Glaucoma and Pelvic Organ Prolapse: How Are These Two Diseases Related? Moran Physician, Barbara Wirostko, MD, Leads a Study to Show the Relationship and Why Treating the Whole Patient Matters

Sep 30, 2016 9:00 AM


Barbara Wirostko, MD, associate professor and glaucoma researcher at the John A. Moran Eye Center, has been investigating how XFS impacts other elastin-containing tissues, in addition to glaucoma, which is characterized by intraocular pressure (IOP). “We know that glaucoma is more than just an IOP-related disease,” Wirostko stated. “We need to shift our focus from just lowering IOP to assessing underlying systemic risk factors—to think more about the whole patient and to delve into medical histories and even family pedigrees.”

Exfoliation syndrome is an age-related disease defined by a dysfunction in the LOXL1 gene locus and by altered elastin repair. As a result, an extracellular matrix protein gets deposited in the eye and other body tissues. In the eye, this condition can increase the IOP, leading to a higher risk of developing more difficult to treat glaucoma, cataracts, and secondary surgical complications. But little is known about the effects of XFS on other body systems.

“In women, the pelvic organs (bladder, uterus, rectum) are held in place by a web of muscles and elastin-containing connective tissue,” said Wirostko. “Pelvic organ prolapse occurs when this webbing is weakened and the pelvic organs drop or prolapse. Since pelvic organ prolapse and XFS both have elastin-related issues, they may share common biological pathways.”

Previously, Wirostko identified over 2,000 patients with XFS in the Utah Population Database (UPDB) who had other chronic conditions. This led to the launch of the Utah Project on Exfoliation Syndrome (UPEXS). “This project was the foundation for further studies aimed at greater understanding of the genetics, related comorbidities, and pathophysiology of XFS as well as other related disorders in affected individuals and family members,” Wirostko explained.

The first publication from that project, Risk for Exfoliation Syndrome in Women with Pelvic Organ Prolapse: A Utah Project on Exfoliation Syndrome (UPEXS) Study, was recently published in JAMA Ophthalmology.

In the article, Wirostko, along with researchers from the University of Utah Dr Karen Curtin and Dr Kristy Allen-Brady, Duke University Dr Rand Allingham, and the New York Eye and Ear Infirmary of Mount Sinai Dr Robert Ritch, looked at female patients in the UPDB to see if there was a link between XFS and pelvic organ prolapse. They wanted to know if there was an association between pelvic organ prolapse and XFS (Group A) as well as the risk of developing XFS in the future after a patient was diagnosed with pelvic organ prolapse (Group B).

Researchers found that women with pelvic organ prolapse were at approximately a 50 percent increased risk of having XFS and that women 30-65 years of age who had a pelvic organ prolapse diagnosis, when followed for 20 years, had a 48 percent increased risk of developing XFS during that time period.

Overall, this study found that an XFS diagnosis was more common in women with pelvic organ prolapse in the UPDB. This supports the idea that there is an association between XFS and another body system condition that affects extracellular matrix and elastin repair. These types of numbers are powerful and advocate for increased awareness and for routine eye exams, especially in women with a diagnosis of pelvic organ prolapse.

This information adds to what is known about XFS and what can help XFS patients who might be at risk for other chronic conditions. As Wirostko summarized, “This goal is critical. If we can look at the underlying genetic causes and associated comorbidities—not just manifestations in the eye—perhaps we can actually find new therapies to cure this type glaucoma.”

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