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Long-term follow-up of pseudoexfoliation, intraocular pressure and glaucoma: epidemiological studies in northern Sweden
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Purpose An age-cohort was studied with long-term follow-up. The population was born in 1915, living in the municipality of Skellefteå in 1981. The purpose was to investigate the prevalence and incidence of pseudoexfoliation (PEX), its influence on intraocular pressure (IOP) and development of open-angle glaucoma (OAG). Another purpose was to estimate the value of screening for glaucoma by comparing the screened group within the cohort with the remaining unscreened group.

Methods In 1981, 339 (40%) of the 856 individuals in the cohort underwent an eye examination. This screened group was re-examined at seven-year intervals until 2002. At each visit the presence of PEX was registered, IOP was measured and the presence of glaucoma was assessed. After the 21-year follow-up period, glaucoma cases were also searched for in the medical records of the remaining unscreened individuals in the cohort. Proportions of glaucoma were compared between the two groups.

Results The prevalence of PEX was 23% (95% confidence interval (CI): 20-26%) at the age of 66 and increased to 61% (CI: 50-71%) at the age of 87. The annual incidence of PEX was 1.8% (CI: 1.3-2.4%). The prevalence of OAG increased from 2.1% (CI: 0.8-4.3%) at the age of 66 years to 25 % (CI: 16-35%) at 87 years. The overall annual incidence of OAG was 0.9% (CI: 0.6-1.3%) and for OAG with PEX 2.1% (CI: 1.2-3.3%). PEX increased the risk of developing glaucoma at least four-fold. The incidence of diagnosed OAG in women was higher in the screened group than in the unscreened group (incidence rate ratio (IRR)=1.94, p=0.035). A corresponding difference could not be verified for men (p=0.58). The mean, agedependent, increase in IOP during the 21-year observation period was 0.05 mmHg/year.

Conclusion The prevalence of PEX in this study population was the highest reported, and it increased with age. The presence of PEX increased the risk of developing OAG four times. In this study a higher proportion of OAG was revealed by screening among women but not among men. The age-related IOP increase was clinically insignificant.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2013. , 33 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1548
Keyword [en]
Pseudoexfoliation, glaucoma, intraocular pressure, age cohort, screening, long-term follow-up
National Category
Ophthalmology
Identifiers
URN: urn:nbn:se:umu:diva-64301ISBN: 978-91-7459-551-2 (print)OAI: oai:DiVA.org:umu-64301DiVA: diva2:599875
Public defence
2013-02-22, Sal E04, Biomedicinhuset, suterrängplan, by 6E, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-01-23 Created: 2013-01-22 Last updated: 2013-01-23Bibliographically approved
List of papers
1. Incidence and prevalence of pseudoexfoliation and open-angle glaucoma in northern Sweden: I. Baseline report.
Open this publication in new window or tab >>Incidence and prevalence of pseudoexfoliation and open-angle glaucoma in northern Sweden: I. Baseline report.
2007 (English)In: Acta Ophthalmologica Scandinavica, ISSN 1395-3907, E-ISSN 1600-0420, Vol. 85, no 8, 828-831 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To evaluate the prevalence of pseudoexfoliation (PEX) syndrome and open-angle glaucoma (OAG) among 66-year-old people in the municipality of Skellefteå in northern Sweden.

METHODS: A population-based study comprising 339 individuals, representing 40% of the age group and 87% of those randomly selected. The examination included tonometry, dilated slit-lamp biomicroscopy, optic disc evaluation and a visual field analysis if glaucoma was suspected.

RESULTS: The overall prevalence of PEX syndrome was 23%[95% confidence interval (CI): 20-26%], 29% (CI: 24-34%) in women and 15% (CI: 10-19%) in men (P < 0.01). The intraocular pressure (IOP) in PEX eyes was higher (17.3 mmHg, SD 4.5 mmHg) than in eyes without PEX [15.7 mmHg, SD 3.7 mmHg; P < 0.001]. IOP exceeded 22 mmHg in 17% (CI: 11-23%) of the PEX eyes and in 3.0% (CI: 1.9-4.1%) of the non-PEX eyes. Seven individuals (2.1%) had OAG. Six were associated with PEX, i.e. 7.7% of the PEX individuals.

CONCLUSION: PEX syndrome is common in northern Sweden, affecting every fourth individual reaching the age of 66 years. The prevalence in women is twice that in men. Elevated IOP is roughly six times more frequent in eyes with PEX than in eyes without PEX syndrome. The prevalence of OAG is 2.1%.

Keyword
epidemiology, exfoliation, open-angle glaucoma, prevalence, pseudoexfoliation
National Category
Ophthalmology
Research subject
Ophtalmology
Identifiers
urn:nbn:se:umu:diva-23656 (URN)10.1111/j.1600-0420.2007.00992.x (DOI)17986290 (PubMedID)
Available from: 2009-06-29 Created: 2009-06-29 Last updated: 2013-01-23Bibliographically approved
2. Incidence and prevalence of pseudoexfoliations and open-angle glaucoma in northern Sweden: II. Results after 21 years of follow-up.
Open this publication in new window or tab >>Incidence and prevalence of pseudoexfoliations and open-angle glaucoma in northern Sweden: II. Results after 21 years of follow-up.
2007 (English)In: Acta Ophthalmologica Scandinavica, ISSN 1395-3907, E-ISSN 1600-0420, Vol. 85, no 8, 832-837 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To prospectively evaluate the prevalence and incidence of pseudoexfoliation (PEX) syndrome and open-angle glaucoma (OAG) with and without PEX and to evaluate PEX as a risk factor for glaucoma in a population born in 1915 and living in the municipality of Skellefteå in northern Sweden.

