Cataracts and Pseudoexfoliation

Question: My husband has cataracts, and his ophthalmologist told him he also has pseudoexfoliation of the lens capsule. What is this, and how is it treated?

Answer: Pseudoexfoliation syndrome is a systemic condition in which a grayish protein material slowly starts to coat and damage the internal structures of the eye. An eye doctor is most likely to notice it while examining the lens capsule inside the eye as part of a cataract evaluation.

There may be no symptoms at first, but over time, the grayish protein may begin to block the normal drainage of the fluid within the eye, which can lead to high eye pressures. High pressures in the eye can lead to a condition called glaucoma, in which the optic nerve connecting the eye to the brain becomes damaged. If left untreated, glaucoma can lead to blindness. People with pseudoexfoliation syndrome are six times more likely to develop glaucoma than people without it.

Pseudoexfoliation syndrome is a particularly common cause of glaucoma in people of Northern European or Arabian descent. The syndrome also appears to affect more women than men and is generally seen in people age 50 and older. The exact cause of the syndrome is not known, but there appears to be a genetic component.

Although cataract extraction (replacement of the internal lens of the eye) will most likely resolve your husband’s cataracts, it will not eliminate the pseudoexfoliation syndrome or the risk of glaucoma. In fact, pseudoexfoliation syndrome may actually make cataract extraction more difficult, and it can increase the risk of the lens of the eye becoming dislocated over time.

Glaucoma caused by pseudoexfoliation is often treated in much the same way as glaucoma without pseudoexfoliation, though medicated eyedrops (a common treatment for glaucoma) are often less effective for glaucoma following pseudoexfoliation. Instead, glaucoma resulting from pseudoexfoliation may be treated with a procedure called argon laser trabeculoplasty, in which a laser is used to decrease pressure in the eye, most likely by increasing drainage.

Fortunately, although pseudoexfoliation syndrome increases a person’s risk of glaucoma, many people with pseudoexfoliation never develop the condition. However, it is important for people with pseudoexfoliation syndrome to be examined by an eye doctor every 6 to 12 months to check for higher eye pressures.

Want to learn more about eye health and pain conditions? Read “Rheumatoid Arthritis and Your Eyes.”

Geoffrey Goodfellow, OD, is an Attending Optometrist at the Illinois Eye Institute, and the Assistant Dean for Curriculum and Assessment at Illinois College of Optometry in Chicago, IL.

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