Chat Highlights
Exfoliating Glaucoma (PSXF)
April 12, 2000

Norma Devine, Editor

On Wednesday, April 12, 2000, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Exfoliating Glaucoma (PSXF)." 

Moderator:   Hi, Dr. Wilson.

Dr. Wilson:   Hello, team.

Moderator:   The topic is Exfoliating Glaucoma (PSXF).  We have someone who is ready with a question.  Go ahead with your question.

P:   What impact might exercise have on PSXF and what types of exercise are potentially harmful?

Dr. Wilson:   PSXF is not nearly as exercise-related as pigmentary glaucoma.  I impose no exercise restrictions, and encourage 20 minutes of exercise four times a week.

P:   Good news.  Next question:  Is  there a link between PSXF and higher rates of stroke and heart disease?  A paper by Dr. Ritch indicated such a correlation.  Could you comment, please?

Dr. Wilson:   Pseudoexfoliation is a systemic finding.  I have not read Dr. Ritch's article, so cannot comment.  No one else has found a relationship that I know of,  and it is increasingly common in our older population.

P:   Can arthritis medication affect PSXF?

Dr. Wilson:   It might help raise the blood aqueous barrier, i.e., make the inflammatory effects of the iris rubbing over the rough surface of the lens less prominent.  I would not shy away from using arthritis medication.

P:   Are there any nutritional therapies that may potentially benefit PSXF?

Dr. Wilson:   It is postulated that Vitamin E, 400 I.U. per day, may be neuroprotective.

P:   I'd like to know what causes PSXF and symptoms?

Dr. Wilson:   I'd like to know as well.  No one knows.

P:   In PSXF, what cells in the front of the eye are flaking?  Are these cells related to other tissue types in the body?

Dr. Wilson:   The lens epithelial cells are the ones that are exfoliating.

P:   Are these epithelial cells related to other tissue types in the body ?

Dr. Wilson:   They are related to the basement membranes of blood vessels, tissue in the liver,  meninges of the brain, et cetera.

P:   Does cataract affect lens exfoliating?

Dr. Wilson:   Having a cataract does not affect exfoliation that I know of.   Having PSXF does make taking the cataract out harder, as the PSXF weakens the support of the lens in the eye.

P:   What impact do epithelial flakes and drugs have on the trabecular meshwork over time with PSXF?

Dr. Wilson:   The flakes block up the drain,  much like leaves in a storm drain.

P:   Does the treatment for this type of glaucoma follow the same schedule:  meds, trabs, implants?  Is the prognosis better or worse for patients?

Dr. Wilson:   The prognosis is slightly worse overall, but PSXF responds better to laser trabeculoplasty than any other type of glaucoma.

P:   I just had ALT procedure.  My pressure dropped from 40 to 18.  Is such a large pressure drop unusual?  How long can I expect it to last?

Dr. Wilson:   That is the kind of pressure drop you can expect with PSXF.  Unfortunately, if you are 53 years old, the effect may not last over a year or two at that level.

P:   What is an ALT procedure?

Dr. Wilson:  ALT (argon laser trabeculoplasty - using a laser to open up the clogged meshwork)

P:   Is any (leading) research on PSFX being done?

Dr. Wilson:   There is research on PSXF being done, but no quick answers do I see.

P:   Is trabeculoplasty the proceedure that creates blebs in your eye(s).   I have had trabeculectomy and am wondering if they are the same.

Dr. Wilson:   No.  A trabeculoplasty is a laser procedure.  It does not create blebs. A trabeculectomy does that.

P:   Doctor, do you recommend upside-down exercises for one with PSXF?

Dr. Wilson:   I do not recommend upside down exercises for anyone with glaucoma or even a strong risk for glaucoma.

P:   Does the rate of exfoliation increase or decrease with age?

Dr. Wilson:   It increases markedly with age.

P:    Could anti-aging strategies like nutrient rich calorie restriction have an effect?  Do you think we are dealing with a connective tissue type disease?

Dr. Wilson:   I don't think anyone has the inside track on what causes PSXF.  It is not like rheumatoid arthritis or lupus.

P:   Is there any procedure beyond a trabeculectomy to help reduce ocular pressure?

Dr. Wilson:   The next procedure is an aqueous shunt, a small tube that delivers fluid from the anterior chamber of the eye to a plate on the equator of the eye that holds the fluid until it can be absorbed into the tissue of the orbit.

P:   How is exfoliating glaucoma found?  Is the pressure up first or can you see something when you examine the eye?  Is it rare, or a common form of glaucoma?

Dr. Wilson:   One can see the pseudoexfoliation material on the surface of the lens.  My Mom developed it when she turned 80.  It is very common in Scandinavia, South Africa, and some of the Mediterranean countries.

P:   Physically in those places, or also in those of that genetic background?

Dr. Wilson:   Of that genetic background.

Moderator:   Any last questions on any subject in ophthalmology?

P:   Are there any major distinctions between pseudoexfoliation and pigmentary glaucoma?

Dr. Wilson:   They are two different diseases and quite different.  One is caused by the white pseudoexfoliative material being rubbed of the lens of  the eye and blocking the drain.  Pigmentary glaucoma is caused by pigment granules being rubbed off the back of the iris and blocking the drain in the eye.

P:   Dr. Wilson, do children with glaucoma have a higher rate of other types of glaucoma?

Dr. Wilson:   I would think not.

P:   What is the concern with zinc oxide in the body as it affects the eyes?

Dr. Wilson:   It has to do with the mechanism for injury of the nerve cells in the retina that are injured in glaucoma.

P:   Why is removing the eye sometimes the only solution for pain?  Isn't there a medical alternative?

Dr. Wilson:   An injection of alcohol behind the eye can stop pain for at least three months, and often forever.

Dr. Wilson:   I need to get going.  Dr. Spaeth will be the monitor next week.  Have a good week and a good holiday. Talk to you in two weeks. Night.

End of highlights for April 12th chat.

On April 19th, Dr. Wilson discussed Normal Tension Glaucoma in the Chat room. Click here for highlights of that meeting.

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