PURPOSE: To determine the 12-year incidence of pseudoexfoliation (PEX), baseline risk factors for incident PEX and risk factors for incident pseudoexfoliative glaucoma (PEXG) among those with PEX in an elderly Caucasian population. METHODS: Longitudinal, population-based study in Thessaloniki, the major urban center in Northern Greece. The baseline cohort included 2,554 participants ≥60 years old. The surviving cohort was reexamined 12 years later using the same methodology. PEX was defined as typical fibrillar material at the pupil margin and/or on the lens capsule. Glaucoma was defined as both structural and functional damage, irrespective of intraocular pressure (IOP). RESULTS: Out of 1,468 eligible subjects in the surviving cohort, 1,092 (74%) participated in the follow-up study. The mean age±standard deviation (SD) at baseline was 68.9±4.6 years. The mean follow-up time was 11.6±1.6 years. The 12-year incidence of PEX was 19.6% (95% confidence intervals (CI), 17.1-22.2), with females more likely to be affected than males (Fisher's exact test, p=.0197). Higher axial length was associated with lower odds of incident PEX (odds ratio (OR) = 0.72 per mm; 95% CI, 0.57-0.92). PEX at baseline was not associated with an increased likelihood of major vascular disease (p=.9038). Higher baseline IOP (OR=1.26 per mmHg; 95% CI, 1.07-1.48) and history of heart attack at baseline (OR=13.49; 95% CI, 2.85-63.87) were associated with a greater likelihood of developing PEXG among those with PEX. A history of alcohol consumption at baseline was protective of individuals developing PEXG if they had PEX at baseline. CONCLUSION: This is one of the very few longitudinal population-based studies that has specifically assessed the incidence of PEX. The association with axial length was previously found only in a cross-sectional study. The associations with heart attack and alcohol consumption are new findings. In individuals with baseline PEX, higher IOP at baseline, history of heart attack at baseline, and no alcohol consumption were associated with a greater likelihood of developing glaucomatous damage approximately 12 years later.
Department of Ophthalmology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece. Electronic address: firstname.lastname@example.org.