Plasma homocysteine is elevated in patients with exfoliation syndrome

PURPOSE: To compare plasma homocysteine concentrations among patients with exfoliation syndrome, exfoliative glaucoma, normal-tension glaucoma, and normal control subjects without vascular or inflammatory ocular disease or glaucoma. DESIGN: Cross-sectional study. METHODS: We tested 25 patients with exfoliation syndrome, 50 with exfoliative glaucoma, 25 with normal-tension glaucoma, and 24 control subjects. Fasting plasma homocysteine concentrations were measured by fluorescence polarization immunoassay. Patients using vitamin supplements or medications known to alter serum homocysteine were excluded. RESULTS: Homocysteine levels were higher in both exfoliation groups compared with controls (exfoliation syndrome: P = .003; exfoliative glaucoma: P =.009); levels in normal-tension glaucoma were higher than but not significantly different from those in controls (P =.2). Hyperhomocysteinemia was present in 16 of 25 (64%) exfoliation syndrome patients, 28 of 50 (56%) exfoliative glaucoma patients, 13 of 25 (52%) normal, tension glaucoma patients, and 7 of 24 (29.2%) controls (P = .005). Multiple logistic regression analyses comparing exfoliation syndrome and exfoliative glaucoma patients with controls indicated that elevated plasma homocysteine concentration was a significant risk factor for exfoliation syndrome, in both those patients (odds ratios per 1.0 mumol/l increase in plasma homocysteine concentrations = 1.47; 95% confidence interval [CI] = 1.08-2.0) and in exfoliative glaucoma patients (odds ratio = 1.3; 95% CI = 1.07-1.6). Although exfoliative glaucoma and normal-tension glaucoma patients were not signficantly different with respect to hyperhomocysteinemia, logistic regression modeling of exfoliative glaucoma vs normal,tension glaucoma patients showed that an increased homocysteine concentration was a significant risk factor for exfoliation syndrome in the presence of glaucoma (odds ratio per 1.0 mumol/l increase in homo cysteine = 1.2, 95% CI = 1.0-1-4). These relationships were not affected by adjustment for potential confounding due to sex, history of hypertension, or other factors. CONCLUSIONS: Elevated plasma homocysteine, a risk factor for cardiovascular disease, is more common in exfoliation syndrome and exfoliative glaucoma patients than healthy controls. Patients with exfoliation syndrome may benefit from measurement of homocysteine levels. (Am J Ophthalmol 2003;136:41-46. (C) 2003 by Elsevier Inc. All rights reserved.).