Abstract
PurposeTo examine the 10-year incidence of the pseudoexfoliation syndrome (PEX) in adults in a population-based follow-up study, to determine its link with vascular diseases, and to identify possible risk factors of the PEX.MethodsThe baseline examination was performed in 2006 on a random sample of 1033 participants from Kaunas city (Lithuania) population. In 2016, a follow-up study of 686 participants who returned for the examination was conducted. The respondents filled out a questionnaire, an ophthalmological examination was performed, and the presence of vascular diseases was determined by the anamnesis and electrocardiogram evaluation data. Binary univariate and multivariate logistic regression analyses were conducted with the PEX and vascular diseases as predictors, controlling for age. Odds ratios (OR) and 95% confidence intervals of OR were calculated for the risk of new PEX cases.ResultsDuring 10 years, the prevalence of the PEX in the study population increased from 10.3 to 34.2%. The rates of ischemic heart disease (IHD) and IHD combined with stroke were significantly higher in the PEX subjects than in the non-PEX subjects. The risk of the PEX among persons with IHD was, on the average, by 1.5-fold higher, and among those with IHD and stroke, on the average, by 1.6-fold higher as compared to persons without the aforementioned pathologies (accordingly, p = 0.014 and p = 0.010).ConclusionThe prevalence of the PEX increased significantly with age. The risk of the PEX was significantly higher among persons with IHD and even higher among persons with IHD and stroke. In the future, a greater understanding of the cardiovascular, metabolic, and environmental components associated with the PEX may lead to more specific lifestyle-related preventive strategies to decrease the disease burden.
Highlights
The pseudoexfoliation syndrome (PEX) is an agerelated disorder in which grayish-white flakes accumulate in different tissues in the anterior segment of the eye
There are many studies on the incidence and prevalence of the PEX in different parts of world, but there is no homogeneous distribution of results for the studies [2]
Various pathogenetic mechanisms have been postulated to explain the higher risk for vascular disease in patients with the PEX, including the deposition of the PEX material in blood vessels, increasing vascular resistance, and vascular dysregulation
Summary
The pseudoexfoliation syndrome (PEX) is an agerelated disorder in which grayish-white flakes accumulate in different tissues in the anterior segment of the eye. Abnormal elastin fibrils identified by electron microscopy in the heart, lung, liver, kidney, gallbladder, and meninges [1] gave rise to the theory that the PEX might be a part of a generalized disorder [2]. Ocular involvement is described as unilateral in 48.0% to 76.0% of patients. Progression to bilateral involvement was reported in up to 50.0% of patients within 5 to 10 years after the diagnosis [5]. Unilateral exfoliation is asymmetric rather than truly monocular. The findings in fellow eyes suggest that blood vessels of the iris become abnormal early in the process, even before exfoliation deposits can be histopathologically seen in the posterior chamber. The evidence supports the theory that the vasculopathy may represent an early preclinical stage of this syndrome and that it is an integral part of the disease [6]
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