Exfoliation Glaucoma – Closer to a Cure

Written by Dr. David Evans   Last modified on August 6, 2018

I recently returned from the Glaucoma Foundation Annual Think Tank, where I was invited to participate as an observer. I began my academic career as a glaucoma researcher, so found the presentations extremely fascinating. The event began on Thursday evening with a Black Tie awards ceremony at Carnegie Hall. (The picture below shows the initial gathering on the 9th floor open deck. The one that looks like a Maître D’ is me.)

The focus this year — as well as for the past 5 years — centered on exfoliation syndrome, a condition that occurs when microscopic granular white flakes accumulate on the surface of the lens and iris. Exfoliation as you’re likely familiar is a cosmetic process of removing old, dead skin cells from the outermost dermal layer; typically part of a facial or spa treatment. The “exfoliation” of exfoliation glaucoma isn’t too dissimilar in that it relates to materials that are rubbed off by the movement of the iris. Except in this instance, the exfoliated materials aren’t removed; they simply accumulate and clog, leading to an increase in intraocular pressure.

Exfoliation is the most common identifiable cause for open-angle glaucoma, and in many countries, is the primary cause. Early research suggested that this syndrome was primarily genetic given that many Nordic countries have high incidence rates of this condition. (Two specific genes associated with exfoliation syndrome have been identified.) However, new data presented at the Think Tank suggests that the condition has much more of an environmental component than first thought. For example, data from a U.S. study shows a much higher incidence rate in colder northern states compared to warmer southern states, leading researchers to now believe that cold climates are more closely related to the condition than genetic heritage.  Nordic countries tend to have colder climates which, when combined with the genetic element, helps to explain the high incidence rates.

Although this new research puts an emphasis on environmental factors, researchers aren’t throwing in the towel on the genetic component. Clusters of high incidence rates were reported across several parts of Asia, including certain islands of Japan, that are in close proximity, suggesting that exfoliation glaucoma has both a genetic and environmental component.

Based on this analysis of environmental facts, the condition is now believed to be a systemic condition and not strictly an eye problem. It was originally thought to be exclusive to the eye because the white flakes had only been observed inside the eye, and not in other areas of the body. However research presented last weekend suggests that blood vessels and certain connective tissues may also be impacted by exfoliation that had not previously been detected. Associations with other conditions, including stroke, cardiovascular dysfunction, Alzheimer’s and hearing loss were also noted.

As Dr. Bob Ritch, Medical Director of the Glaucoma Foundation and Think Tank Organizer stated, “We now know that exfoliation is not a type of glaucoma, but an ocular manifestation of a systemic disease.” He went on to add that armed with this new research information, “We feel that the time is ripe and the technology available to begin to consider reversing the formation of exfoliation material, reducing the clinical symptoms and eventually achieving a cure.”

From a personal perspective, it’s interesting to note that this syndrome was discovered more than 100 years ago, but it is only now being more fully defined and evaluated. As this focus increases, a cure for exfoliation glaucoma appears to be on the horizon, which will open the door for further understanding of other causes of glaucoma, and their respective cures.

Congratulations to the Glaucoma Foundation for spearheading this research thrust… and for giving me a chance to wear my tux in Carnegie Hall.

If you’d like to help make a difference you can donate to The Glaucoma Foundation for continued research.