BLOG: Saving lives in the eye clinic
My residency director, David Carey, used to say ironically, “If you step back and take a careful look, you’ll see there’s a whole patient behind that eyeball.”
Indeed, we often overlook the responsibility we have for our patients’ general health. With every eye exam, we get a view into the microcirculation of the central nervous system and other structures where the earliest stages of systemic disease may manifest. Many times, I have diagnosed sarcoidosis by looking at the conjunctiva. Pulling down the lower lid, more than once I have been surprised to find a salmon-pink mass that turned out to be lymphoma. How many of us have not diagnosed a pituitary adenoma based on a visual field test or diabetes based on a fundus exam?
Now, sleep apnea is increasingly recognized for its association with common eye diseases like age-related macular degeneration, low-tension glaucoma and nonarteritic anterior ischemic optic neuropathy, as described in the cover story of this issue of Healio | OSN. While we eye care providers don’t typically treat sleep apnea, we can and should think frequently about making the diagnosis in our patients because the disease is so common and so harmful when overlooked.
We probably should update our patient intake questionnaires to include short screening questions like the Epworth Sleepiness Scale, Berlin Questionnaire or STOP-Bang questionnaire to identify sleep apnea suspects, and we should develop relationships with sleep specialists to make it easy for patients to act.
Patients formally diagnosed with sleep apnea often resist treatment, which usually involves weight loss and the use of devices like continuous positive airway pressure; both are difficult and require a change of lifestyle. That’s why we ophthalmologists may have a particularly important role in getting patients to take sleep apnea seriously simply because patients respect what we say so much. Telling a patient “You might go blind if you don’t manage this condition” is a powerful opportunity we shouldn’t forego, especially for those sleep apnea suspects who are willing to risk other consequences like hypertension and coronary artery disease.
How many times in your career has a patient told you that you saved his or her life? For me, usually, this is a complete surprise that comes months or years after I saw the patient last and referred for general medical evaluation of a suspicious finding. It makes me think back to why I became a doctor and why I should always try to listen to the words of my residency director.
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For more information:
John A. Hovanesian, MD, FACS, an ophthalmologist specializing in cataract, refractive and corneal surgery at Harvard Eye Associates in Laguna Hills, California, can be reached at drhovanesian@harvardeye.com.
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