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Samuel Crandall Thomas, Karen Curtin, Brian M Besch, Rand R Allingham, Robert Ritch, Gregory S Hageman, Barbara M Wirostko; Association of Pelvic Organ Prolapse (POP) and Exfoliation Syndrome in Utah Medicare Beneficiaries. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2619.
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© 2017 Association for Research in Vision and Ophthalmology.
Exfoliation syndrome (XFS) is complex inherited disorder associated with abnormal accumulation of extracellular matrix, specifically involving elastin metabolism and LOXL1. Given LOXL1 repairs elastin tissue, we hypothesized that XFS may be associated with Pelvic Organ Prolapse (POP) in women resulting from damage and impaired LOXL1 repair to elastin-containing connective tissues. The purpose of this study was to test the association of XFS with POP among Utah females over the age of 65 using Centers for Medicare & Medicaid Services (CMS) beneficiary claims data from 1992-2009 linked to the Utah Population Database (UPDB).
With a retrospective, cross-sectional design, 132,772 females of age >65 yrs were identified who had been enrolled in Medicare for >3 consecutive yrs between 1992-2009. International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9) diagnosis and Current Procedural Terminology (CPT) codes were used to identify subjects with a diagnosis history of XFS and/or POP from the UPDB. Odds ratios from unconditional logistic regression models, adjusted for age last enrolled, number of years enrolled, and parity were used to estimate risk of XFS in females with a history of POP, compared to women without a POP diagnosis.
3,126 patients with XFS and 12,340 with POP were identified. Women had a 1.6-fold increased risk overall (95%CI 1.4-1.7, P<0.0001) and a 2.2-fold risk if <75 years old, of suffering from XFS if they had POP (95%CI 1.5-3.1, P<0.0001). Although increasing age appeared to attenuate risk, XFS remains significantly associated with POP across the participant’s age spectrum (P-interaction= 0.0004).
XFS, known to be a systemic condition with vasculopathies, can now be extended to include elastotic diseases making this a protean disorder. Women with POP or XFS may be at increased risk of both conditions, potentially through shared abnormalities in reparative mechanisms for damaged elastin, collagen-containing tissues and LOXl1. Determining the genetic, molecular, and environmental relationship between XFS and POP may shed light on their shared pathophysiology, thus impacting earlier diagnosis and treatment of these disorders.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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