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Tzukit Zehavi-Dorin, Louis R Pasquale, Hani Levkovitch-Verbin; Exfoliation Syndrome - The Maccabi Glaucoma Study. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5613.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate exfoliation syndrome (XFS) epidemiology and its association with systemic diseases and solar exposure related diseases including skin cancer, pterygium and actinic keratosis.
This is a population-based, retrospective, case control study, conducted using the electronic medical database of Maccabi Health Services, the second largest HMO in Israel, insuring 25% of the total population with a nationwide distribution . Study population included Maccabi members from January 2003 to April 2016. The study group included patients diagnosed with XFS with or without glaucoma, according to ICD-9 and CPT codes. The control group was age, sex and ancestry matched and included patients without XFS that were examined by an ophthalmologist within the last 12 months.
We have identified 16,393 patients with XFS, in whom 40.3% (n=6613) had exfoliation glaucoma. The control group included 14,101 patients. Mean age was 78.3 years old and 75.8 for the XFS and control group, respectively. XFS was significantly associated with higher rate of hospitalizations (5 hospitalizations on average in the XFS group (SD± 5.3) and 3.3 in the controls (SD± 4), p< 0.0001) and significantly higher mortality (22.2% in XFS vs 2.3% in the controls, p< 0.0001). XFS was associated with cardiovascular diseases including hypertension (77.7% vs 74.5% in the controls, p<0.0001), myocardial infarction (10.4% vs 8.4% in the controls, p< 0.0001%), and congestive heart failure (9.2% vs 5% in the controls, p< 0.0001). However, diabetes mellitus was less frequent in the XFS group (32.5% vs 40.8%, p < 0.0001). Overall cancer diagnoses were more common in the XFS group (28.16% vs 26.74%, p < 0.0001), yet skin cancer (including melanoma, basal cell carcinoma or squamous cell carcinoma) was not associated with XFS (11.8% in the XFS group vs 15.1% in the controls). Cataract was significantly more common in XFS patients (82.7% vs 59.2%, p< 0.0001). Pterygium and actinic keratosis were not associated with XFS.
These data support strong associations between systemic disease and XFS with significantly higher mortality in these patients.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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