Exfoliation Syndrome in Egypt: Prevalence and Association with Cataract in a Large Cohort

Abstract

Exfoliation syndrome is an age-related disease leading to ocular and systemic complications. We aimed to evaluate the prevalence of exfoliation syndrome (XFS) in Egypt and its association with cataract as one of its comorbidities. In a retrospective, hospital-based study, 155,032 Egyptians aged over 40 years from all 27 Egyptian governorates were evaluated for the prevalence of XFS and cataract in the period between January 2015 and June 2020. A total of 2448 (1.6%) of the studied subjects had XFS. Their mean age was 71.2\u2009±\u20099.62 years which was significantly higher than those of subjects with no XFS. Men comprised 1348 (55.1%) of those diagnosed with XFS and this association was statistically significant (OR 1.57, 95% CI 1.45–1.70). Considering the ratio between subjects in our cohort from each region and its real population, the overall corrected prevalence in Egypt was 4.49% (Territorial regions 6.89%, Upper Egypt 5.51%, Lower Egypt 4.38%, and Greater Cairo 3.29%). Among all subjects with XFS, cataract was found in 2150 subjects (87.8%) and XFS represented 6.4% of all subjects diagnosed with cataract in our cohort (n\u2009=\u200933,610). Among subjects with no cataract (n\u2009=\u2009121,422), 298 subjects had XFS (OR 0.04, 95% CI 0.03–0.04). Egypt has a moderate XFS prevalence compared to other countries. There is a strong association between XFS and cataract, and XFS was more common in elderly males. The results can be explained by differences in diet, ethnicity, climate, and maybe other factors. Exfoliation syndrome (XFS) is an age-related disease characterized by the deposition of distinctive material in many eye and systemic tissues, with resultant eye (lens opacities, chronic rise in eye pressure, and more frequent surgical complications during lens surgeries) and systemic health implications (hearing loss and cardiovascular diseases). It is a universal disease that occurs in virtually all countries and whose percentage among individuals varies from one country to another, hence the importance of studies determining its percentage. We conducted our study on a large group of individuals encompassing more than 155,000 individuals aged over 40 years in the period between January 2015 and June 2020, to determine how frequent it is in Egypt and its different regions, and determine its common associations. Overall, it had moderate frequency, most commonly found among older subjects, men, those residing in territorial areas of Egypt as well as those having cataracts and lens opacities. Given Egypt’s unique geographical location being a transcontinental country (Afro-Asian), and belonging to Middle Eastern as well as Mediterranean countries, our results can be extrapolated to other neighboring countries and are not exclusive to Egypt. Studying this prevalence will give insights into risk factors for the disease that could possibly be modified, as well as determining the population at risk to help stakeholders to design effective screening programs.