Experience with cardiovascular risk model offers useful lessons

San Francisco - Many parallels can be drawn between glaucoma and coronary heart disease - both are chronic diseases that can be depicted on a continuum of progression from disease that is first undetectable, then asymptomatic, and ultimately results in functional impairment - and both are associated with a modifiable causal risk factor (IOP and serum cholesterol) that when treated effectively results in a reduction in disease progression risk.

Consequently, it is not surprising that glaucoma experts have been able to learn a number of important lessons from their cardiology colleagues with respect to developing a calculator for global risk assessment, said Jeffrey M. Liebmann, MD, clinical professor of ophthalmology, New York University School of Medicine and director, glaucoma services, Manhattan Eye, Ear & Throat Hospital and New York University Medical Center, New York.

“Assessing risk for glaucoma is more complex than just measuring IOP, but rather it should involve the assessment of overall risk based on multiple factors, and ideally it should be based on evidence gathered in well-controlled clinical trials and help drive decision making for optimal clinical care,” Dr. Liebmann said.

As ophthalmologists begin to apply the new risk calculator for glaucoma to their ocular hypertension patients, they should also be aware of the challenges faced in cardiovascular medicine with respect to implementation by physicians and patient adherence to treatment recommendations. Yet, it is encouraging to note that despite those difficulties, the application of risk assessment in cardiovascular medicine has had a tremendous positive impact on cardiovascular-related mortality in the United States and thereby on life expectancy.

“Considering that precedent, we can anticipate that development of the risk calculator and guidelines for intervention should help us in improving the management of glaucoma,” Dr. Liebman said.