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Pseudoexfoliation in Southern India: The Andhra Pradesh Eye Disease Study

¹From Glaucoma Services, L. V. Prasad Eye Institute and ²Epidemiology and Biostatistics, International Center for Advancement of Rural Eye Care, L. V. Prasad Eye Institute, Hyderabad, India.

PURPOSE. To report the prevalence of pseudoexfoliation (PXF) and its associations with ocular diseases in a south Indian population.

METHODS. This was a population-based, cross-sectional epidemiologic study in the south Indian state of Andhra Pradesh (AP). A total of 10,293 subjects of all ages from one urban and three rural areas representative of the population of AP were interviewed and underwent a comprehensive ophthalmic evaluation. PXF was diagnosed on slit lamp biomicroscopy by the presence of white dandruff-like material in the pupillary margin, on the trabecular meshwork, and/or on the anterior lens capsule of one or both eyes.

RESULTS. The age-gender-area–adjusted overall prevalence of PXF was 0.69% (95% CI: 0.53–0.86). The prevalence of PXF increased with increasing age: 3.01% (95% CI: 2.45–3.80), in those 40 years of age or older, and 6.28% (95% CI: 4.80–7.76), in those 60 years of age or older. The prevalence of PXF was significantly higher among people whose occupation involved outdoor activities (adjusted odds ratio [OR], 2.14; 95% CI: 1.10–4.16). After adjustment for age, the prevalence of PXF was significantly higher in those with nuclear cataract (adjusted OR, 2.00; 95% CI: 1.13–3.54). PXF was significantly associated with blindness (adjusted OR, 2.19; 95% CI: 1.16–4.13). Fifteen (20.5%; 95% CI: 11.20–29.80) of those with PXF were blind, with age-adjusted relative risk (RR) = 4.25 (95% CI: 4.01–4.51). Unilateral blindness (41.2%; 95% CI: 29.81–52.39) and visual impairment (45.21%; 95% CI: 34.29–57.13) were also more common with PXF. Four subjects (5.5%; 95% CI: 0.27–10.2) of those with PXF had glaucoma. The prevalence of PXF in those with glaucoma was 4.2%; (95% CI: 0.17–8.23). In general linear models, the estimated mean ± SE of IOP with glaucoma and PXF was 24.14 ± 1.41 mm Hg and was 18.94 ± 0.26 mm Hg with glaucoma in the absence of PXF; the difference was statistically significant (P < 0.0001).

CONCLUSIONS. The association of PXF with blindness and aging has public health implications for India. This is especially so considering the burden of cataract with aging and the association of PXF with cataract as well as complications of cataract surgery. The diagnosis of PXF may also be important in the management of glaucoma in this population.

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