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Disclaimer: About 80% to 90% of this piece was written by Laurel A. Rockefeller. The other 10% to 20% was written by Arpi Haroutunian.

Laurel A. Rockefeller

Issue 2, September 17, 2004: Risk Supplement Program

Publication
Introduction to the Supplement. Ocular hypertension: defining risks and clinical options. Robert N. Weinreb, MD. Am J Ophthalmol. 2004;138 Supplement: S1-S2.

Discussion synopsis

• In this introduction to the supplement for the September, 2004 edition of the American Journal of Ophthalmology, Dr. Weinreb ties together both the results of the Ocular Hypertension Treatment Study (OHTS) which establishes that lowering intraocular pressure (IOP) reduces the risk of progression to glaucoma, and the findings of glaucoma specialists that are presented in the supplement.

• Dr. Weinreb emphasizes the importance of glaucoma treatment by translating what appears to be a small number of affected individuals (5%) into actual number of Americans who suffer from glaucoma (3.9 million).

  • Dr. Weinreb places each article into context within the supplement and outside of it.

  • At the end of the introduction, Dr. Weinreb introduces an article he wrote that does not appear in the supplement at all, but rather in the regular volume 138 of the journal.

• As an introduction, its primary relevance is to convince readers that the articles that follow are relevant to them.

• Dr. Weinreb suggests that critical questions remain regarding the application of these findings to patient management:

  • If left untreated, what is the likelihood that patients with ocular hypertension will lose their vision?

  • What is the impact of therapy on the eventual progression to blindness?

  • Considering that not all patients with OH will require or desire treatment, how can physicans distinguish those patients who will benefit most from therapy?

• While there are no easy answers to these questions, it is reasonable to try to develop a sound scientific approach to quantifying an individual patient's risk for progression to functional impairment.

• A reasonable approach is to apply risk assessment methods parallel to those used in the management of patients with coronary heart disease (CHD).

• A panel of glaucoma experts whose work appears in this supplement was convened to review the cardiovascular model of risk analysis and the existing literature on the risks of progression in OH and glaucoma. This panel then used this evidence to estimate the risk of progression of OH and glaucoma to functional impairment, identifying individual patient risk factors for progression, and discussing tools for quantifying and estimating the benefits of therapy for OH in an individual patient.

• Dr. Weinreb concludes, "A patient's overall health status, life expectancy, commitment to treatment, and risk factors for progression must be weighed against the potential adverse effects and costs of treatment in effective management of OH" and that this supplement provides ophthalmologists with a "fresh perspective on the often complex decision of when and whether to treat ocular hypertension."

• Together, the articles in the supplement offer a step toward developing a risk assessment tool that can assist ophthalmologists in their management of patients with OH

Strengths

• The introduction is easy to read with a smooth narrative prose that guides the reader through each article in the supplement and explains the importance of each.
  

• The introduction grabs the attention of the reader in the first paragraph by concisely defining glaucoma as a problem and establishing the major issues that make diagnosis and treatment challenging.
  
  

BACK TO HOMEPAGE

Disclaimer: About 80% to 90% of this piece was written by Laurel A. Rockefeller. The other 10% to 20% was written by Arpi Haroutunian.