Twelve-year Incidence of Exfoliation Syndrome in the Reykjavik Eye Study

To examine the 12-year incidence of exfoliation syndrome (XFS) in persons aged 50-79 years at baseline and also to monitor changes in related ophthalmologic variables, to identify possible risk factors for incidence and to estimate the reliability of our diagnostic criteria.

Baseline examination was performed in 1996 on a random sample of 1045 participants from the population of Reykjavik, 50 years and older. Five years later, in 2001, 88.2% of survivors returned for a follow-up. In 2008, 12 years after the baseline examination, a total of 573 participants returned for the third examination (71.5% of survivors). On all three occasions, the participants underwent a thorough eye examination including slitlamp examination specifically looking for XFS and answered a comprehensive questionnaire.

A total of 8.0% of participants developed XFS during the follow-up period in at least one eye, with women being more commonly affected than men, 9.2% versus 6.6%. The overall 12-year incidence for either eye increased with increasing age, from 6.5% in those participants aged 50-59 years at baseline to 10.6% in those that were 70-79 years at baseline; 71% of clinically unilateral cases had converted to bilateral over 12 years.

Twelve-year incidence of XFS is higher in women than in men and higher in older age groups than in younger ones. Most persons deemed on the slitlamp to be unilaterally affected have converted to bilateral over 12 years. Eyes with XFS at baseline were 3-4 times more likely to have cataract surgery during the 12 years. Our definition of definite XFS generally holds, while our definition of probable XFS is of no prognostic value over 12 years.