Question 1

What is pseudoexfoliation syndrome?

Accepted Answer

Pseudoexfoliation syndrome (PXF) is when tiny flakes of dandruff-like protein material build up in the body. These microscopic clumps are produced in many tissues, but only cause disease in the eye, where they settle on the iris, lens and drainage structures.

Question 2

Is pseudoexfoliation syndrome an eye disease?

Accepted Answer

The material is produced throughout the body, but it only manifests as a disease in the eye. When the drainage system is clogged by the flaky pseudoexfoliative material and pigment, eye pressure can increase and lead to glaucoma and vision loss.

Question 3

What is pseudoexfoliation glaucoma?

Accepted Answer

Pseudoexfoliation glaucoma is the same condition as pseudoexfoliation syndrome, but with the addition of elevated eye pressure and evidence of damage to the optic nerve. It should not be confused with 'true exfoliation', which is due to heat or infrared exposure.

Question 4

What causes pseudoexfoliation?

Accepted Answer

Doctors do not know for sure. Most think there are both genetic and environmental causes. It is rare in people younger than 50, pointing to age-related changes in the eye tissues. Some people carry a variant in the LOXL1 gene that increases the risk.

Question 5

Who is likely to have pseudoexfoliation syndrome?

Accepted Answer

It is rarely seen before age 50 and its incidence increases with age. It is more common in women and has a high prevalence in Scandinavian countries, where it is estimated to account for up to half of open-angle glaucoma. It is relatively rare in African Americans and Eskimos but is seen across Europe, the Middle East, South Africa and South America.

Question 6

What are the symptoms of PXF?

Accepted Answer

PXF glaucoma does not have any noticeable symptoms. High pressure inside the eye does not cause pain, so patients can slowly lose vision without knowing it. This is why regular eye examinations are important.

Question 7

How is PXF diagnosed?

Accepted Answer

An ophthalmologist can usually find signs of PXF during a comprehensive eye exam. A slit lamp examination using a bright light and microscope is used to look for tiny flakes of PXF material at the front of the eye. A detailed drainage-angle examination and a dilated eye exam are also important.

Question 8

If I have pseudoexfoliation syndrome, will I develop glaucoma?

Accepted Answer

Not everyone with pseudoexfoliation syndrome develops glaucoma. However, it is estimated that approximately 40–50 percent of people with the syndrome will eventually develop glaucoma, so regular follow-up is important to monitor for this.

Question 9

What are the unique features of pseudoexfoliation glaucoma?

Accepted Answer

Eye pressure can be quite high and more difficult to control than in primary open-angle glaucoma. It is often associated with worse visual field loss and greater optic nerve damage. Sometimes it can also be associated with angle-closure glaucoma because the material weakens the structures holding the lens, allowing the lens to move forward and narrow the drainage angle.

Question 10

How is pseudoexfoliative glaucoma treated?

Accepted Answer

As with all glaucomas, the aim is to lower the eye pressure. Medications are often used first, but sometimes they fail to control the pressure adequately. Laser treatment can be very effective, and surgery such as trabeculectomy may be needed for long-term control.

Question 11

What are the challenges of cataract surgery with pseudoexfoliation?

Accepted Answer

Pseudoexfoliation weakens the structures that hold the lens in place, increasing the risk of complications during cataract surgery and the risk of the implanted lens dislocating later. Your surgeon will take extra precautions and may recommend not waiting too long before surgery, as dense cataracts make the operation more difficult. It is important to discuss the risks fully with your ophthalmologist beforehand.

Question 12

Can pseudoexfoliation syndrome be prevented?

Accepted Answer

There is no proven way to prevent it. The best recommendations are the same as for other age-related eye diseases: have regular comprehensive eye examinations and wear sunglasses. If you are diagnosed with pseudoexfoliation syndrome, maintain follow-up visits with your ophthalmologist to monitor for glaucoma.

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