optometry’s Meeting with great feedback.
Sex hormone receptors are present throughout ocular tissues, including the meibomian glands, cornea, conjunctiva, retina and optic nerve. As hormone levels fluctuate, clinicians may observe changes in tear film stability, meibomian gland function, ocular comfort and visual quality.
Even many of the medications commonly prescribed to manage perimenopausal and menopausal symptoms such as antidepressants, antihistamines, diuretics and certain sleep aids can carry ocular side effects. Dry eye, reduced tear production and blurred vision are frequently medication-related, yet rarely flagged in that context. Knowing what your patient is taking is as important as knowing where she is hormonally.
NEW NUTRITIONAL DEMANDS
Hormonal transition also shifts nutritional demands in ways that can directly affect eye health. Estrogen plays a role in how the body processes and utilizes key nutrients, and as levels change during perimenopause and menopause, so does a woman’s ability to maintain the nutritional status that supports ocular tissue. This is not simply about eating less well with age. It is about physiology changing the rules.
As estrogen declines, endogenous DHA synthesis also declines. DHA, an essential polyunsaturated fatty acid, is highly concentrated in photoreceptor membranes and can play an important role in tear film quality. Zinc metabolism can also be affected. As we know, the retina is one of the most zinc-dependent tissues in the body. Macular carotenoids like lutein and zeaxanthin can potentially become less bioavailable due to body composition shifts that occur during this transition. The practical takeaway is straightforward. A woman who was nutritionally adequate at 40 may not be at 50, and that gap shows up in the exam chair. Asking about diet, supplementation and hormonal status as part of a dry eye or macular health workup is not outside our lane. It is exactly where we should look.
Importantly, hormonal eye health extends beyond the natural aging menopause. Women who undergo hysterectomy with bilateral oophorectomy often experience an abrupt hormonal transition and may seek care from gynecologists, menopause specialists, and other healthcare providers for new symptoms, without recognizing that their hormonal changes may also be related to ocular health complications. Recognizing these patients creates additional opportunities for education, interdisciplinary collaboration and referral relationships.
SLEEP: AN OVERLOOKED PIECE OF THE PUZZLE
Another area that deserves greater attention is sleep. Many women experience sleep disturbances during the perimenopause and menopause transition, often related to hormonal fluctuations, vasomotor symptoms, and changes in circadian rhythm. Emerging research has linked poor sleep quality with dry eye disease, glaucoma, diabetic retinopathy and other chronic ocular conditions.
This presents another opportunity for optometrists to expand the conversation. Discussing digital eye health, evening screen habits, and strategies that support healthy sleep may benefit both visual comfort and overall well-being. As we learn more about the connection between sleep, inflammation and ocular health, sleep hygiene may become one of the most underutilized tools in supporting midlife women’s eye health.
When a perimenopausal woman presents with sudden-onset dry eye or unexplained visual fluctuations, the question “Where are you in your hormonal transition?” is a clinical question, not a lifestyle question. This also may be a time to inquire about other symptoms that come with the perimenopause transition such as sleep disturbances and connect your patient to the right referral center.
FIVE ACTION STEPS TO GET STARTED
You don’t need to overhaul your practice overnight. Here’s how to begin:
1. Add a hormonal health question to your intake form. For female patients over 40, include: “Are you currently experiencing perimenopause or menopause symptoms?” It signals to patients that you think about their whole health picture. It opens the door to a richer exam conversation.
2. Learn the basics of HRT and the ocular surface. The Menopause Society has updated its guidelines. There is growing evidence and research with systemic hormone replacement. You don’t need to prescribe it, but you need to know enough to co-manage intelligently and refer appropriately. There is growing research evaluating systemic hormone therapy and ocular surface symptoms and visual comfort, although outcomes remain mixed and patient-specific at this time.
3. Build one key relationship with a menopause-literate clinician in your area creating a new referral ecosystem. This is your single highest leverage move. Find a gynecologist or integrative medicine physician who takes perimenopause seriously and is interested in the eye-hormone connection. A warm co-management relationship generates bidirectional referrals and positions you as a trusted partner who understands how hormonal transitions affect the eyes with treatment and management options that can support the patient along this long journey.
4. Develop a simple patient handout. Title it “How Hormonal Changes Affect Your Eyes” and cover dry eye, visual fluctuations and what questions to discuss with their OB-GYN. It takes one afternoon to create. It communicates expertise instantly, and patients share it.
5. Start speaking about it. Bringing this topic into your local community tends to open doors quickly. Provide patient education through women’s health events, social media or simple handouts in your waiting room. Talk to local healthcare providers, including other optometrists or gynecologists. Most eyecare providers have never been prompted to think about it, which means there is real opportunity to lead that conversation close to home.
Women’s hormonal health remains a largely underrecognized area within eyecare, creating an opportunity for clinicians interested in education, collaboration and practice differentiation.
A MISSED CONNECTION—AND A BIG OPPORTUNITY
There is a large, underserved and motivated patient population potentially dealing with symptoms that nobody is connecting to their hormonal health. They want a doctor who sees the whole picture.
That can be you. And when it is, the clinical satisfaction and the business case move in the same direction. What surprised me most was how frequently women reported that no one had ever asked about their eyes during discussions about menopause. Likewise, many eyecare visits never included conversations about hormonal transitions. That communication gap creates an opportunity for optometrists to improve patient care while becoming valuable members of a broader women’s healthcare ecosystem.
References
Lobo RA, Gompel A. Management of menopause: a view towards prevention. Lancet Diabetes Endocrinol. 2022;10(6):457-470.
Clayton JA. Dry eye. N Engl J Med. 2018;378(23):2212-2223.
Zhao M, Yu Y, Roy NS, et al. Sex-related differences and hormonal effects in the DREAM study. Br J Ophthalmol. 2023;107(12):1767-1773.
Ayaki M, Tsubota K, Kawashima M, et al. Sleep disorders are a prevalent and underrecognized comorbidity in patients with dry eye disease. Sleep Medicine. 2018;50:181-186.
Harris WS, Tintle NL, Manson JE, Metherel AH, Robinson JG. Effects of menopausal hormone therapy on erythrocyte n-3 and n-6 PUFA concentrations in the Women’s Health Initiative randomized trial. Am J Clin Nutr. 2021 Jun 1;113(6):1700-1706. doi: 10.1093/ajcn/nqaa443.
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Neda Gioia, OD, CNS, FMCP, FOWNS, is the founder of Integrative Vision, a concierge optometry practice in New Jersey integrating eyecare with functional medicine & nutrition to support vision and whole-body health. Her mission is to help transform healthcare “one patient and one clinician at a time.” She is the past president of the Ocular Wellness & Nutrition Society, serves on the NJSOP board and is a subject matter expert for the Institute for Functional Medicine, consulting across industry and medical education platforms on integrative, preventive, and lifestyle-based health strategies. To contact her: info@drnedagioia.com |
