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To examine the prevalence and systemic associations of pseudoexfoliation syndrome (PXS) in a Japanese population.In 1998, a cross-sectional population-based survey was conducted among residents of Hisayama. Of a total of 3054 residents living in Hisayama, Japan, aged 50 years or older, 1844 consented to participate in the study. Each participant underwent a comprehensive examination that included an ophthalmic examination. The presence of any pseudoexfoliation material on the iris or lens capsule was determined by slit-lamp examination. The participants were classified as having pseudoexfoliation syndrome if any pseudoexfoliation material was present in either eye. Using these cross-sectional data, logistic regression analyses were performed to determine the systemic associations of pseudoexfoliation syndrome. The following eight possible correlates were considered: age, sex, hypertension, diabetes, hyperlipidemia, current smoker, alcohol intake, and body mass index.Among the subjects, 50 (3.4%) had pseudoexfoliation syndrome. The prevalence of pseudoexfoliation syndrome increased significantly with age. Multiple logistic regression analysis showed that age and hypertension were significantly associated with pseudoexfoliation syndrome.The prevalence of pseudoexfoliation syndrome in a Japanese population was 3.4%, and increased with age. This study suggests that hypertension strongly correlates with pseudoexfoliation syndrome in our population-based sample of Japanese subjects aged 50 years or older.