ACTA 0 P H T H A L M 0 L O G I CA 66 (1988) 467-468

S H 0 R T C 0 M M U N I C A T I 0 N

Pseudoexfoliation in Eskimos (Inuit) in Greenland

Annette Ostenfeld-Akerblom

Department of Ophthalmology (Head M Lundstrom), County Hospital, Karlskrona, Sweden and Local Medical Clinic (Head E Nielsen), Nuuk, Greenland

Abstract. In a Greenland municipality, slit-lamp bio- microscopy was performed in 44 individuals aged 70 or above. Two were found to have pseudoexfoliation curre- sponding to 4.5%. This is the first time pseudoexfoliation has been demonstrated in Eskimos.

Key words pseudoexfoliation (fibrillopathia epitheliocap- ailaris) - Eskimos (Inuit) -frequency - geographical dis- tribution.

There are reports in the literature of the occur- rence of pseudoexfoliation from virtually all parts of the world. Thus pseudoexfoliation is more com- mon in Northern Sweden, where Ekstrom (1987) in a population study found pseudoexfoliation in 17.9% of 65-74-year-olds, than in Southern Sweden where Bengtsson (1987) found pseudoexfoliation in 2.9% of the age group 65-69 and 4.3% of the age group 70-74 years.

Even in geographical areas very close to each other, as for example in different municipalities in South Trcdndelag in Norway, large frequency varia- tions occur (Ringvold et al. 1987).

Pseudoexfoliation is also seen in mongoloids, e.g. in Japan. Kinoshita (1979) reported the incidence of pseudoexfoliation in the age group 70-79 years as 5.3% in males and 8.5% in females. In the age group 80-89 he found an incidence of 8.3% in males and 14.4%0 in females. In spite of fairly extensive glau- coma studies, pseudoexfoliation has not previously been observed among Inuit in Greenland (Forsius 1979; Alsbirk 1987; Norn 1987).

Pseudoexfoliation also occurs in extrabulbar tissue in the palpebral conjunctiva (Ringvold 1973).

The purpose of this study has been to determine whether pseudoexfoliation also occurs in Eskimos.

Material and Methods

In August 1987 in the Nuuk municipality in Creen- land, 48 Eskimos born 1917 or earlier were investi- gated for pseudoexfoliation along with the author’s work. The material consists in part of patients referred to an ophthalmologist for known eye dis- ease, in part of residents of the local Home for Aged and in part of patients from the local hospital’s Ge- riatric Department. All the people investigated were considered to be Inuit residing in the Nuuk Municipality according to information from the local authority. At the time of the study, 182 people aged 70 or above were living in the municipality. According to ‘The Population of Greenland’ of the 1st January 1987 issued by the Ministry for Green- land, 182 people aged 70 or above lived in the mu- nicipality. Of these, 176 were born in Greenland and 6 abroad, thus one can probably assume that about 97% of the current population of 182 were Es- kimos with or without Caucasian admixture.

All patients were examined in a dark room with a Haag-Streit 900 slit-lamp using a narrow light slit from both right and left sides in order to detect pseudoexfoliation on the anterior lens capsule and the pupillary edge. Patients considered not to have occludable chamber angles were dilated with Tropicamide 0.5Oh. Four patients were excluded from the study because the iris and anterior lens capsule could not be assessed in any eye for the fol-

467 30*

Tnblr 1. Sex and age di5tribution of 44 examined patients.

~

70-74 7 6 13 75-79 4 6 10 80-84 5 9 14 85-89 4 3 7

lowing reasons: extensive corneal changes, anoph- thalmia or because Haag-Streit 900 slit-lamp exam- ination could not be carried out.

Twenty-eight phakic patients were dilated. In 5 of these, one of the eyes could not be assessed for the same reasons as in those patients excluded from the study. In addition, one of these patients was aphakic in one eye. Ten phakic and one mono- phakic patients considered to have either narrow or occludable chamber angles were not dilated. Five of the patients included in the material were bilat- erally aphakic. Age and sex distribution is shown in Table 1 .

Results

A brown- eyed female aged 79 years referred for im- paired vision in the right eye, showed, after dilata- tion, a peripheral pseudoexfoliation band on the left anterior lens capsule plus a fine central pseu- doexfoliative ring most pronounced nasally. N o pseudoexfoliative material was seen in the right eye. IOP right and left 11 mmHg(app1anation tono- metry). The impaired vision in the right eye was caused by senile macular degeneration. The pa- tient’s parents and all 4 grandparents were Inuit.

A brown-eyed male aged 74 years, with a history of right-sided blow-out fracture with eye injury 10 years previously, was referred for failing vision in the left eye and showed fine pseudoexfoliation ma- terial at the left pupillary border. After dilatation, bilateral pseudoexfoliation bands were observed. IOP right and left 12 mmHg (applanation tono- metry). In the left eye there was a relatively dense cataract, probably the cause of the visual impair- ment. The patient’s father and paternal grandpar- ents were Greenlanders, though his mother’s rela- tives were mixed Danish-Greenlanders. Both pa- tients lived in the local Home for the Aged.

468

Concluding Remarks

A study was made ofa patient material consistingof 44 individuals out ofthe I82 aged 7 0 or above living in a Greenland municipaiity. At least 97‘h of these were probably Eskimos. Pseudoexfoliation was found in 2 individuals corresponding to 4.5% of those examined. This is the first time pseudoexfoli- ation has been demonstrated in Inuit.

The late discovery ofpseudoexfoliation in the Es- kimos ofGreenland brings to mind the fact that car- diovascular disease has first made its appearance in Greenland in only recent years (Landslzgens irsbe- retning 1951-1984; Dyerberg 1987). Could a die- tary factor be sipilkant in the development of pseudoexfoliation?

Acknowledgments

1 would very much like t o thank Professor M. Norn for his stimulating interest and constructive criticism.

References

Alsbirk P H (1987): Personal communication. Bengtsson R (1987): I’ersonal conimunication. 1)yerberg J (1987): Lgeskr l ~ e g e r 141): 1723- 1778. Ekstriim C (1987): 1’rev;ilcnce of pseudoexfoliation in a

population 65-74 years of age. Acta Ophthalmol (Copenh). Suppl 182: 9-10,

Forsius H (1979): Prevalence of pscudoexfoliatioIi of the lcns in Finns, Lapps, Icelanders, Eskimos and Russians. ‘l’rans Ophthalmol Soc LJK 99: 29ti-298.

Kinoshita A (1979): Incidence of pseurtoexti)liation in Japan. Jpn J Ophthalmol 23: 85-88.

Landslzgcns Arsheretning 1951 - 1984. Norn M (1‘987): Personal communication. Kingvold A et al. (1987): The prevalence ofpseudoexfolia-

tion in three separate municipalities of Middle Norway. Acta Ophthalmol (Copenh). Suppl 182: 17-20.

Ringvolt1 A (1973): On the occurrence of pseudoexfolia- tion material in extrahulbar tissue from patients with pseiido-exfoliation syndrome ofthe eyc. Acta Ophthal- mol (Copenh) 51: 411-418.

Received on December 28th. 1987.

Author’s address Annette Ostenfeld-Akerblom, Department of Ophthalmology, County Hospital, Karl,krona, S-371 85 Karlskrona, Sweden.