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Original Investigation
April 2017

Association of Pseudoexfoliation With Systemic Vascular Diseases in a South Indian Population

Author Affiliations
  • 1Aravind Eye Care System, Tamil Nadu, India
  • 2Wilmer Eye Institute and Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland
  • 3Department of Ophthalmology, University of Maryland, Baltimore
  • 4Kellogg Eye Center, University of Michigan, Ann Arbor
JAMA Ophthalmol. 2017;135(4):348-354. doi:10.1001/jamaophthalmol.2017.0064
Key Points

Question  Are patients with pseudoexfoliation more likely to demonstrate cardiovascular risk factors compared with persons without pseudoexfoliation?

Findings  In this cross-sectional postoperative study of 1406 individuals in India, 930 patients with pseudoexfoliation demonstrated higher systolic blood pressure and a greater likelihood of electrocardiographic abnormalities compared with 476 control patients. No association was noted between pseudoexfoliation and other risk factors, including blood glucose, serum cholesterol, and serum homocysteine levels.

Meaning  Indian patients with pseudoexfoliation presenting for cataract surgery show higher blood pressures and a slightly higher frequency of cardiac morbidity than do patients without pseudoexfoliation presenting for cataract surgery.


Importance  Ocular pseudoexfoliation (PEX) syndrome may be associated with systemic vascular diseases, which might suggest a broader health significance of PEX, although previous reports are conflicting.

Objective  To determine whether prespecified vascular risk factors and cardiac abnormalities are more common among patients with PEX than among control individuals without PEX.

Design, Setting, and Participants  This cross-sectional analysis of patients recruited into the Aravind Pseudoexfoliation study included South Indian patients older than 40 years with or without PEX who required cataract surgery. Surgical procedures were performed at 4 tertiary Aravind eye hospitals in Tamil Nadu, India, from December 2, 2010, through March 26, 2012. Nine hundred thirty patients with PEX and 476 non-PEX controls underwent detailed ocular examinations, including specific ocular features reflecting PEX. Patients also underwent evaluation for multiple systemic potential cardiovascular diseases and their risk factors. The data collection for this analysis on systemic vascular diseases started on December 2, 2010, and ended on April 30, 2014. This study analysis was specified in the study protocol.

Main Outcomes and Measures  Five cardiovascular outcomes compared between patients with and without PEX included blood glucose, cholesterol, and homocysteine levels; blood pressure; and cardiac morbidity (defined by electrocardiographic [ECG] abnormalities).

Results  The study analysis included 930 patients in the PEX group and 476 in the non-PEX group. The mean (SD) ages of patients in the PEX and non-PEX groups were 64.8 (6.8) and 59.9 (7.3) years (P < .001), respectively. More patients in the PEX group were men (470 [50.5%] vs 460 women [49.5%]) than in the non-PEX group (201 [42.2%] vs 275 women [57.8%]; P < .001). In multivariable analyses adjusting for age and sex, higher systolic blood pressure values were noted for the PEX group (difference [Δ], 4.0 mm Hg; 95% CI, 1.7-6.2 mm Hg; P = .001). Also, patients in the PEX group were more likely to demonstrate an ECG abnormality than in the non-PEX group (odds ratio, 1.64; 95% CI, 1.04-2.60; P = .03). Pseudoexfoliation was not observed to be associated with a higher level of blood glucose (Δ, 6.2 mg/dL; 95% CI, −2.0 to 14.3 mg/dL; P = .14), serum cholesterol (Δ, −0.6 mg/dL; 95% CI, −5.1 to 4.0 mg/dL; P = .81), or serum homocysteine level (Δ, 0.004 mg/L; 95% CI, −0.12 to 0.14; P = .96).

Conclusions and Relevance  Of the 5 cardiovascular outcomes examined in South Indian patients requiring cataract surgery, PEX was associated with higher systolic blood pressure and more frequent ECG abnormalities but not with higher blood glucose, serum cholesterol, or serum homocysteine levels. Patients with PEX are more likely to require attention to blood pressure and cardiac morbidity.