43 EyeWorld Asia-Pacific | June 2025 GLAUCOMA Pseudoexfoliation syndrome is a systemic, age-related disease—with an up to 20% prevalence in the 60+ age group—that most obviously affects the eye, though there is evidence that it has associations with increased cardiovascular and cerebrovascular morbidity” as well.1 These patients need more frequent monitoring due to an increased risk of developing secondary open angle glaucoma from the condition, and it can impact ocular surgery, such as cataract surgery, as well. Kevin Halenda, MD, and Michael Krause, MD, PhD, provided their perspectives on the condition and advice for its identification, management, and considerations for surgery when pseudoexfoliation syndrome is present. Prevalence And Identification Dr. Halenda said that pseudoexfoliation syndrome in his practice is not rare though not entirely common either. “It’s probably under diagnosed. There are a lot of patients who have it, and there are some subtle exam findings,” he said. Dr. Krause has found in his diverse patient population that pseudoexfoliation is present in many different ethnic groups. The review by Schlötzer-Schrehardt and Naumann cited variation in prevalence with those of Nordic and Eastern Mediterranean descent being most affected. They stated that “variation in prevalence has been proposed to be due to epigenetics, the attitude of inhabitants, UV exposure, climatic conditions, proximity to the equator, dietary factors, oxidative stress mechanisms, genetic predisposition, etc.”1 Identification of pseudoexfoliation is important, Dr. Krause noted, because up to 40–50% of these patients will develop glaucoma as a result. As such, Dr. Halenda said if glaucoma is not yet present, he thinks patients with pseudoexfoliation should be seen in the clinic every 6 months. What’s more, he said glaucoma, if it develops, is often more aggressive and can progress faster than in primary open-angle glaucoma. “They tend to require surgery more frequently and earlier than in primary open angle glaucoma patients because they tend to present with more severe disease,” Dr. Halenda said, noting that he’ll often see patients who have been diagnosed with pseudoexfoliation glaucoma every 4 months until he has an idea of how stable their disease is. There are characteristic exam findings associated with pseudoexfoliation syndrome, Dr. Krause said, noting white fibrillar material on the iris border and white flaky by Ellen Stodola, Editorial Co-Director Pseudoexfoliation Glaucoma: Management And Considerations For Ocular Procedures
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