A prospective study of 2,121 patients, 30 years of age or older, examined in two clinics in the southeastern United States with dilated slit-lamp biomicroscopy, revealed the exfoliation syndrome in 1.6% of the total population and in 6.0% of an open-angle glaucoma subpopulation. All but one of the 33 patients with exfoliation syndrome were over age 60 years, and the prevalence of exfoliation syndrome in the subgroup over age 60 was 3.2%. Among the patients over age 60 who did not have open-angle glaucoma, 1.6% had exfoliation syndrome. By chi square analysis, the prevalence of the exfoliation syndrome in the over age 60 population without glaucoma was found to be significantly less (P = 0.00009) than reported in studies from other geographic areas.