Preventing Vision Loss by Predicting and Treating Exfoliation Syndrome Earlier in Patients
Co-Principal InvestigatorsBarbara M. Wirostko, MD University of Utah
In patients with exfoliation syndrome, which is marked by abnormal threadlike white fibers in the front of the eye that accumulate over time. Can we correctly predict who will go on to develop a buildup of pressure in one or both eyes known as glaucoma, a leading cause of blindness worldwide? We believe the answer is ‘yes.’ From researching thousands of medical records of exfoliation patients to find the clinical conditions and personal characteristics that correlate with changes in the eyes of our exfoliation patients over time, we will help doctors who care for these patients prevent or delay loss of vision from glaucoma through earlier medical treatment.
Exfoliation syndrome, an ocular condition associated with other systemic medical conditions, is a common cause of rapid and debilitating glaucoma globally ─ yet we do not understand fully why certain individuals have asymmetric disease or rapid progression to vision loss, while others never develop glaucoma. We are not yet able to define risk factors that predict who is at risk for a more rapid progression with precision. Our objective is to improve outcomes for exfoliation patients by using innovative database resources to develop a targeted way to accurately predict more rapid progression to glaucoma. Using a statewide population resource containing millions of demographic and medical records linked to patient data, the Utah Population Database at the University of Utah, we will use a two-stage modeling approach. First, we will determine prognostic factors associated with progression to exfoliation glaucoma and progression-free survival using data spanning two decades of more than 3,000 exfoliation patients. Second, we will determine a smaller set of predictive markers that can accurately guide tailored therapy in exfoliation patients and validate these markers in an independent clinical data repository, the Sight Outcomes Research Collaborative (SOURCE) at the University of Michigan’s Kellogg Eye Center. At the end of the predictive modeling phase including validation, we will translate our set of prediction factors into a clinical prediction tool which will be designed targeting ease and practicality of use, meaningful results, and applicability to patients in a general or specialty ophthalmology practice. Our work will translate to earlier identification of exfoliation patients who are at risk for development of debilitating glaucoma by providing clinicians with an easy to administer prediction tool that can be used widely for patient assessment and referral and timing for interventions, such as medication or surgery to lower intraocular pressure. Our innovative project will fuel clarity into who with exfoliation progresses to glaucoma and why? and inform interventions in patients to help prevent vision loss.