Purpose: To examine the 10-year incidence of the pseudoexfoliation syndrome (PEX), possible risk factors of PEX, and its association with aging and ocular changes in cornea, lens, retina within a population-based follow-up study.Methods: The baseline examination was conducted in 2006 on a random sample of 1,033 adult participants from Kaunas city (Lithuania) population. Out of them 631 participants returned to the follow-up study in 2016. Ophthalmological examination included keratometry, central corneal pachymetry, after diagnostic mydriasis lens opacification was evaluated by LOCS III International classification, PEX was diagnosed by the presence of typical grayish-white exfoliation material on the anterior capsule surface of the lens.Results: During the 10 years follow-up, the prevalence of the PEX increased from 9.8% to 34.2%. Nuclear cataract was diagnosed the most both in the PEX-group and those without, however, there was no statistically significantly increased risk of developing cataract in those with PEX when compared to those without PEX (OR 1.2; p=0.61). Central corneal thickness (CCT) was thinner in PEX group (529±34μm) and in the eldest group (525±36μm) (p<0.001). Compared to baseline, corneal curvature (CC) became steeper both in the PEX and the no-PEX groups during the follow-up (p=0.013), but the difference didn’t reach significance between groups. The biggest part of corneal astigmatism was with-the-rule in no-PEX and PEX groups (37 vs 148; p>0.05). The age, sex and PEX had no influence to age related macular degeneration distribution.Conclusion: The prevalence of the PEX increased significantly with age. CCT was thinner in PEX group and in elder people. CC was flatter in PEX group.