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What have we learned about exfoliation syndrome since its discovery by John Lindberg 100 years ago?
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  • Published on:
    Letter to the Editor - XFS Reply
    • Samir Nazarali, Medical Student University of Ottawa
    • Other Contributors:
      • Faraz Damji, Student
      • Karim F Damji, Glaucoma Specialist and Chair of the Department of Ophthalmology and Visual Sciences

    Dear Sir,

    We appreciate Dr. Taylor’s interest in our paper as well as drawing our attention to environmental factors that may influence XFS in Australian aboriginal people. Certainly, this is an area that deserves further investigation. Dr Taylor’s review article presents some interesting findings, particularly regarding the high incidence of XFS in Aboriginal individuals. (1)

    Consistent with recent literature, Dr. Taylor identified a ‘latitude effect’. Interestingly however, XFS was more commonly observed at lower latitudes, which contrasts other findings of high altitude exposure associated with XFS in an American population. (2)

    The recognition of solar radiation exposure as an environmental factor associated with XFS is plausible due to accumulating evidence that supports this relationship. (3) While providing some useful insights, this article justifies the lack of understanding and the need for further research on environmental factors.

    1. Taylor HR. Pseudoexfoliation, an environmental disease? Trans Ophthalmol Socs UK 1979; 99: 302- 307
    2. Stein JD, Pasquale LR, Talwar N, Kim DS, Reed DM, Nan B, Kang JH, Wiggs JL,Richards JE. Geographic and climatic factors associated with exfoliation syndrome. Arch Ophthalmol. 2011 Aug;129(8):1053-60.
    3. Jiwani AZ, Pasquale LR. Exfoliation Syndrome and Solar Exposure: New Epidemiological Insights Into the Pathophysiology of the Disease. International ophthalmology clinics. 2015;55(4):13.

    ...Show More
    Conflict of Interest:
    None declared.
  • Published on:
    Letter to the Editor - XFS

    Dear Sir,

    I was most interested to read the review by Nazarali and co-authors to mark the centenary of the description of the exfoliation syndrome, XFS(1) sometimes called the pseudo-exfoliation syndrome (2). It is always interesting to see how our understanding increases incrementally with time and reviews such as these are important in helping shape further investigations.

    The linkage of environmental factors and XFS is important and as they say not well understood. Nazarali and co-authors might like to reflect on the findings in Australian Aboriginal people (3). Aboriginal people were found to have very high rates of XFS, being present in 16% of those aged 60 and above. The presence of XFS was related to total global radiation exposure and occupation. Most interestingly, XFS was not associated with high intraocular pressure or glaucoma. Surely this is an area where more research is required.

    1. Nazarali S, Damji F, Damji KF. What have we learned about exfoliation syndrome since its discovery by John Lindberg 100 years ago? Br J Ophthalmol 2018; doi:10.1136/bjophthalmol-2017-3111321
    2.Dvorak-Theobald G. Pseudo-exfoliation of the lens capsule - relation to “true” exfoliation of the lens capsule as reported in the literature and role in the production of glaucoma capsulocuticulare. Am J Ophthalmol 2018; doi.org/10.1016/j.ajo2108.02.018
    3. Taylor HR. Pseudoexfoliation, an environmental disease? Trans Ophthalmol Socs UK 1979; 99: 302-307...

    Show More
    Conflict of Interest:
    None declared.