The Residency Report: Cardiovascular risk scores as a window into ocular disease

In this installment of “The Residency Report,” NYU Langone ophthalmology resident (PGY3) Jordan Mandell, MD, moderates an Ophthalmology Times–NYU Langone Department of Ophthalmology journal club discussion with Ariana Levin, MD, assistant professor of ophthalmology at NYU Langone, and visiting professor Anne Coleman, MD, PhD, Bradley R. Straatsma, MD, Endowed Chair in Ophthalmology, Chair and Executive Medical Director of the Department of Ophthalmology and Director of the UCLA Jules Stein Eye Institute.

The discussion centers on Coleman’s recent publication examining the relationship between the Pooled Cohort Equations (PCE)—a cardiovascular risk scoring tool developed by the American College of Cardiology and the American Heart Association—and the incidence of ocular disease.¹

The PCE and ocular disease

The PCE estimates atherosclerotic cardiovascular disease (ASCVD) risk in individuals aged 40 to 79 using data already available in the electronic health record and assigns patients to low, borderline, intermediate, or high risk categories. Using the All of Us research database with approximately 6 years of follow-up, the study evaluated whether PCE risk category was associated with the incidence of glaucoma, age-related macular degeneration (AMD), retinal vein occlusion, diabetic retinopathy, and hypertensive retinopathy. The paper was initiated by medical student Deyu Sun, who Coleman credits with originating the idea and leading the analyses.

Levin raises the question that many ophthalmologists would ask: Given that associations between systemic disease and ocular conditions are already well established—hypertension and retinal vein occlusion, diabetes and diabetic retinopathy, for instance—how does the PCE add something new? Coleman’s response is that the tool’s value lies primarily with the primary care physician rather than the ophthalmologist, giving internists and general practitioners a prompt to consider ocular disease risk alongside cardiovascular risk.

Coleman adds that the tool’s primary value is not for the ophthalmologist but for the primary care physician. “This is for the primary care physician so that they’re aware that, wait a second, this individual not only has a risk of atherosclerotic cardiovascular disease, but increased risk of age-related macular degeneration, for example—and that’s not something that they’re necessarily facile with.” One unexpected finding was that body mass index (BMI) showed virtually no variation across all 4 risk categories, contrary to Coleman’s expectation that higher BMI would track with both cardiovascular and ocular disease risk.

For glaucoma specifically, the association with PCE risk was more moderate than for AMD or diabetic retinopathy. Coleman notes that the original PCE only included Black and white racial groups, and the study expanded this to capture other ethnicities given their importance in glaucoma risk. Sleep apnea and circadian rhythm disruption are mentioned as additional environmental factors under investigation for their potential role in glaucoma susceptibility.

Clinical implications

The discussion touches upon what screening should look like if a primary care physician identifies an elevated PCE score. Coleman’s answer is referral for a comprehensive eye examination, since pressure measurement or optic nerve assessment alone can miss glaucoma. Whether a high PCE score should prompt more frequent follow-up or additional imaging within ophthalmology practices is an open question. “This is new information, and it might end up being one of our risk factors because it actually is good at summarizing all of the systemic risks—but that study needs to be done.”

Looking ahead, Coleman describes her primary goal as integrating the PCE as an automatic score within the electronic health record to enable routine referrals from primary care—infrastructure that does not yet exist at UCLA or NYU Langone. Whether acting on elevated PCE scores improves real-world detection of ocular disease at a population level remains to be demonstrated prospectively.

Reference

1. Sun D, Tseng VL, Yu F, Coleman AL. Cardiovascular risk and eye health: a cohort study of the pooled cohort equations and ocular disease incidence. Ophthalmology. 2026;133(5):645-653. doi:10.1016/j.ophtha.2025.12.021