In a large prospective cohort, this widely used primary care tool identified individuals at the highest risk of future ocular conditions, highlighting its potential role in guiding targeted eye screening and supporting ophthalmologists in personalized follow-up and surveillance.
Cardiovascular risk factors affect eye health, yet primary care tools are seldom assessed for predicting ocular disease. To examine this link, Deyu Sun, MD, from the David Geffen School of Medicine at UCLA, and colleagues evaluated whether the Pooled Cohort Equations (PCE) score is associated with future risks of age-related macular degeneration, glaucoma, diabetic retinopathy, retinal vein occlusion, and hypertensive retinopathy.
The team conducted a historical prospective cohort study using electronic health records from the All of Us Research Program. Adults aged 40 to 79 years with complete data for PCE calculation between 2009 and 2015 were included, while those with pre-existing cardiovascular disease or ocular conditions were excluded. The final cohort comprised 35,909 participants.
Participants were classified into four PCE risk categories: low, borderline, intermediate, and high. Time-to-event analyses, including Kaplan–Meier curves and Cox regression models, were used to assess associations between cardiovascular risk and incident eye disease. Models were adjusted for non-PCE factors such as race, body mass index, chronic kidney disease, and education.
The analysis revealed the following findings:
• A clear, graded association was observed between increasing PCE risk categories and the future development of ocular diseases.
• Individuals in the high-risk PCE group had substantially higher risks of age-related macular degeneration, diabetic retinopathy, glaucoma, retinal vein occlusion, and hypertensive retinopathy compared with those in the low-risk group.
• The strongest risk associations were seen for age-related macular degeneration and diabetic retinopathy.
• Hypertensive retinopathy showed a moderate but notable association with higher PCE risk.
• Model performance was highest for predicting age-related macular degeneration, diabetic retinopathy, and hypertensive retinopathy.
• Predictive performance was moderate for glaucoma and retinal vein occlusion.
Results remained consistent across sensitivity analyses with varying follow-up durations. Additional component-based analyses suggested that age largely explained the association between PCE and AMD, while the links with diabetic and hypertensive retinopathy remained robust even after accounting for individual PCE components.
According to the authors, these findings indicate that a single cardiovascular risk score, already embedded in routine primary care, can meaningfully stratify the future risk of multiple eye diseases. They concluded that incorporating PCE into primary care decision-making could help identify individuals who may benefit from earlier ophthalmologic referral and preventive eye care, potentially improving long-term visual outcomes.
Reference:
Sun D, Tseng VL, Yu F, Coleman AL. Cardiovascular Risk and Eye Health: A Prospective Cohort Study of the Pooled Cohort Equations and Ocular Disease Incidence. Ophthalmology. 2025 Dec 29:S0161-6420(25)00802-4. doi: 10.1016/j.ophtha.2025.12.021. Epub ahead of print. PMID: 41475545.
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