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Educate patients on systemic benefits of eye exam
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We learn it the very first day of our optometric training and live it every day thereafter. It is the fact that an eye examination is much more than just that, it is often a snapshot of an individual’s systemic well being.
While diagnosing hypertension by virtue of a retinal vein occlusion, diabetes through retinopathy and carotid artery disease in the presence of a Hollenhorst plaque may be relatively mundane to us, it is often anything but to our patients. Patients are utterly amazed – and often quite impressed – by the systemic conclusions we derive from an eye examination. They are so for good reason, as many of our patients know no better. For them, an eye examination pretty much equates with refraction, new corrective lenses and a clearer view of the world. It is for precisely this reason we strive to better understand the relation between ocular and systemic health, to thoroughly examine each patient and to educate our patients.
This month’s Primary Care Optometry News includes two exceptional articles underscoring the ever-expanding role optometrists play in patient systemic health management. In our update on Marfan syndrome (“ECPs can play vital role in diagnosis of Marfan syndrome,” Andrew W. Nahas, OD, emphasizes the importance of good optometric care in the diagnosis and management of this multisystem disease. While knowing what to look for in a previously diagnosed patient with Marfan syndrome is relatively easy, Nahas reminds us that a tremulous or subluxated crystalline lens can be the first sign – preceding the classic body habitus of Marfan – and allowing optometrists to make a critical early diagnosis.
In a similar fashion, J. James Thimons, OD, and Allan Panzer, OD, PA, provide an exceptional overview of the ocular findings associated with sleep apnea (“Consider sleep apnea in patients with normal–tension glaucoma,”. Again, they remind us that patients often present with ocular symptoms and findings consistent with undiagnosed systemic disease. Thimons and Panzer aptly point out that optometrists must consider sleep apnea in the differential diagnosis of progressive low-tension glaucoma and in those presenting with floppy eyelid syndrome. Given the underdiagnosed nature of sleep apnea – and its significant cardiovascular sequelae – early diagnosis is essential.
While the ocular sequelae of sleep apnea and Marfan syndrome are excellent examples of the role optometrists play in diagnosing systemic disease, the list of other conditions just continues to grow. Is there an increased risk of cardiovascular disease in patients of Scandinavian ancestry with ocular exfoliation? Does the presence of congenital hypertrophy of the retinal pigment epithelium indicate an increased risk of familial adenomatous polyposis colorectal cancer? While none of these ocular findings are an absolute indication of a specific systemic disease, each warrants careful questioning, assessment of risk factors and – where appropriate – dialogue with a patient’s primary care physician.
Perhaps, most importantly, these conditions remind us of how essential it is we remain committed to staying abreast of the literature, providing exceptional comprehensive care and communicating with our patients. After all, if we do not educate our patients, how will they ever learn that an eye examination is so much more than just an eye examination?