Exfoliation syndrome: association with systemic diseases—the Maccabi glaucoma study

Purpose: To investigate the relationship between exfoliation syndrome (XFS) and systemic diseases. Methods: A population-based, retrospective study with control group was conducted using the electronic medical database of Maccabi Health Services, the second largest Health Maintenance Organization (HMO) in Israel. Study population included Maccabi members from January 2003 to April 2016. Cases consisted of patients diagnosed with XFS regardless of glaucoma. The control group included Maccabi members without XFS, matched on age, sex, and ancestry, that were examined by an ophthalmologist within the last year. Main outcome measures: Associations between XFS and systemic diseases. Results: We identified 16,388 patients with XFS, in whom 40.3% (n = 6613) had glaucoma. The control group included 14,015 patients. Mean age was 78.3 ± 8.9 years and 76.2 ± 8.5 years for the XFS and control group, respectively. In unconditional logistic regression analyses, after adjusting for age, sex, and ancestry, XFS was significantly associated with risk of cardiovascular diseases including hypertension (OR 1.07, 95% CI 1.01–1.13, p = 0.02), myocardial infarction (OR 1.21, 95% CI 1.17–1.31, p < 0.0001), and congestive heart failure (OR 1.70, 95% CI 1.55–1.88, p < 0.0001) as well as higher risk for high creatinine (OR 1.28, 95% CI 1.2–1.37, p < 0.0001). Diabetes mellitus and body mass index were inversely associated with XFS (OR 0.70, 95% CI 0.67–0.73, p < 0.0001 and OR 0.88, 95% CI 0.84–0.93, p < 0.0001, respectively). Overall cancer diagnoses were more common in the XFS group (OR 1.05, 95% CI 1.0–1.1, p = 0.05). XFS was associated with more hospitalizations (mean 5 ± 5.3 hospitalizations in the XFS group and 3.3 ± 4.0 in the controls, p < 0.0001). Conclusion: XFS is significantly associated with cardiovascular systemic diseases (in a population living in Israel and predominantly born in Russia).[Figure not available: see fulltext.]