title: Combined exfoliation and pigment dispersion: paradigm of an overlap syndrome.
abstract: OBJECTIVE
  To describe a series of patients with combined pigment dispersion syndrome (PDS) and exfoliation syndrome (XFS) and to introduce a concept, the overlap syndrome, to aid in assessing multiple risk factors for glaucomatous damage.
  
  
  METHODS
  Clinic-based, cross-sectional study.
  
  
  METHODS
  New York Eye and Ear Infirmary.
  
  
  METHODS
  Twenty-six patients identified from the glaucoma database as having combined pigment dispersion syndrome-glaucoma and exfoliation syndrome-glaucoma.
  
  
  METHODS
  Quantification of patients with both pigment dispersion syndrome-glaucoma (PDS/PG) and exfoliation syndrome-glaucoma (XFS/XFG) and its clinical implications.
  
  
  RESULTS
  Among the 26 patients (all white) having both XFS/XFG and PDS/PG, the average age was 64.3 +/- 9.8 years and 19 of 26 were men. All patients had bilateral PDS/PG. Bilateral XFS/XFG was present in 9 of 26 patients and, of the 17 patients with unilateral involvement, the left eye was affected in 13.
  
  
  CONCLUSIONS
  Both XFS and PDS are common. Middle-aged patients with known PDS/PG should be suspected of having the onset of XFS if one eye escapes intraocular pressure control. Patients with unilateral XFG at presentation may also have signs of PDS/PG, often remitted. We define the term overlap syndrome to describe the sequential appearance over time of two or more risk factors for glaucomatous damage. The appearance of a new risk factor in a patient whose condition has been stable can alter the course and prognosis of the disease. This concept should prove useful in dealing with secondary and normal-tension glaucomas.
authors.affiliation: Department of Ophthalmology, New York Eye and Ear Infirmary, New York 10003, USA. ritch@inx.net
authors.forename: R
authors.initials: R
authors.lastname: Ritch
authors.forename: R
authors.initials: R
authors.lastname: Mudumbai
authors.forename: J M
authors.initials: JM
authors.lastname: Liebmann
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D017889:Exfoliation Syndrome / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005902:Glaucoma, Open-Angle / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000150:complications* / Q000175:diagnosis; D010857:Pigment Epithelium of Eye / Q000473:pathology*; D012307:Risk Factors