Original articles
Pseudoexfoliation syndrome in Australian adults

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Abstract

PURPOSE: To describe the prevalence and correlates of pseudoexfoliation syndrome in Australians aged 40 years and older.

METHODS: Cluster, stratified sampling was employed to identify a cohort representative of the population of the state of Victoria aged 40 years and older that included urban, rural, and nursing home residents. A standardized personal interview and clinical eye examination, including intraocular pressure, were performed at locally established test sites. The presence of any pseudoexfoliation material on the iris or lens capsule was noted on dilated slit-lamp examination. Participants were classified as having pseudoexfoliation syndrome if any pseudoexfoliation material was present in either eye. Univariate analyses with t tests and chi-square were first employed to evaluate risk factors for pseudoexfoliation. Any factors with P < .10 were then fitted in a backward stepwise logistic regression model. For the final multivariate models, P < .05 was considered statistically significant.

RESULTS: A total of 3,271 of the urban residents (83% of eligible), 403 nursing home residents (90% of eligible), and 1473 rural residents (92%) participated. The urban residents ranged in age from 40 to 98 years (mean = 59), and 1,511 (46%) were men. The nursing home residents ranged in age from 46 to 101 years (mean 82), and 85 (21%) were men. The rural residents ranged in age from 40 to 103 years (mean 60), and 701 (47.5%) were men. Participants with bilateral cataract extraction were excluded from further analyses. The overall rate of pseudoexfoliation syndrome in this population was 0.98% (95% confidence limit = 0.57, 1.28). The prevalence of pseudoexfoliation material in either eye increased significantly with age. No cases of pseudoexfoliation syndrome were observed in people aged 90 years and older. However, people with bilateral cataract surgery had been excluded from these analyses. After adjusting for age and cataract, only glaucoma remained significantly related to pseudoexfoliation (odds ratio = 3.80, 95% confidence limit = 1.73, 8.33).

DISCUSSION: In conclusion, we found only two strong correlates of pseudoexfoliation in our population-based sample of Victorians aged 40 years and older: age and glaucoma.

Section snippets

Methods

Details of the methodology for the Visual Impairment Project have been published previously.20 Briefly, cluster, stratified random sampling was employed to identify a cohort representative of the population of the state of Victoria, Australia, who were aged 40 years and older. The study cohort comprised nine pairs of urban census collector districts, 14 nursing homes, and four pairs of rural census collector districts. The nursing home and rural areas were oversampled relative to the urban

Results

A total of 3,271 of the urban residents (83% of eligible), 403 nursing home residents (90% of eligible), and 1,473 rural residents (92% of eligible) participated. Nonparticipants did not differ from participants in any way likely to bias these results.26 Non–English-speaking residents were significantly less likely to participate than English-speaking residents (odds ratio = 0.60, 95% confidence limit = 0.44, 0.81). However, the rate of participation was fairly high in all language groups

Discussion

Pseudoexfoliation syndrome was found to be a relatively common condition, affecting 6% of people in their eighties. The overall rate of 0.98% (95% confidence limit, 0.57, 1.28) in the Visual Impairment Project is slightly less than the rates reported in the Framingham Eye Study (1.8%)15 and the Blue Mountains Eye Study (2.3%),18 but the Visual Impairment Project study population is younger than the other two studies, so the rates are not directly comparable. The Framingham Eye Study and the

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    The Visual Impairment Project was funded in part by grants from the National Health and Medical Research Council, Woden, ACT, the Victorian Health Promotion Foundation, Melbourne, VIC, the estate of the late Dorothy Edols, Melbourne, VIC, and the Jack Brockhoff Foundation, Melbourne, VIC. Dr McCarty is the recipient of a Wagstaff Fellowship in Ophthalmology from the Royal Victorian Eye and Ear Hospital, Melbourne, VIC.

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