Exfoliation Syndrome in Baja Verapaz Guatemala: A Cross-Sectional Study and Review of the Literature

Abstract

There are little epidemiologic data on exfoliation syndrome (XFS) or exfoliation glaucoma (XFG) in Guatemala, especially in the underserved Baja Verapaz region. This observational study assessing XFS/XFG and demographic factors of this region aims to better understand unique exogenous and endogenous risk factors associated with XFS/XFG in Guatemala. During Moran Eye Center’s global outreach medical eye camps from 2016–2017, 181 patients age 15 years and older presented for complete eye exams. These individuals were screened for eye disease and evaluated for possible surgical interventions that could occur during the camps to improve eyesight. During the dilated exams, XFS was noted as missing or present. Of those 181, 10 had insufficient data and 18 lacked a definitive diagnosis of XFS or XFG, resulting in 153 evaluable patients; 46 XFS and 9 XFG were identified. Age, gender, hometown, ancestry (languages spoken by parents and grandparents), past medical history, family medical history, and occupational data (only 2017 trip) were obtained for each patient. The most common occupations of these individuals were farming and housekeeping. Higher rates of XFS/XFG were noted in individuals of rural compared to urban settings and Mayan speaking people compared with Spanish speakers. Based on this subset of patients, with various ocular pathologies being evaluated during medical eye outreach camps, the prevalence of XFS/XFG appeared to be 36%, a high prevalence compared to other world populations. Location and higher altitude, along with a farming occupation, may contribute to XFS development and subsequent progression to XFG. To our knowledge, this is the largest study looking at the epidemiology of XFS/XFG in the Baja Verapaz region of Guatemala for those over the age of 15 years seeking eye exams and interventions.

Secondary glaucoma: Toward interventions based on molecular underpinnings

“…Increased solar exposure, especially that reflected off surfaces, such as snow or water, increases the risk of developing PEX (Pasquale et al, 2014). Individuals with a greater average of outdoor activities and ultraviolet (UV) light exposure throughout their lifetime may be more susceptible to PEX (Kim et al, 2016; Paulson et al, 2022; Sureshkumar et al, 2022). Higher altitudes have been associated with an increased risk of PEX (Paulson et al, 2022; Stein et al, 2011).…”

“…Individuals with a greater average of outdoor activities and ultraviolet (UV) light exposure throughout their lifetime may be more susceptible to PEX (Kim et al, 2016; Paulson et al, 2022; Sureshkumar et al, 2022). Higher altitudes have been associated with an increased risk of PEX (Paulson et al, 2022; Stein et al, 2011). Dietary factors also play a role in PEX development.…”

Toxic External Exposure Leading to Ocular Surface Injury

“…Several studies have suggested implications of UV exposure in increased risk of conjunctival melanoma as well [ 256 , 257 ]. Exfoliation syndrome and exfoliation glaucoma, characterized by abnormal deposition of fibrillar extracellular material in the anterior chamber of the eye, although genetically based, may also be promoted by excess UV exposure [ 258 , 259 ].…”