The Science behind the Tip
Systemic vascular dysfunction in XFS patients and statistically significant associations of
systemic diseases with XFS have been extensively studied in the last decades. Recently in the
Utah project on exfoliation syndrome, a large database study, significant associations were
found between exfoliation syndrome and the risk of pelvic organ prolapse in women (HR:
1.48); indirect inguinal hernia (HR: 12.32); chronic obstructive pulmonary disease (OR:
1.41); and obstructive sleep apnea (OR: 1.27). These associations have been linked with an
associated dysfunction of the elastic fibers coded by the LOXL1 gene. Single nucleotide
polymorphisms of the LOXL1 gene are strongly associated with exfoliation syndrome, which
explains elastic fibers related dysfunction both in the eye and the whole body. Therefore,
active enquiry about systemic non-vascular conditions and obstructive or apnea related
symptoms are proposed in the routine clinical glaucoma practice when patients with
exfoliation syndrome or exfoliative glaucoma are investigated.
References
Dai J, Suo L, Xian H, Pan Z, Zhang C. Investigating the impact of sun/UV protection
and ease of skin tanning on the risk of pseudoexfoliation glaucoma: a mendelian
randomization study. Invest Ophthalmol Vis Sci. 2023;64(13):4.
Besch BM, Curtin K, Ritch R, at al. Association of exfoliation syndrome with risk of
indirect inguinal hernia: the Utah Project on Exfoliation Syndrome. JAMA
Ophthalmol. 2018;136:1368-1374.
Shumway C, Curtin K, Taylor S, at al. Association between obstructive sleep apnea
and exfoliation syndrome: the Utah Project on Exfoliation Syndrome. Ophthalmol
Glaucoma 2021;4:260-267.
Hwang AY, Ahn HB, Jin SW. Comparison between primary Ahmed valve
implantation and primary trabeculectomy with mitomycin C in pseudophakic patients
with exfoliative glaucoma. Graefe's Arch. Clin. Exp. Ophthalmol, published online 03
October 2023, https://doi.org/10.1007/s00417-023-06233-8
Contributors: Exfoliation SIG, Gabor Hollo & Anastasios Konstas
Tip of the Month manager: Frances Meier-Gibbons
Tip of the Month editorial board: Francisco Goni, Karl Mercieca, Humma Shahid
Tip of the Month editors in chief: Manuele Michelessi, Francesco Oddone