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New information about<jats:styled-content style=\"fixed-case\">XFS<\/jats:styled-content>is akin to puzzle pieces that do not quite join together to reveal a clear picture regarding how exfoliation material (<jats:styled-content style=\"fixed-case\">XFM<\/jats:styled-content>) forms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Meeting participants concluded that it is unclear how the mild homocysteinemia seen in<jats:styled-content style=\"fixed-case\">XFS<\/jats:styled-content>might contribute to the disarrayed extracellular aggregates characteristic of this syndrome. Lysyl oxidase\u2010like 1 (<jats:italic><jats:styled-content style=\"fixed-case\">LOXL<\/jats:styled-content>1<\/jats:italic>) variants are unequivocally genetic risk factors for<jats:styled-content style=\"fixed-case\">XFS<\/jats:styled-content>but exactly how these variants contribute to the assembly of exfoliation material (<jats:styled-content style=\"fixed-case\">XFM<\/jats:styled-content>) remains unclear. Variants in a new genomic region,<jats:italic><jats:styled-content style=\"fixed-case\">CACNA<\/jats:styled-content>1A<\/jats:italic>associated with<jats:styled-content style=\"fixed-case\">XFS<\/jats:styled-content>, may alter calcium concentrations at the cell surface and facilitate<jats:styled-content style=\"fixed-case\">XFM<\/jats:styled-content>formation but much more work is needed before we can place this new finding in proper context. It is hoped that various animal model and<jats:italic>ex\u00a0vivo<\/jats:italic>systems will emerge that will allow for proper assembly of the puzzle pieces into a coherent picture of<jats:styled-content style=\"fixed-case\">XFS<\/jats:styled-content>pathogenesis. A clear understanding of<jats:styled-content style=\"fixed-case\">XFS<\/jats:styled-content>pathogenesis may lead to \u2018upstream solutions\u2019 to reduce the ocular morbidity produced by<jats:styled-content style=\"fixed-case\">XFS<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aos.12918","type":"journal-article","created":{"date-parts":[[2015,12,11]],"date-time":"2015-12-11T00:05:54Z","timestamp":1449792354000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":53,"title":["Exfoliation syndrome: assembling the puzzle pieces"],"prefix":"10.1111","volume":"94","author":[{"given":"Louis R.","family":"Pasquale","sequence":"first","affiliation":[{"name":"Department of Ophthalmology Mass Eye &amp; Ear Infirmary Harvard Medical School Boston Massachusetts USA"},{"name":"Department of Medicine Harvard Medical School Brigham and Women's Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terete","family":"Borr\u00e1s","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology University of North Carolina Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John H.","family":"Fingert","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences University of Iowa Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janey L.","family":"Wiggs","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Mass Eye &amp; 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