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Exfoliation Syndrome in Black South Africans
Alan P. Rotchford, MA, MSc, FRCOphth;
James F. Kirwan, MA, FRCOphth;
Gordon J. Johnson, MA, MD, FRCOphth;
Paul Roux, DPH, FCS(Ophth)(SA)
Arch Ophthalmol. 2003;121:863-870.
Background Data on exfoliation syndrome (XFS) in Africans are scarce.
Objective To determine the prevalence and clinical features of XFS among black South Africans.
Design Random cross-sectional samples of the black population aged 40 years or older from 2 districts in South Africa: Hlabisa, in northern KwaZulu-Natal Province, and Temba, North West Province.
Methods Standardized examination, including slitlamp biomicroscopy with pupil dilatation, gonioscopy, pachymetry, tonometry, binocular indirect ophthalmoscopy, and visual field testing.
Results Among 1840 participants, the prevalence of XFS was 7.7% (95% confidence interval, 5.4%-10.5%) in Hlabisa and 6.0% (95% confidence interval, 4.1%-8.4%) in Temba. The prevalence increased with age, with 18.9% (Hlabisa) and 16.5% (Temba) of those 70 or older affected. The clinical appearance was similar to that reported in other ethnic groups. Exfoliative glaucoma accounted for approximately one fourth of open-angle glaucoma cases (OAG). Open-angle glaucoma was associated with XFS; the age-adjusted and sex-adjusted odds ratios were 2.3 (95% confidence interval, 1.0-5.2) and 2.8 (95% confidence interval, 1.2-6.3) for Hlabisa and Temba, respectively. The relationship with OAG was absent when adjusting for intraocular pressure. Exfoliative glaucoma was characterized in this predominantly untreated population by high intraocular pressure and severe visual loss. Among subjects with XFS and OAG, 16 of 18 were blind in 1 or both eyes.
Conclusions Exfoliation syndrome occurs at a high prevalence among black South Africans and incurs a moderate increase in risk of glaucoma. In this untreated population, this increased risk was dependent on raised intraocular pressure. Open-angle glaucoma in association with XFS appears to be associated with a poor prognosis.
From the International Centre for Eye Health, Institute of Ophthalmology, London (Messrs Rotchford and Kirwan and Dr Johnson), and Department of Ophthalmology, Eye, Ear, Nose, and Throat Centre, Nottingham University Hospital, Queen's Medical Centre, Nottingham (Mr Rotchford), United Kingdom; and Department of Ophthalmology, Faculty of Health Sciences, University of Pretoria, Pretoria, Republic of South Africa (Dr Roux). The authors have no relevant financial interest in this article.
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