Pseudo-Exfoliation syndrome is a fairly common condition in which “dandruff-like flaking” is found in the anterior segment of the eye including on the lens. The cause is unknown. The material probably arises from multiple sources in the front of the eye. It usually affects both eyes but may be asymmetrical.
True exfoliation is a condition caused by exposure to intense heat, most typically seen in glass blowers. Here the capsule of the lens becomes wrinkled and peeled. In time, a cataract forms. In the condition being described above, the appearance of the “peeling” lens capsule is similar thus the name “pseudo” meaning false, exfoliation.
Pseudo-exfoliation is seen in all races and ethnic groups but usually is not seen before age 55. PXF is important to diagnose because it is associated with two important ocular diseases, namely CATARACTS and GLAUCOMA.
75% of patients with pseudo-exfoliation syndrome will eventually develop cataracts. Surgery is not necessary until symptoms of blurred vision or glare begin to bother the patient. There is an increased risk with surgery due to poor dilation of the pupil, an abnormal anterior capsule and weak lens support. However, most patients do very well with the operation. A newer technique, called Laser-Assisted Cataract Surgery (LACS) may reduce the risk of complications during cataract surgery and may be advisable for patients with PXF.
Between 15 and 20% of patients with pseudo-exfoliation will develop glaucoma over a 5 year period. This is compared to 1-2% of the normal population. This disorder is somewhat more difficult to manage than the typical glaucoma case. Extra effort is needed in keeping a close eye on intraocular pressures, visual fields and optic nerve changes. Visual Field Tests, Fundus Photography, and OCT imaging will be utilized annually to monitor for the development of glaucoma. Topical medication, laser treatments and filtering eye surgery may all be necessary to control the intra-ocular pressure.
In conclusion, pseudo-exfoliation by itself is not a threat to vision. However, it is a condition which must be identified. Once identified, a patient with this condition must be followed carefully for the rest of their life for the above-mentioned concerns to ensure good vision.
