Pseudoexfoliation in a rural population of southern India: The Aravind comprehensive eye survey

OBJECTIVE: To determine the prevalence and risk factors for pseudoexfoliation in a rural population of southern India. DESIGN: A population-based cross,sectional study of pseudoexfoliation with and without glaucoma in rural southern India. PARTICIPANTS: A total of 5,150 subjects aged 40 years and older from 50 clusters representative of three southern districts of Tamil Nadu in southern India. METHODS: All participants had a comprehensive eye examination at the base hospital, including visual acuity using logarithm of minimal angle of resolution (logMAR) illiterate E charts and refraction, slit-lamp biomicroscopy, gonioscopy, applanation tonometry, dilated fundus examinations, and automated central 24-2 full,threshold perimetry. Pseudoexfoliation (PXF) was diagnosed by the presence of typical white deposits on the anterior lens surface; additional sites included the cornea, iris, anterior vitreous face, posterior capsule, and intraocular lens in cataract-operated eyes and changes in the angle determined through gonioscopy, including increased pigmentation, PXF deposition, and PXF material within the angle. RESULTS: The prevalence (95% confidence interval) of PXF was 6.0% (5.3, 6.6). The prevalence increased with age (P <.001) and was greater in males (P =.01). Of subjects with PXF, 25.7% remained bilaterally blind after best correction; 89.3% of this bilateral blindness was the result of cataracts. The prevalence of glaucoma among subjects with PXF was 7.5%; exfoliation was present in 26.7% of those identified as primary open-angle glaucoma. On multivariate analysis, increasing age and male gender were significantly associated with PXF. CONCLUSIONS: Pseudoexfoliation appears to be a relatively common disorder in older individuals in southern India. Ophthalmologists in India may wish to focus on the detection of PXF, especially considering the relatively large burden of cataracts in this population, the risks for operative complications related to PXF, and the fact that PXF may be used as a marker to aid in the detectection of glaucoma. (C) 2003 by Elsevier Inc. All rights reserved.