Pseudoexfoliation: normative data and associations: the Beijing eye study 2011

Objective: To assess the prevalence of pseudoexfoliation syndrome (PEX) and its associations in a population-based setting.

Design: Population-based, cross-sectional cohort study.

Participants: Of 4403 eligible subjects with an age of ≥ 50 years, 3468 individuals (78.8%) participated in the Beijing Eye Study 2011 (mean age, 64.6 ± 9.8 years; range, 50-93 years).

Methods: All study participants underwent a detailed ophthalmologic examination. After medical pupil dilation, PEX was assessed by an experienced ophthalmologist using slit-lamp-based biomicroscopy.

Main outcome measures: Prevalence and associations of PEX.

Results: Slit-lamp examination results were available for 3022 study participants (87.1%). Definite pseudoexfoliation was observed in 72 of the 3022 subjects, with a prevalence of 2.38% (95% confidence interval [CI], 1.84-2.93). Suspected PEX was detected in 104 of the subjects (3.44%; 95% CI, 2.8-4.1). The overall prevalence of PEX (definite and suspected) was 176 of 3022 or 5.82% (95% CI, 4.99-6.66). In 80 subjects (45.5%), PEX was detected in both eyes, whereas it was detected only in the right eye in 42 subjects (23.9%) and only in the left eye in 54 (30.7%). The prevalence of PEX increased from 1.1% in among those 50 to 54 years old, to 3.5%, 5.7%, and 11.8% among those 60 to 64 years, 70 to 74 years, and ≥ 80 years, respectively. In multivariate analysis, presence of PEX was significantly associated with older age (P<0.001; odds ratio [OR], 1.08; 95% CI, 1.04-1.10), shorter axial length (P = 0.03; OR, 0.82; 95% CI, 0.68,0.98), and shallower anterior chamber (P = 0.03; OR, 0.59; 95% CI, 0.36-0.95). We found that PEX was not associated (all P>0.05) with sex, diabetes mellitus, blood pressure, psychological depression, smoking, dyslipidemia, body mass index, central corneal thickness, corneal diameter, optic nerve head measurements, choroidal thickness, retinal vessel diameters, early age-related macular degeneration, or retinal vein occlusion.

Conclusions: In a North Chinese population aged ≥ 50 years, the prevalence of definite PEX was 2.38% (95% CI, 1.84-2.93), suspect PEX was 3.4% (95% CI, 2.8-4.1) and overall PEX was 5.82% (95% CI, 4.99-6.66). We found PEX to be associated with older age, shorter axial length, and shallower anterior chamber. The relationship between PEX and glaucomatous optic neuropathy remained inconclusive among our population.

Financial disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.