Demographic and Geographic Features of Exfoliation Glaucoma in 2 United States-Based Prospective Cohorts

Published:October 10, 2011DOI:


      To examine prospectively the association between demographic and geographic factors in relation to exfoliation glaucoma (EG) or exfoliation glaucoma suspect (EGS).


      Prospective cohort study.


      Seventy-eight thousand nine hundred fifty-five women in the Nurses' Health Study and 41 191 men in the Health Professionals Follow-up Study.


      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).


      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.


      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.


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      Linked Article

      • Pseudoexfoliation
        OphthalmologyVol. 119Issue 7
        • In Brief
          I 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.
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