Exfoliation Syndrome and Exfoliative Glaucoma 215CONCLUSION
Since XFS is a common condition, and XFG is an especially severe,
rapidly progressing and common secondary open-angle glaucoma, better
understanding of the pathophysiological processes in XFS and XFG and
establishing a disease-specific targeted therapy of XFG would be of great
clinical importance. Currently XFS is not considered a disease to treat, but
rather a genetically determined condition to observe for conversion to XFG. In
contrast, XFG requires effective IOP lowering treatment which needs to be
introduced early in the course of the disease to prevent progression. In XFG,
IOP reduction is satisfactory when the diurnal IOP curve shows no high peaks
but low mean value (IOP <17 mmHg) and low fluctuation, the visual field
does not progress or the rate of progression is small, and the patient is adherent
to the successful treatment. Even in such cases regular ophthalmological
examinations are unavoidable, and ophthalmologists need to know that due to
the continuous synthesis of XFM and the gradual buildup of pigment in the
trabecular outflow system there is always a risk of sudden loss of IOP control,
and a need to introduce a more complex IOP lowering medication, laser
therapy or surgery. Since XFG is a disease of the elderly it is important to
simplify therapy using fixed dose combination eye drops and minimal number
of daily instillations, thus supporting adherence. Consulting with a glaucoma
subspecialist is also important when optimal IOP control is not achievable in
XFG because unnecessary delay prior to surgery results in unavoidable disease
progression.
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