Glaucoma is
significantly more common in eyes with exfoliation syndrome (XFS). In normotensive persons with XFS, the
risk of developing exfoliation glaucoma (XFG) is cumulative over time with the
rate of conversion calculated to be approximately 1,5% per year. Thus, the presence of XFS in an
otherwise normal eye is an important risk factor for the development of
glaucoma. It has been estimated
that in normal eyes XFS increases 10 times the risk for glaucoma. Overall, XFS patients would have
approximately a 40% chance of either having initially, or developing ocular
hypertension or glaucoma within ten years. However, a significant number of patients
with XFS do not develop XFG in their lifetime. It appears that the risk of XFG development (1,5% per year)
in patients with XFS is at least similar to that of POAG in patients with
ocular hypertension. Therefore,
long term monitoring of XFS patients is crucial in preventing visual loss from
XFG. Although most, if not all, patients
with clinically visible unilateral XFS probably have bilateral disease, the
asymmetry of involvement and progression of glaucoma in XFS is striking.
Specific clinical attributes distinguish XFG from POAG. There is uniform agreement that XFG has a more serious
clinical course than POAG. There is a significantly higher frequency and
severity of optic nerve damage at the time of diagnosis, worse visual field
damage, poorer response to medications, more severe clinical course, and more
frequent necessity for surgical intervention. The more rapid progression of glaucomatous damage in XFG
compared with POAG can probably be attributed to the worse IOP characteristics
in XFG. The mean diurnal IOP, the
mean range of IOP and the mean maximum IOP are significantly greater in eyes
with XFG. The
worse prognosis for XFG is shown by the fact that the probability for severe
visual loss is two times greater compared with POAG.