Eye Cues

Chronic illnesses can have an impact on vision, making coordination between healthcare and eye care providers is important.

Signs of disease may be detectable in the eye years in advance

Shakespeare said the eyes are windows to the soul. They can also give a pretty clear indication of health issues that may be developing in other parts of the body.

A patient’s primary physician and eye care provider may not cross paths all that often, but a closer working relationship could possibly unmask disorders earlier when they are more treatable.

The classic case is diabetes, which may first present in an eye exam chair with a patient complaining of blurred vision. High blood sugar can attack the vascular system of the eye, and it can eventually lead to early cataracts or diabetic retinopathy, a leading cause of blindness.

Unfortunately, economically disadvantaged people, who tend to have an elevated risk of diabetes, are also less likely to have eye exams.

A UAB study published in JAMA Ophthalmology found that low socioeconomic status is a risk factor for visual impairment because of decreased preventive services and poor continuity of care, which can delay diagnoses and increase complications. Paul McLennan, PhD, lead author of the study, said “Our results show that frequency of eye care was low, just 33 percent within the first year, and only 45 percent within two years.”

A second UAB study looked at the value of using Telemedicine for diabetic eye screenings in underserved communities. One in five patients examined had early stage diabetic retinopathy, and nearly half of the mostly minority populations screened had additional vision conditions such as glaucoma or cataracts.

Encouraging diabetics to get regular eye exams is an area of collaboration between health professionals that can have a positive effect on patient health.

Looking into a patient’s eyes can also reveal early signs of heart and vascular conditions, hypertension, and autoimmune and metabolic disorders.

Dry, red eyes may suggest it’s time to see an allergist, but they can also be a sign of Sjogren’s syndrome or other disorders related to arthritis. Eyes may be where emerging symptoms of thyroid disorders such as Graves Disease first show themselves.

Recent research shows that early evidence of Alzheimer’s can sometimes be found in the eye years before more obvious symptoms appear with the detection of an amyloid protein in the lens and fluid of the eye.

Changes to the eyes may also help diagnose the onset of frontotemporal dementia, the second most common form of dementia. Scientists from UAB, Gladstone Institutes and the University of California found that individuals with a genetic mutation associated with FTD showed a significant thinning of the retina before any cognitive signs of dementia were present. This thinning is not present in people who do not have the mutation.

“We can use the thinning of retinal cells as a marker for this type of dementia,” UAB neurologist Erik Roberson said. “Further studies may also help determine whether the changes in the retina can be a marker of disease progression or a means of gauging the effectiveness of new therapies.”

Another area where primary physicians, specialists and eye care providers can work together for better outcomes is in making sure that patients whose vision has been impaired by systemic diseases know about and have access to advances that could improve their sight.

Jeff Henson of Heflin was legally blind from the effects of arthritis and inflammation.

“I didn’t have any vision at all,” he said. “I was running into doors and walls.”

Carol Rosenstiel, OD is the chief of the contact lens service in the UAB Department of Ophthalmology. She specializes in using contact lenses to correct severe vision issues, particularly in cases like Henson’s, where surgery or eyeglasses are not an option.

Henson’s cornea was badly scarred from inflammation. Light entering the eye scattered and did not focus on the retina properly. Rosenstiel prescribed a hard, gas-permeable lens which created a new spherical refractive surface on the front of the eye which allowed light rays to focus accurately on the retina. She piggybacked it with a soft contact lens Henson could wear underneath the hard lens to tolerate it better. With his contacts, Henson’s vision in his left eye is now nearly normal.

Eye movements and pupil reactions can also signal the possibility of brain tumors, stroke and other neurological conditions as well as the presence of traumatic brain injuries. Such findings during an eye exam would likely result in an immediate referral for follow up with a physician.

There are also eye emergencies that may first show up in a primary care physician’s office that warrant an expedited referred to an eye specialist. Retinal detachments are a vivid example. When patients complain of flashes of light, a dramatic increase in floaters, shadows in peripheral vision or loss of central vision, it could be an emergency requiring immediate assessment and treatment by a retina specialist to preserve sight.

Fortunately, for such emergencies and for eye injuries, Alabama has the nation’s first designated eye trauma center at the Callahan Eye Foundation Hospital in Birmingham. Open 24 hours a day, it is the only emergency department totally dedicated to eye emergencies in Alabama and one of only two in the Southeast. The department’s recent renovations feature a new optical coherence tomography system to capture three-dimensional images of the eye.

Perhaps a good resolution for the coming year would be for primary physicians, specialists and eye care providers to work more closely. It might be a good idea to ask patients who their other health care providers are and keep contact information on file.

And next time patients come in for a checkup, it might be helpful to ask when they last had an eye exam. And how did it go?


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