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Residential geography, time spent in the sun, and whether or not sunglasses are worn may help explain why some people develop exfoliation syndrome (XFS), according to new study. 

XFS is an eye condition that is a leading cause of secondary open-angle glaucoma and can lead to an increased risk of cataract and cataract surgery complications. 

"The discovery that common genetic variants in the lysyl oxidase-like 1 gene (LOXL1) are associated with 99 percent of XFS cases represented a significant advance in our understanding of this condition," said the study's lead author, Louis Pasquale, M.D., Associate Professor of Ophthalmology at Harvard Medical School (HMS), and director of the HMS Glaucoma Center of Excellence and Mass. Eye and Ear Glaucoma Service and Telemedicine Service, in the press release. 

"However, 80 percent of control individuals also harbor these variants and that ratio of cases to control individuals with trait-related variants is fairly similar in regions where XFS is very prevalent and in regions where the condition is relatively rare; this suggests that other genetic or environmental factors contribute to XFS."

Prior studies have shown that residential (geographic) history and extent of solar exposure may be important risk factors for XFS. However, no study has evaluated the detailed lifetime solar exposure.

"Lifetime outdoor activities may contribute to XFS," said Dr. Pasquale. "The association between work over snow or water and the lack of association with brimmed hat wear suggests that ocular exposure to light from reflective surfaces may be an important type of exposure in XFS etiology. If confirmed in other studies, there could be reason to consider more widespread use of UV-blocking eyewear in these cases to help prevent XFS."

Findings of the study have been published in the journal JAMA Ophthalmol.