NEW large-scale cohort evidence indicates that eye health can be meaningfully predicted using a cardiovascular risk tool already embedded in routine primary care. The Pooled Cohort Equations (PCE), traditionally used to estimate atherosclerotic cardiovascular disease risk, was shown to stratify future risk for several major ocular diseases, suggesting that cardiovascular risk profiling may play an important role in proactive eye health management.
Eye Health and Cardiovascular Risk
Eye health is closely linked to systemic vascular integrity. Retinal and choroidal tissues are highly sensitive to microvascular dysfunction, making them particularly vulnerable to the same pathophysiologic processes that drive cardiovascular disease. This study evaluated whether this widely used score could also forecast long-term ocular outcomes, providing a single, efficient marker for both cardiovascular and ophthalmic risk stratification.
Prospective Evidence from Over 35,000 Adults
Using electronic health record data from the All of Us Research Program, investigators followed 35,909 adults aged 40 to 79 years who were free of both cardiovascular disease and major ocular disorders at baseline. Participants were classified into low, borderline, intermediate, and high PCE risk categories. Higher PCE categories were consistently associated with a substantially increased risk of developing age-related macular degeneration, diabetic retinopathy, glaucoma, retinal vein occlusion, and hypertensive retinopathy. Individuals in the high-risk PCE category experienced the greatest elevations in future ocular disease risk, even after adjustment for demographic and clinical covariates.
Model performance analyses showed that the PCE demonstrated particularly strong predictive accuracy for age-related macular degeneration, diabetic retinopathy, and hypertensive retinopathy, with moderate predictive value for glaucoma and retinal vein occlusion. Sensitivity analyses confirmed the robustness of these associations across multiple follow-up periods, indicating that the observed relationships were not dependent on specific analytical assumptions.
Implications For Preventive Eye Care
These findings support the integration of cardiovascular risk scoring into eye health strategies. Because the PCE is already routinely calculated in primary care, it could be leveraged to identify individuals who would benefit from earlier ophthalmologic referral, intensified monitoring, and targeted prevention. This approach offers a practical pathway to shift eye care from reactive treatment toward proactive prevention, particularly for populations at elevated vascular risk.
Reference
Sun D et al. Cardiovascular risk and eye health: a prospective cohort study of the pooled cohort equations and ocular disease incidence. Ophthalmology. 2025; DOI:10.1016/j.ophtha.2025.12.021.
