Proliferation in research provides promise of XFS becoming a curable disease

Findings from burgeoning research are providing new information about the pathophysiology of exfoliation syndrome (XFS), its genetics, and ultimately clues for developing directed therapy that could eventually eliminate this common condition, which is also the leading identifiable cause of glaucoma, said Robert Ritch, MD.

Dr. Ritch, holder of the Shelley and Steven Einhorn Distinguished Chair in Ophthalmology, New York Eye and Ear Infirmary, was honored as the American Glaucoma Society Lecturer based on the contributions he has made to glaucoma research and teaching throughout his career. Dr. Ritch is also surgeon director and chief of glaucoma services at the New York Eye & Ear Infirmary, New York, and professor of clinical ophthalmology at The New York Medical College, Valhalla, NY.

He told attendees that his interest in XFS began when he was an ophthalmology resident. The philosophy then and even into the recent past has been that there was no need to diagnose XFS in eyes with glaucoma because all glaucoma is treated the same. The fallacy in that thinking, however, is that identification of novel therapeutic approaches requires that the disease be diagnosed so that it can be studied, he said.

"I've always thought that XFS is a distinct disease with a specific mechanism for development and distinct cellular and biochemical abnormalities," Dr. Ritch said. "Now, we are standing at the brink of an explosion of information about XFS and at the beginning of a sea change in our therapeutic approaches for this disease that I believe is at least reversible and potentially curable."

Dr. Ritch provided an overview of findings from investigators around the world who have been studying XFS. These studies provide evidence that exfoliation syndrome is a conformational disorder involving fibrillin and a disease of oxidative stress and free radical induced damage with a low grade inflammatory component. They also show associations between XFS and multiple systemic disorders, ischemia, hyperhomocysteinemia, and possibly an infectious etiology.

Further research, especially to elucidate the molecular basis for many of these findings, is expected to provide important clues to treating and perhaps preventing XFS.

"Over the next generation, we will be amazed by new therapies that we can't even imagine at this time," Dr. Ritch said.