An understanding of the nature of risk is important, not only in work but life in general.

Media coverage and anecdotal reports tend to skew our perception of what represents significant risk and what we may take for granted without ever perceiving inherent risk. Obvious examples include the assumption that air travel is risky. Obviously, whenever a plane crashes, the risk to those on board is as high as it gets, but the chances of this occurring are exceptionally low when compared with, for example, the risk of crossing the road in a busy city. A recent information film warning travellers of what to do if confronted by a terrorist attack on a beach has been rightly criticised for over-emphasising a low risk.

There are still practitioners out there arguing that it is not our business to ask about lifestyle and smoking habits, even when the evidence for their being risk factors for ocular disease is far more significant than for most systemic drugs which are routinely asked about and recorded without often a thought. And when risk factors are identified, for example a risk of primary open angle glaucoma, this may not be acted upon by the clinician, for example using a full threshold fields strategy. Primary eye care has to involve risk assessment if monitoring and referral is to be targeted and implemented most efficiently. This means we need to keep up to date as risk factor data evolves.

A study in this month’s American Journal of Ophthalmology has suggested ‘Cardiovascular disease is a major determinant of glaucoma disease progression. The risk of having rapidly progressive disease is doubled in those with a cardiovascular history.’ However, ‘All other risk factors studied, including sex, age, refraction, central corneal thickness... were not shown to be statistically significant predictors of rapid progression in our study.’

I am updating my notes…