Not all patients diagnosed with pseudoexfoliation will develop glaucoma; however, in those with concurrent ocular hypertension, more intensive management is needed.
April 20, 2026

Not all patients diagnosed with pseudoexfoliation will develop glaucoma; however, in those with concurrent ocular hypertension, more intensive management is needed.

Pseudoexfoliation (PEX) is a common disorder and the most common cause of secondary glaucoma. Despite this, not all subjects with PEX will develop glaucoma.1 According to epidemiological studies, only 15%-30% of subjects with PEX have developed glaucoma.2 Gene variants of LOXL1 do not help identify those with PEX at increased risk of glaucoma.2 Although the presence of PEX is not directly included in the risk calculation formula for glaucoma in subjects with ocular hypertension (OHT), the risk for glaucoma in subjects with PEX and OHT is three times higher than in those with similar high IOP (>21 mmHg) but without PEX.3 Therefore, the management of OHT in the co-existence of PEX should be more intensive. In addition, in individuals who have already developed pseudoexfoliative glaucoma, the rate of progression is also three times higher compared to that in those with primary open-angle glaucoma.4 More aggressive treatment options (Lower target IOP, closer follow-ups and glaucoma surgery) are deemed necessary to mitigate the relative risk of progression to blindness in those patients.


References

  1. Ritch R, Schlötzer-Schrehardt U. Exfoliation syndrome. Surv Ophthalmol. 2001 Jan-Feb;45(4):265-315. doi: 10.1016/s0039-6257(00)00196-x. PMID: 11166342.
  2. Konstas AGP, Ringvold A. Epidemiology of Exfoliation Syndrome. J Glaucoma. 2018 Jul;27 Suppl 1:S4-S11. doi: 10.1097/IJG.0000000000000908. PMID: 29419641
  3. Anastasopoulos E, Coleman AL, Wilson MR, Sinsheimer JS, Yu F, Katafigiotis S, Founti P, Salonikiou A, Pappas T, Koskosas A, Katopodi T, Lambropoulos A, Topouzis F. Association of LOXL1 Polymorphisms With Pseudoexfoliation, Glaucoma, Intraocular Pressure, and Systemic Diseases in a Greek Population. The Thessaloniki Eye Study. Invest Ophthalmol Vis Sci. 2014 Jun 10;55(7):4238-43. doi: 10.1167/iovs.14-13991.
  4. Topouzis F, Wilson MR, Harris A, Founti P, Yu F, Anastasopoulos E, Pappas T, Koskosas A, Salonikiou A, Coleman AL. Risk factors for primary open-angle glaucoma and pseudoexfoliative glaucoma in the Thessaloniki eye study. Am J Ophthalmol. 2011 Aug;152(2):219-228.e1. doi: 10.1016/j.ajo.2011.01.032. Epub 2011 Jun 12. PMID: 21664597.
  5. Heijl A, Bengtsson B, Hyman L, Leske MC; Early Manifest Glaucoma Trial Group. Natural history of open-angle glaucoma. Ophthalmology. 2009 Dec;116(12):2271-6. doi: 10.1016/j.ophtha.2009.06.042. Epub 2009 Oct 24. PMID: 19854514.


Contributor: Eleftherios Anastasopoulos, MD, PhD Glaucoma specialist, AXEPA Hospital, Thessaloniki, Greece

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