Purpose
To examine prospectively the association between demographic and geographic factors
in relation to exfoliation glaucoma (EG) or exfoliation glaucoma suspect (EGS).
Design
Prospective cohort study.
Participants
Seventy-eight thousand nine hundred fifty-five women in the Nurses' Health Study and
41 191 men in the Health Professionals Follow-up Study.
Methods
Female and male health professionals were followed prospectively from 1980 through
2008 and from 1986 through 2008, respectively. Eligible participants were 40 years
of age or older, did not have EG or EGS at baseline, and reported undergoing eye examinations
during follow-up. Information regarding demographic features, lifetime geographic
residence, and potential confounders was collected. During follow-up, 348 EG or EGS
cases were confirmed with medical record review. The relative risk of EG or EGS in
each cohort was estimated separately and the results were pooled with meta-analysis.
Main Outcome Measures
Multivariate rate ratios (MVRRs) of EG or EGS and their 95% confidence intervals (CIs).
Results
Exfoliation glaucoma or EGS was strongly age related with subjects 75 years of age
or older at 46.22-fold (95% CI, 22.77–93.80) increased risk compared with those between
40 and 55 years of age. Although men were 68% less likely to develop EG or EGS than
women (MVRR, 0.32; 95% CI, 0.23–0.46), no predisposition to EG or EGS by ancestry,
particularly Scandinavian ancestry, emerged. Compared with a lifetime of living in
the northern tier of the continental United States, lifetime residence in the middle
geographic tier (MVRR, 0.53; 95% CI, 0.40–0.71) and in the southern geographic tier
(MVRR, 0.25; 95% CI, 0.09–0.71) was associated with markedly reduced risks of EG or
EGS.
Conclusions
In this mainly white cohort from the United States, increasing age and female gender
were significant risk factors for EG or EGS; however, Scandinavian heritage was not.
Living in the middle or southern regions of the United States relative to living in
the northern region was associated with a reduced risk of EG or EGS.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed
in this article.
References
- The management of exfoliative glaucoma.Prog Brain Res. 2008; 173: 211-224
- Exfoliation syndrome as a risk factor for cataract development: five-year follow-up of lens opacities in exfoliation syndrome.J Cataract Refract Surg. 2001; 27: 1992-1998
- Pseudoexfoliation and glaucoma in eyes with retinal vein occlusion.Int Ophthalmol. 1999; 23: 75-78
- Pseudoexfoliation syndrome in eyes with ischemic central retinal vein occlusion: a histopathologic and electron microscopic study.Acta Ophthalmol Scand. 2001; 79: 476-478
- Central retinal vein occlusion in pseudoexfoliation of the lens capsule.Clin Experiment Ophthalmol. 2002; 30: 176-187
- Association of exfoliation syndrome and central retinal vein occlusion: an ultrastructural analysis.Acta Ophthalmol. 2010; 88: 91-95
- Exfoliation syndrome as a risk factor for vitreous loss in extracapsular cataract surgery (preliminary report).Acta Ophthalmol Suppl. 1988; 66: 129-131
- Pseudoexfoliation syndrome: a cohort study on intraoperative complications in cataract surgery.Ophthalmologica. 1998; 212: 278-280
- Outcomes of phacoemulsification in patients with and without pseudoexfoliation syndrome.J Cataract Refract Surg. 2003; 29: 1080-1086
- Uveal and capsular biocompatibility of 2 foldable acrylic intraocular lenses in patients with uveitis or pseudoexfoliation syndrome: comparison to a control group.J Cataract Refract Surg. 2002; 28: 1160-1172
- Kliniska Undersokningar over Depigmentering av Pupillarranden och Genomlsybarhet av Iris vid Fall av Aldersstarr samt i Normala Ogon hos Gamla Personer [thesis].University of Helsinki, Helsingfors, Finland1917
- The basement membrane exfoliation syndrome.Arch Ophthalmol. 1979; 97: 510-515
- Common sequence variants in the LOXL1 gene confer susceptibility to exfoliation glaucoma.Science. 2007; 317: 1397-1400
- Exfoliation syndrome: prevalence and inheritance in a subisolate of the Finnish population.Acta Ophthalmol Scand. 2007; 85: 500-507
- Incidence and prevalence of pseudoexfoliations and open-angle glaucoma in northern Sweden: II.Acta Ophthalmol Scand. 2007; 85: 832-837
- Prevalence of exfoliation syndrome in Finland.Acta Ophthalmol Suppl. 1988; 66: 120-122
- Ancestral LOXL1 variants are associated with pseudoexfoliation in Caucasian Australians but with markedly lower penetrance than in Nordic people.Hum Mol Genet. 2008; 17: 710-716
- Pseudoexfoliation syndrome in Australian adults.Am J Ophthalmol. 2000; 129: 629-633
- Prevalence of open-angle glaucoma in Greece: the Thessaloniki Eye Study.Am J Ophthalmol. 2007; 144: 511-519
- The prevalence of pseudoexfoliation syndrome in Pakistan: hospital based study.BMC Ophthalmol [serial online]. 2006; 6 (Accessed June 3, 2011): 27