METHODS: A randomized population study comprising 339 individuals. The cohort was followed for 21 years at 7 year intervals. The examination included tonometry, dilated slit-lamp biomicroscopy, optic disc evaluation and, if glaucoma was suspected, a visual field analysis.

RESULTS: The prevalence of PEX increased from 23%[95% confidence interval (CI): 20-26] at 66 years of age to 61% (CI 50-71) at 87 years. The annual incidence of PEX was 1.8% (CI 1.3-2.4). In the group of subjects with unilateral PEX, 55% converted to bilateral PEX during follow-up. The prevalence of OAG was 2.1% (CI 0.8-4.3%) at 66 years of age and 25% (CI 16-35) at 87 years. Of the glaucoma cases, 59% had PEX. There was no difference in incidence between the sexes. The annual incidence of PEX and OAG did not increase with time. The overall annual incidence of OAG was 0.9% (CI 0.6-1.3%) [0.5% (CI 0.2-0.9) without PEX and 2.1% (CI 1.2-3.3) with PEX]. PEX increased the risk of glaucoma four fold in both sexes. There was no significant difference in mortality between individuals with or without PEX.

CONCLUSION: PEX syndrome and OAG are common in the north of Sweden. Prevalences increase with age. PEX increases the risk of glaucoma four fold. The consequences of this situation demand guidelines for handling patients with PEX, with or without other risk factors. In order to issue guidelines, more information is needed on the impact of the disease on the general health in the ageing population.

Keyword
Age Distribution, Aged; 80 and over, Cohort Studies, Exfoliation Syndrome/complications/*epidemiology, Female, Follow-Up Studies, Glaucoma; Open-Angle/complications/*epidemiology/etiology, Humans, Incidence, Male, Prevalence, Prospective Studies, Risk Factors, Sex Distribution, Sweden/epidemiology
National Category
Ophthalmology
Research subject
Ophtalmology
Identifiers
urn:nbn:se:umu:diva-7315 (URN)10.1111/j.1600-0420.2007.00980.x (DOI)17986292 (PubMedID)
Available from: 2008-01-08 Created: 2008-01-08 Last updated: 2013-01-23Bibliographically approved
3. Intraocular pressure changes over 21 years: a longitudinal age-cohort study in northern Sweden
Open this publication in new window or tab >>Intraocular pressure changes over 21 years: a longitudinal age-cohort study in northern Sweden
2014 (English)In: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 92, no 5, 417-420 p.Article in journal (Refereed) Published
Abstract [en]

Purpose:  To follow intraocular pressure (IOP) and the influence of pseudoexfoliation (PEX) and cataract extraction in an age-cohort in northern Sweden; patients were followed prospectively for 21 years from age 66 to 87 years.

Methods:  Three Hundred and thirty-nine individuals, randomly selected from an age-cohort born in 1915 underwent ophthalmological examination including measurement of IOP with Goldmann applanation tonometry, screening for PEX and glaucoma. Follow-up examinations were performed three times with 7-year intervals. Medical records were reviewed for dates of cataract surgery and glaucoma treatment. A linear mixed model was used to analyse the impact of sex, eye (right/left), PEX, cataract extraction and time on IOP.

Results:  Without cataract surgery, the IOP from age of 66 to 87 years, increased by 0.05 mmHg/year (p < 0.001). If cataract surgery was included in the model, no significant change in IOP over time was found. The estimated contribution of PEX to IOP was +2.05 mmHg (p < 0.001), and the contribution of cataract surgery was −2.13 mmHg (p < 0.001). The mean IOP in women was 1.22 mmHg higher than in men (p = 0.001).

Conclusion:  A small but statistically significant increase in IOP with age was detected when excluding eyes that had undergone cataract surgery. PEX was associated with a higher IOP and cataract extraction with a lower.

Place, publisher, year, edition, pages
John Wiley & Sons, 2014
Keyword
cataract surgery, intraocular pressure, longitudinal, long-term, pseudoexfoliation
National Category
Ophthalmology
Identifiers
urn:nbn:se:umu:diva-64308 (URN)10.1111/aos.12232 (DOI)000339482700027 ()
Available from: 2013-01-22 Created: 2013-01-22 Last updated: 2017-12-06Bibliographically approved
4. Open-angle glaucoma in screened versus unscreened subjects: a long-term age-cohort study
Open this publication in new window or tab >>Open-angle glaucoma in screened versus unscreened subjects: a long-term age-cohort study
(English)Article in journal (Other academic) Submitted
National Category
Ophthalmology
Identifiers
urn:nbn:se:umu:diva-64309 (URN)
Available from: 2013-01-22 Created: 2013-01-22 Last updated: 2013-01-23Bibliographically approved

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