Incorporating Mortality Risk Into Estimates of 5-Year Glaucoma Risk
Published In: American Journal of Ophthalmology, v. 148, no. 6, Dec. 2009, p. 925-931, Appendix 931.e1-931.e7
Posted on RAND.org on December 31, 2008
PURPOSE: To incorporate mortality risk, a potentially important factor to consider when deciding whether to initiate therapy for ocular hypertensives, into estimates of 5-year glaucoma risk. DESIGN: Comparison study of estimates of glaucoma risk that do and do not account for mortality risk. METHODS: The authors computed 5-year risk of glaucoma for a set of hypothetical glaucoma suspects. They then determined their 5-year risk of death using the Charlson index, which is based on age and comorbidity, and computed mortality-adjusted 5-year risk that the individual will develop glaucoma before death. RESULTS: Accounting for mortality risk reduces the risk of developing glaucoma in one's lifetime. For example, a 75-year-old patient with an unadjusted 5-year glaucoma risk of 51.0% can have mortality-adjusted 5-year glaucoma risks of 41.8% (18% relative risk reduction) or 20.2% (60% relative risk reduction) assuming the patient has a Charlson comorbidity score of 1 or 3, respectively. CONCLUSIONS: Shortened life expectancy reduces 5-year risk of developing glaucoma. Thus, mortality risk is another factor clinicians should consider when deciding whether to initiate treatment of glaucoma suspects.