What is the burden of pseudoexfoliation (PXF) syndrome in the world and India?

From the Guidelines

Pseudoexfoliation (PXF) syndrome poses a substantial global health burden, with significant economic and social implications, particularly in India where it affects a considerable portion of the adult population over 50 years old. The prevalence of PXF syndrome varies globally, with approximately 60-70 million people affected worldwide [no specific reference provided in the given evidence]. In the context of India, while specific prevalence data is not provided in the given evidence, it's crucial to understand that the burden of glaucoma, including pseudoexfoliation glaucoma, is significant and impacts the quality of life and economic stability of individuals and society [ 1 ].

Burden of Pseudoexfoliation Syndrome

• The economic burden of glaucoma, which includes pseudoexfoliation glaucoma, is substantial, with direct medical costs, direct nonmedical costs, and indirect costs contributing to the overall expense [ 1 ].
• The cost of care for patients with pseudoexfoliation glaucoma is significantly higher than for those with primary open-angle glaucoma (POAG) due to increased office visits, surgeries, and medications [ 1 ].
• Treatment strategies for glaucoma, including generic prostaglandin analogs and laser trabeculoplasty, have been found to be cost-effective, especially when considering the impact on quality of life [ 1 ].

Quality of Life and Economic Impact

• Glaucoma, including pseudoexfoliation glaucoma, can dramatically impact an individual's quality of life, affecting daily activities such as reading, walking, and driving [ 1 ].
• The average annual direct medical costs for patients with early glaucoma, advanced glaucoma, and end-stage glaucoma were $623, $1915, and $2511, respectively, highlighting the increasing burden with disease severity [ 1 ].
• The economic burden is not only limited to direct medical costs but also includes indirect costs such as loss of productivity and the cost of caregivers, which can be substantial [ 1 ].

Conclusion on Burden

Given the significant impact of pseudoexfoliation syndrome on both the individual and societal levels, particularly in terms of morbidity, mortality, and quality of life, it is essential to prioritize early diagnosis and effective management of PXF syndrome to mitigate its economic and social burden. This includes cost-effective treatment strategies and public health initiatives to improve awareness and access to care, especially in regions like India where the prevalence is notable [ 1 ].

From the Research

Burden of Pseudoexfoliation Syndrome

• Pseudoexfoliation syndrome (PES) is a systemic disorder that affects various tissues, including the eyes, and can lead to pseudoexfoliation glaucoma (PEG) 2.
• The exact pathophysiological process of PES is still unclear, but it is thought to be related to the accumulation of abnormal cross-linked fibrils in various organs, including the eyes 3.
• PES is a common age-related disorder that affects intraocular and extraocular tissues, and its pathogenesis is associated with dysregulation of lysyl oxidase-like 1 (LOXL1) expression 4.

Global Burden

• Pseudoexfoliation glaucoma is a major complication of PES and represents the main cause of identifiable glaucoma worldwide 3.
• The reported incidence and prevalence of PES vary widely between ethnicities and geographical areas, with a worldwide distribution 3.
• Secondary chronic open-angle glaucoma associated with PES accounts for approximately 25% of all glaucomas and represents the most common identifiable cause of glaucoma overall 5.

Burden in India

• There is limited information available on the burden of PES in India specifically.
• However, it is known that PES is a common cause of glaucoma in many parts of the world, including Asia 6.
• Further studies are needed to determine the prevalence and incidence of PES in India and to understand its impact on the Indian population.

Complications and Management

• PES can lead to severe visual impairment and blindness, mainly related to glaucoma and cataract 3.
• Visual field progression is more rapid in PES than in primary open-angle glaucoma, and filtering surgery is more frequently required 3.
• Cataract surgery with PES is associated with a 5- to 10-fold increase in surgical complications compared to cataract surgery without PES 3.
• Various surgical techniques, such as Argon Laser or Selective Laser Trabeculoplasty, have been proposed for the management of PEG affected patients 2.