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Editor,—Diethylstilboestrol (DES) is a synthetic, non-steroidal pseudo-oestrogen. It was prescribed for many pregnant women between 1948 and 1971 with the intention of preventing spontaneous abortions and premature delivery.1
Embryonic neural tissue is particularly sensitive to gonadal hormones which play a vital part in axonal growth.2 “Estrogen and androgen appear to induce inherent neural programs in which androgen increases neurite arborization and the receptive field of individual cells, increasing the likelihood for intercellular communication, while estrogen actually induces this communication, in the form of spines, synapses, and gap junctions.”3 High myopia rates in opposite sex twins has been attributed to ocular development in the unusual hormonal environment.4 DES, among various oestrogenic compounds, is the most effective competitive inhibitor for binding oestrogen receptors in the developing monkey brain.5
The purpose of this retrospective study was to assess the effect of DES exposure in utero on ocular development and explore its relation with refractive status associated with amblyopia.
The DES exposed subjects were recruited by placing a notice in the newsletter “DES Action News”, asking for people with amblyopia who had been exposed to DES in utero to provide their visual acuity and refractive error measurements. Thirteen DES exposed amblyopic subjects responded. The refractive errors of 10 are shown in Table1.
The refractive status of the DES exposed group of amblyopes was compared with 255 amblyopic patients with no history of DES exposure. Thirty nine amblyopic subjects with a myopic spherical equivalent in both eyes were identified in the group of 255 patients (15.3%). It was assumed that this represents the true frequency of myopia among the non-DES exposed amblyopic population. The probability that 10 out of 13 amblyopic subjects will be myopic in a sample of amblyopes was found to be p ⩽3.4 × 10−6 using the exact binomial test.6
Table 2 compares the spherical equivalents for both eyes of a group of bilaterally myopic subjects with amblyopia to the DES exposed amblyopes. It is noted that the average and median values indicate that there is a higher degree of myopia among the DES exposed group.
These findings suggest that prenatal exposure to DES, which blocks oestrogen receptors in developing neural tissue, may be a factor in the appearance of myopia among some amblyopic patients who were born in the two decades beginning in 1950. Similarly, prenatal exposure to other pseudohormones which are present in some plants and pesticides, may also affect ocular development.7
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