A visit to your eye doctor can go far beyond just improving your vision. Using specialized instruments, eye doctors can shed light on your overall health, detecting disease or inflammation in the heart, kidneys, immune system and more. In fact, ophthalmologists and optometrists often are the first to detect medical conditions running rampant throughout the body, says holistic optometrist ­Britney Caruso, OD.

Example: A 55-year-old patient thought a subtle tweak to her contact lens prescription would help her see her computer and TV screens more clearly. But an eye examination showed alarming damage to the back of her eye, including swelling and microscopic hemorrhaging, both of which indicate uncontrolled high blood pressure. Even though the patient said her high blood pressure was controlled with medication, it measured a potentially life-threatening 240/160 mmHg. (A normal blood pressure reading is 120/80 mmHg.) She was taken straight to the hospital, where her blood pressure was stabilized and her vision improved significantly.

What other medical conditions can an eye-care clinician detect? Read on…

Diabetes. The tiny blood vessels in the back of the eyes are among the most fragile blood vessels in the body. They are highly susceptible to damage stemming from diseases elsewhere in the body, including diabetes, a serious condition affecting 30% of US adults age 65 and older in which the body fails to produce or utilize insulin sufficiently, fueling excess blood sugar levels. The first manifestations of untreated ­diabetes often occur as microscopic blood vessel bleeds in the eyes. Excess blood sugar interferes with blood flow to the retina, starving it of nourishment. The eye responds by growing new blood vessels…but they’re weak and leak easily.
When they dilate the eyes and perform a fundoscopic exam in which they can visualize the retina in the back of the eye, ophthalmologists are able to see these damaged blood vessels—called diabetic retinopathy—before a patient even knows that he/she has diabetes. Early-stage diabetic retinopathy usually is asymptomatic. By the time it starts to affect vision—causing floaters, blurred vision, eye pain and/or new vision loss—the retinopathy is severe. More than one out of every four people with diabetes has diabetic retinopathy.

Other red flags: Blood spots or thickening in the back part of the eye and dramatic changes in a patient’s eyeglass prescription.
If diabetes is suspected: Many eye-care providers can check your blood sugar levels in the office or will refer you to your physician for bloodwork. Diabetes or not, an annual dilated eye exam allows your eye doctor to catch any problems early, when they’re most treatable. Some eye-care practices also offer widefield retinal scanning—Optomap and Optos are two brands—which scans the entire back of your eye without dilation.

If you have diabetes:
Treating it can prevent permanent vision loss (untreated diabetic retinopathy is a leading cause of blindness). As your blood sugar levels become more controlled, your vision can improve, and your eyeglass and contact lens prescriptions probably will change.

High blood pressure. Also known as hypertension, high blood pressure is nicknamed “the silent killer” because of its tendency to sneak up on people without symptoms. Of the 75 million Americans with hypertension, nearly half don’t have it under control…and 11 million don’t even realize they have the condition. Like diabetes, uncontrolled hypertension can produce changes to the back of the eye that can be seen with widefield retina imaging. There are three stages in hypertensive retinopathy, all of which are detectable only during an eye exam…

Mild hypertensive retinopathy:
Changes in the shape of blood vessels in the back of the eye.

Moderate hypertensive retinopathy:
Flame-shaped blood spots or white patches in the back of the eye resembling wool or cotton.

Severe hypertensive retinopathy: The nerve connecting the eye to the brain swells and may appear to pop out of the back part of the eye.

Chronic hypertensive retinopathy doesn’t typically cause permanent or ­significant visual loss, nor does it alter patients’ lens prescriptions, but it is an all-important warning sign. Uncontrolled blood pressure elevates risk for heart disease and stroke. When blood pressure is high enough to cause chronic hypertensive retinopathy and not treated, it is nearly always fatal within one year of diagnosis. When hypertension is treated properly, your eyes should improve.

Rheumatoid arthritis (RA) is a painful, often debilitating inflammatory condition in which the immune system mistakenly attacks the joints causing painful swelling and stiffness. But the inflammation doesn’t affect only the joints—it can affect various organs, including the heart, skin and eyes. One in four RA patients will experience co-occurring eye problems ranging from dry eye to the dangerous condition ­uveitis, one of the world’s leading causes of blindness.

Dry Eye. Between 20% and 30% of RA patients develop dry eye (versus about 5% to 17% in the general population). It typically occurs when the immune system attacks the tear glands in the eyes. Many individuals with RA also have a second autoimmune condition called Sjögren’s syndrome that prompts the immune system to attack moisture-producing cells, such as tear and salivary glands. Besides persistent dry eye, other ocular symptoms can include itching, burning and redness…sensitivity to light…and a gritty feeling in the eye.

Uveitis. RA can inflame the uvea, a section of the eye made up of three main structures, including the iris (the colored part of the eye), the ciliary body (the structure that secretes the liquid within the front of the eye) and the choroid (part of the retina). Uveitis may cause deep eye pain and blurred vision or subtler symptoms such as floaters and redness. Untreated uveitis, which may appear a bit like pink eye, can cause permanent vision loss. It can pop up after an RA diagnosis, but in some cases, it occurs before the patient has any clue that he/she has RA.

Many other conditions can cause dry eye and uveitis (uveitis, for instance, also can be caused by Crohn’s disease or multiple sclerosis). Both dry eye and uveitis are treatable, but early diagnosis is critical. Even if you have never been diagnosed with an autoimmune disease, don’t ignore dryness, redness or other eye symptoms. If you are diagnosed with uveitis, tell your eye doctor if you’ve noticed any RA symptoms, such as joint pain and swelling. You’ll likely be referred to a rheumatologist.

Other diseases: A comprehensive eye exam can reveal early signs of thyroid disease, high cholesterol, Lyme disease and other tick-borne illnesses, multiple sclerosis, skin cancer (on the eyelids) and even brain tumors. Always be sure to tell your ophthalmologist or optometrist if you’ve been diagnosed with any new medical conditions or are taking new medications—drugs ranging from antihistamines to antihypertensives also can affect vision.

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