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The article by Martin et al1 on the cardiovascular risk assessment in a group of patients with compromised retinal circulation brings to light an important issue. For this group of patients and especially those with central retinal vein occlusion very little can be offered in the form of treatment. They are regularly followed up in the eye clinics for up to 2 years, with many of them worrying about secondary ophthalmic complications including that of neovascular glaucoma.
This article offers scope for evidence based practice in risk assessment and appropriate intervention in the form of primary preventive measures against coronary heart disease. The authors used a proprietary version of the Framingham algorithm for personal computers. Although this makes it simple for the ophthalmologist to feed in appropriate data to obtain the 10 year risk figure it may not be feasible in every ophthalmology unit that diagnoses and manages patients with retinal vein occlusion. A significant proportion of these patients are seen and managed in the district general hospitals. Access to a personal computer in the clinic may be difficult and this may discourage the risk assessment process.
The authors briefly mention in their introduction about the various tables that may help in calculating the risk. The Joint British Societies Coronary Risk Prediction Chart is available at the back of the British National Formulary (BNF). This provides the risk figure based on the various parameters like age, sex, smoking status, systolic blood pressure, presence or absence of diabetes, and total to HDL cholesterol ratio. This should serve the same purpose as that of the software mentioned in the article. The BNF should be more freely available and should encourage the practice of 10 year cardiovascular risk assessment much more widely for this group of patients.
The authors are to be congratulated for this excellent article that should change practice in many ophthalmology units.