Exfoliation Syndrome in the Baja Verapaz Region of Guatemala

Abstract

Purpose : There is little epidemiologic data on exfoliation syndrome (XFS) or exfoliation glaucoma (XFG) in Guatemala, especially in the Baja Verapaz region. XFS is an ocular and systemic proteinaceous disorder that causes abnormal fibrillar extracellular material deposition in the eye, heart, brain, lungs and skin (1,2,3). Solar exposure and outdoor occupation have been linked to XFS development (4). This observational study assessing XFS and demographic factors of this region aims to better understand unique exogenous and endogenous risk factors associated with XFS in Guatemala.

Methods : During Moran Eye Center’s global outreach cataract trips in 2016 and 2017, 171 patients were evaluated; 46 XFS and 9 XFG patients over age 49 were identified on site and by chart review (Dr. Orlando Gonzalez, Lions Health Club in Salamá). Age, gender, hometown, ancestry (languages spoken by parents and grandparents), past medical history, family medical history and occupational data were obtained for each patient. Under translated informed consent, blood samples from XFS patients and their family members were collected. This research was conducted under Utah IRB (00081512).

Results : Out of 171 total cataract patients and their cataract-free family relatives, 18 lacked a clear diagnosis of either XFS/XFG or control resulting in 153 viable patients. Of these, 66 were male (43%) and 81 were female (53%) and 6 did not indicate gender. The average age of all patients was 64yrs. Those 55 having XFS and XFG were on average 72yrs. The most common occupations were farming and housekeeping. Higher rates of XFS/XFG were noted in individuals of rural (41%) compared to urban settings (24%). Rates of XFS/XFG in Mayan speaking people were 39% compared with 35% in Spanish speakers. Based on this subset of patients , the prevalence of XFS/XFG appeared to be roughly 35%. Blood analysis is underway.

Conclusions : Although study limitations exist (i.e. small sample size and cataract selection bias), this specific population appears to have a high prevalence of XFS compared with other world populations. Further studies are warranted to better understand possible environmental stressors contributing to XFS. Location, higher altitude, along with a farming occupation may contribute to XFS development and subsequent progression to XFG. To our knowledge, this is the first study looking at the epidemiology of XFS/XFG in Guatemalans.

This is a 2021 ARVO Annual Meeting abstract.