Aim: To examine the age- and gender-specific prevalent and 5-year incident risk of developing exfoliation syndrome (XFS). Methods and participants: In a population-based random sample of citizens 50 years and older, 1045 persons had baseline examination in 1996; 846 of the 958 survivors (88.2%) had a follow-up examination in 2001. Following maximum dilatation of pupils, a diagnosis of exfoliation was established on slit-lamp examination. An extensive questionnaire was administered at baseline and follow-up. Prevalent and incident risk was then calculated using a multivariate analysis. Results: The following variables were found to correlate significantly with prevalence risk of XFS at baseline: age, female gender, increased iris pigmentation, moderate use of alcohol and self-reported asthma. We also found that, compared with those who consumed dietary fibrerich vegetables, green or yellow vegetables, and fruit less than once a month in their 20s and 40s, those consuming the same food items once or twice every 2 weeks were found to be less likely to have XFS. The same applied to those consuming dietary fibre rich once or twice every 2 weeks in their 40s and 60s. Conclusion: Food items that are possibly surrogates for antioxidative effect may correlate with decreased risk of XFS and increased iris pigmentation may correlate with increased risk. Given the large number of comparisons, these findings require validation through additional clinical studies. Increased age and female gender increase the likelihood of XFS.