What have we learned about exfoliation syndrome since its discovery by John Lindberg 100 years ago? | British Journal of Ophthalmology

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What have we learned about exfoliation syndrome since its discovery by John Lindberg 100 years ago?

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Letter to the Editor - XFS Reply
Samir Nazarali, Faraz Damji and Karim F Damji
Published on: 24 September 2018
Letter to the Editor - XFS
Hugh R Taylor
Published on: 24 September 2018

Published on: 24 September 2018
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

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 Less

Conflict of Interest:
None declared.
- Back to top
Published on: 24 September 2018
Letter to the Editor - XFS
- Hugh R Taylor, Ophthalmologist The University of Melbourne
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

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 Less

Conflict of Interest:
None declared.
- Back to top