A Comparison of Genomic Advances in Exfoliation Syndrome and Primary Open-Angle Glaucoma

Purpose of Review This review compares recent progress of the genetics of primary open-angle glaucoma (POAG) and exfoliation syndrome/glaucoma (XFS/XFG). Recent Findings Many common variants and associated endophenotypes have been discovered in POAG through genomic wide association studies (GWAS), particularly in ethnically diverse cohorts. Though the functional significance of these common variants is unknown, these advances have increased heritability estimates and helped create polygenic risk scores. In contrast, few variants have been identified in XFS/XFG, hindering efforts to examine endophenotypes, create satisfactory animal models, and establish a firm genetic basis. Rapid genetic advancements have demonstrated that genes of small effect may contribute a larger role in POAG than previously thought. Given the pace of gene discovery, it is likely that novel therapies and genetic screening tools are future possibilities. Limited progress in XFS/XFG suggests an underlying non-hereditary disease component. A multiomic approach for XFS/XFG may provide further insights.