Changes in visual acuity and refraction in the exfoliation syndrome. A five-year follow-up study.

Objective: To examine changes in visual acuity (VA) and refraction in non-glaucomatous patients with unilateral exfoliation syndrome (EXS).

Methods: The best corrected values for VA (Snellen acuity cards) subjectively adjusted for refraction, and IOP were measured, and the development of lens opacities was examined in 46 non-glaucomatous patients with unilateral EXS.

Results: After five years the rate of conversion to bilateral exfoliation was 22% and to exfoliative glaucoma 30%. There was a significant decrease in VA in the exfoliative (E) eyes (median; QI, QIII, range: 1; 0.8, 1, 0.4-1.3 vs. 0.55; 0.4, 1, 0.05-1.4, p<0.0001) and the fellow, initially non-exfoliative (NE), eyes (1; 0.9, 1, 0.3-1.3 vs. 0.7; 0.5, 0.9, 0.1-1.4, p<0.0001) and a significant myopic change in refraction in the E eyes (+1.02 +/- 2.48 vs. +0.11 +/- 3.06, p=0.0001) and the NE eyes (+0.99 +/- 2.25 vs. +0.43 +/- 2.55 D, p<0.01). At study entry the difference in refraction between the fellow eyes (refraction in the NE eye--refraction in the E eye) was -0.27 +/- 1.00D. After five years it was +0.32 +/- 1.44 (p 0.016), reflecting greater myopic changes in the E eyes. The main type of lens opacification was nuclear sclerosis.

Conclusions: In five years, significant decreases in VA and myopic shifts in refraction occurred in the E and fellow eyes. The E eyes showed significantly greater myopic changes than the fellow eyes; the cause was clearly nuclear sclerosis, which must be taken into account in the long-term management of patients with EXS.