Understanding risk is very complicated. It is made more complicated if there is overlap and influence between many different risk factors and if there is no clear answer to the question ‘risk to whom or what?’

Is the risk of dying in a plane crash very high? If you are on board a crashing plane, yes. For the general population over a specific time, the risk is far lower than that of dying in a car crash, though car crash risk has a much greater correlation with age. And are we comparing risk to any cause of death or just crash death? The model of plane, nature of crash, profile of passenger and their protective environment; without further info, this is an impossible and leading question.

This is not news to us, of course. Look at visual fields testing (new post-Covid guidance now available on the College website) in many practices. Ask who is screened for defects, and many say those with raised IOP, funny discs or if there is ‘a family history.’ Suggest that everyone over the age of, say, 30 is screened and many will argue this is excessive and eats into time despite age being the major risk factor in isolation for POAG. Ironically, the commercial argument here is mirrored in the resistance to a recent call for lockdown for the over-50s. Based on limiting immediate health risk to a disease with affinity for the elderly, perhaps this is sensible. Based on long- term economic impact and with no future immunity route confirmed, could there be greater long-term risk to health from mental illness and lack of funding for health and infrastructure in a crashed economy? And what about the obese under-50s?

While statistics bases are growing, lines need redrawing; ultimately the question of overall aim needs to be addressed in open and honest debate. In the meantime, off to Australia where influenza rates are lower than ever this winter.