Epidemiology

• Pex disease is more common in geriatric populations (patients above the age of 50), and rates of occurrence double with each subsequent decade. Research shows that it is more common in Nordic countries (Norway, Sweden and Finland), Saudi Arabia and Africa. Pex disease is more prevalent in women than in men, but the combination of glaucoma and pex disease occurs equally in both genders. Pex is an inherited disease, and factors such as a slow virus, an autoimmune response and even sunlight may trigger its manifestation.
  
  

Characteristics

• Pex disease is characterized by grey fleck-like deposits (made of proteins that are manufactured by the iris) on the lens capsule of the eye (corneal endothelium) and surrounding tissues. The margin of the iris and pupil appears moth eaten. Pex deposits clog the drainage system of the eye and give rise of a special kind of glaucoma called pseudoexfoliative glaucoma. Other areas of the body, including the kidneys, liver, heart, lung and skin, also exhibit pseudoexfoliation deposits.
  
  

Features

• The most prominent feature of pex disease is the deposit of exfoliating material on the lens, therefore changing the appearance of an otherwise healthy eye. The flaky substance is also deposited on the margin of the iris, reducing the number of blood vessels. Pex disease is the most common cause of secondary open-ended glaucoma, which is harder to control than primary open-ended glaucoma.
  
  

Risks

• According to notes from the Seventh International Meeting on Scanning Laser Ophthalmoscopy, pex disease is not associated with any systemic disorder, but patients have a higher risk of developing chronic cerebral conditions (e.g., Alzheimer's disease), acute cerebrovascular diseases, pseudoexfoliation, high risk of stoke, hypertension and retinal vein thrombosis. Pseudoexfoliation deposits are also associated with the production of pathological (disease-causing) organisms in the eye.
  
  

Treatment

• People with pex disease need to be examined regularly to monitor the progress of pseudoexfoliation deposits. Pex disease typically leads to glaucoma, which requires standard medical treatment for management. Antiglaucoma medications, such as a twice-daily timolol maleate solution or the application of timolol maleate gel, can control and decrease intraocular pressure. The addition of apraclonidine with timolol further reduces pressure. Other medications used for treatment include latanoprost and dorzolamide. Argon laser trabeculoplasty (laser treatment) is another effective way to decrease pseudoexfoliation. Surgical removal of pseudoexfoliation debris is more effective than both laser treatment and medical therapy.