- The prevalence of exfoliation syndrome in different areas of France.Acta Ophthalmol Suppl. 1988; 66: 86-89
- Prevalence of exfoliation syndrome in central Sri Lanka: the Kandy Eye Study.Br J Ophthalmol. 2008; 92: 1595-1598
- The prevalence of pseudoexfoliation syndrome in Chinese people.Br J Ophthalmol. 2004; 88: 193-195
- Pseudoexfoliation in South India.Br J Ophthalmol. 2003; 87: 1321-1323
- Geographic and climatic factors associated with the exfoliation syndrome.Arch Ophthalmol. 2011; 129: 1053-1060
- Geographic variation of MS incidence in two prospective studies of US women.Neurology. 1999; 53: 1711-1718
- Analysis of Survival Data.in: Chapman and Hall, London1984: 1-201
- Meta-analysis in clinical trials.Control Clin Trials. 1986; 7: 177-188
- Estimated incidence of pseudoexfoliation syndrome and pseudoexfoliation glaucoma in Olmsted County, Minnesota.J Glaucoma. 2003; 12: 193-197
- Pseudoexfoliation in the Reykjavik Eye Study: five-year incidence and changes in related ophthalmologic variables.Am J Ophthalmol. 2009; 148: 291-297
- Endothelial nitric oxide synthase gene variants and primary open-angle glaucoma: interactions with gender and postmenopausal hormone use.Invest Ophthalmol Vis Sci. 2010; 51: 971-979
- Increased occurrence of exfoliation in the male, Spanish American population of New Mexico.J Am Optom Assoc. 1992; 63: 643-648
- Exfoliation syndrome: frequency, gender distribution and association with climatically induced alterations of the cornea and conjunctiva.Acta Ophthalmol Scand. 2002; 80: 478-484
- The Middle-Norway eye-screening study.Acta Ophthalmol (Copenh). 1988; 66: 652-658
- Prevalence of open-angle glaucoma in Iceland: Reykjavik Eye Study.Eye (Lond). 2003; 17: 747-753
- Epidemiology of pseudoexfoliation.New Trends Ophthalmol. 1993; 8: 131-134
- Exfoliation syndrome prevalence in the glaucoma population of South Louisiana.Acta Ophthalmol Suppl. 1988; 66: 93-98
- Exfoliation syndrome in black South Africans.Arch Ophthalmol. 2003; 121: 863-870
- Pseudocapsular exfoliation in the Bantu of South Africa.Br J Ophthalmol. 1973; 57: 41-45
- The prevalence of pseudoexfoliation syndrome in a Japanese population: the Hisayama study.J Glaucoma. 2005; 14: 482-484
- Pseudoexfoliation syndrome (prevalence based on random survey hospital data).Indian J Ophthalmol. 1984; 32: 169-173
- Pseudoexfoliation in southern India: the Andhra Pradesh Eye Disease Study.Invest Ophthalmol Vis Sci. 2005; 46: 1170-1176
- Exfoliation syndrome in the Reykjavik Eye Study: risk factors for baseline prevalence and 5-year incidence.Br J Ophthalmol. 2010; 94: 831-835
- Epidemiology of exfoliation syndrome in the Reykjavik Eye Study [dissertation].in: Acta Ophthalmol. 87. University of Iceland, Reykjavik, Iceland2009: 1-17
- Exfoliation syndrome: prevalence in a southeastern United States population.Arch Ophthalmol. 1988; 106: 335-336
- Pseudoexfoliation in a rural Burmese population: the Meiktila Eye Study.Br J Ophthalmol. 2008; 92: 1325-1328
- Compromised autoregulatory control of ocular hemodynamics in glaucoma patients after postural change.Ophthalmology. 2006; 113: 1832-1836
- Epidemiology of pseudoexfoliation in the island of Crete (Greece).Acta Ophthalmol Scand. 1997; 75: 726-729
- Incidence and prevalence of pseudoexfoliation and open-angle glaucoma in northernSweden: I.Acta Ophthalmol Scand. 2007; 85: 828-831
- The relationship between glaucoma and pseudoexfoliation: the Blue Mountains Eye Study.Arch Ophthalmol. 1999; 117: 1319-1324
Article Info
Publication History
Published online: October 10, 2011
Accepted:
June 15,
2011
Received in revised form:
June 13,
2011
Received:
March 1,
2011
Footnotes
Manuscript no. 2011-357.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
A Physician Scientist Award from Research to Prevent Blindness, Inc., New York, New York, supports Dr. Pasquale. The National Institutes of Health , Bethesda, Maryland (grant nos.: CA87969 , CA55075 , EY09611 , HL35464 , EY019511 , EY015473 [LRP]); the Arthur Ashley Williams Foundation, Holliston, Massachusetts; and the Harvard Glaucoma Center of Excellence (JLW and LRP), Boston, Massachusetts.
Identification
Copyright
© 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- PseudoexfoliationOphthalmologyVol. 119Issue 7
- In BriefI read with interest the recent paper by Kang et al,1 in which they look at the geographic distribution of exfoliative glaucoma in the United States and found lower rates in those who had lived in the middle or southern regions of the country, which suggested an environmental or ecological effect. They do review a number of epidemiologic studies including that by Stein et al.2 However, they seem to have overlooked a study performed some years ago in Australian Aboriginal people.3 The calculation of ocular exposure to radiation is relatively difficult and geographic location is at best only a poor surrogate.
- Full-Text
- In Brief
