Eye Examinations and General Health

By Michael J. Dodd, MD

Maryland Eye Associates

. http://marylandeyeassociates.com

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Eye Examinations and General Health

Patients may wonder if an eye exam can help evaluate the general health status of a person. The answer is yes. This month's Your Health Magazine is dedicated to issues about Heart Disease, Stroke and Diabetes. How can an eye exam aid in diagnosing these disorders?

Let's start with Heart Disease. The most common medical problem that results in heart disease is high blood pressure or hypertension. There are many conditions that may cause hypertension including kidney disease, endocrine (hormonal) disorders, anxiety and so on. A condition known as essential hypertension is the most common type and it's exact cause is still not well understood. Whatever the cause of hypertension the signs are the same elevation of the blood pressure and narrowing of the small arteries (arterioles) throughout the body. The only place in the human body where the arterioles can be seen is the retina of the eye. By examining the retina a physician can document narrowing of the arterioles. There can also be other signs of hypertension in the eye whites spots in the retina (exudates), flame hemorrhages in the retina and in severe hypertension, swelling of the optic nerve (papilledema). Therefore a retinal exam can be very useful in assessing a patient for hypertension and can often be the first sign of hypertension.

What about strokes? A stroke is a condition where one of two things occurs in the brain either there is a broken blood vessel, which causes bleeding in the brain, or a clot blocks an artery and the brain tissue “downstream” is damaged. Both of these conditions cause cell death and a malfunction of the affected brain tissue. Some stroke patients develop weakness of an arm or leg. Others may lose consciousness and die. If the part of the brain affected is an area involved in vision, certain patterns of vision may be lost. This can be evaluated by testing the side vision for each eye by a test known as a visual field. For example, it is possible to lose the left field of vision from both eyes. This localizes the damaged brain tissue to the right side of the brain behind the optic nerves. Brain tumors can often be localized by certain defects on a visual field test.

Diabetes is a well-known cause of eye problems. But the eye exam may also lead to early diagnosis of diabetes. I see several patients a year who have eye signs of diabetes and are not aware they have the condition. Here are three examples. During an inspection of the retina, small dilated capillaries (micro aneurisms), retinal hemorrhages or white exudates can be seen and often indicate diabetes unknown to the patient. In addition, a type of cataract known as a “posterior sub-capsular cataract,” is often an early sign of diabetes. Sudden changes in the refractive status (causing blurry vision) can be a sign of wide blood sugar fluctuations.

In summary, an eye exam is an important aid in diagnosing these and other medical conditions.