Pseudoexfoliation Syndrome in
Australian Adults
CATHERINE A. M
C
CARTY, P
H
D, MPH, AND HUGH R. TAYLOR, MD, FRACO
●
PURPOSE
: To describe the prevalence and correlates of
pseudoexfoliation syndrome in Australians aged 40 years
and older.
●
METHODS
: Cluster, stratified sampling was employed
to identify a cohort representative of the population of
the state of Victoria aged 40 years and older that included
urban, rural, and nursing home residents. A standardized
personal interview and clinical eye examination, includ-
ing intraocular pressure, were performed at locally estab-
lished test sites. The presence of any pseudoexfoliation
material on the iris or lens capsule was noted on dilated
slit-lamp examination. Participants were classified as
having pseudoexfoliation syndrome if any pseudoexfolia-
tion material was present in either eye. Univariate
analyses with t tests and chi-square were first employed
to evaluate risk factors for pseudoexfoliation. Any fac-
tors with P < .10 were then fitted in a backward stepwise
logistic regression model. For the final multivariate mod-
els, P < .05 was considered statistically significant.
●
RESULTS
: A total of 3,271 of the urban residents (83%
of eligible), 403 nursing home residents (90% of eligi-
ble), and 1473 rural residents (92%) participated. The
urban residents ranged in age from 40 to 98 years
(mean ؍ 59), and 1,511 (46%) were men. The nursing
home residents ranged in age from 46 to 101 years (mean
82), and 85 (21%) were men. The rural residents ranged
in age from 40 to 103 years (mean 60), and 701 (47.5%)
were men. Participants with bilateral cataract extraction
were excluded from further analyses. The overall rate of
pseudoexfoliation syndrome in this population was 0.98%
(95% confidence limit ؍ 0.57, 1.28). The prevalence of
pseudoexfoliation material in either eye increased signif-
icantly with age. No cases of pseudoexfoliation syndrome
were observed in people aged 90 years and older. How-
ever, people with bilateral cataract surgery had been
excluded from these analyses. After adjusting for age and
cataract, only glaucoma remained significantly related to
pseudoexfoliation (odds ratio ؍ 3.80, 95% confidence
limit ؍ 1.73, 8.33).
●
DISCUSSION
: In conclusion, we found only two strong
correlates of pseudoexfoliation in our population-based
sample of Victorians aged 40 years and older: age and
glaucoma. (Am J Ophthalmol 2000;129:629 – 633.
© 2000 by Elsevier Science Inc. All rights reserved.)
T
HE STATE OF KNOWLEDGE IN RELATION TO PSEUDO-
exfoliation syndrome was recently reviewed. Nau-
mann and coauthors
1
state that the intraocular
manifestations of pseudoexfoliation syndrome can include
phakopathy, cyclopathy, iridopathy, trabeculopathy, and
keratopathy, whereas extraocular manifestations can in-
clude skin, extraocular muscles, heart, lung, liver, kidney,
and meninges. They also stress the importance of diagnosis
of pseudoexfoliation syndrome so that potential preopera-
tive, intraoperative, and postoperative complications of
cataract surgery can be avoided.
Pseudoexfoliation syndrome has been shown to increase
with age,
2
to be associated with glaucoma,
3–10
and to vary by
racial origin.
11–16
This research raises further questions about
the pathogenesis of glaucoma and potential shared pathways
between glaucoma and pseudoexfoliation syndrome. Other
purported risk factors include radiation,
17
vascular condi-
tions,
18
and an human leucocyte antigens (HLA) associa-
tion.
19
However, there are relatively few population-based
data regarding pseudoexfoliation syndrome.
The purpose of this study was to investigate the prevalence
and correlates of pseudoexfoliation syndrome in a represen-
tative sample of Australians aged 40 years and older.
METHODS
DETAILS OF THE METHODOLOGY FOR THE VISUAL IMPAIR-
ment Project have been published previously.
20
Briefly,
cluster, stratified random sampling was employed to iden-
Accepted for publication Nov 30, 1999.
From the Centre for Eye Research Australia, East Melbourne, Victoria,
Australia.
The Visual Impairment Project was funded in part by grants from the
National Health and Medical Research Council, Woden, ACT, the
Victorian Health Promotion Foundation, Melbourne, VIC, the estate of
the late Dorothy Edols, Melbourne, VIC, and the Jack Brockhoff
Foundation, Melbourne, VIC. Dr McCarty is the recipient of a Wagstaff
Fellowship in Ophthalmology from the Royal Victorian Eye and Ear
Hospital, Melbourne, VIC.
Reprint requests to Catherine A. McCarty, PhD, MPH, Centre for Eye
Research Australia, 32 Gisborne St, East Melbourne, VIC 3002, Austra-
lia; fax: (613) 9662 3859; e-mail: cathy@cera.unimelb.edu.au
©
2000 BY
E
LSEVIER
S
CIENCE
I
NC
.A
LL RIGHTS RESERVED
.
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