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Use fundus photos to educate patients on systemic conditions
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It has been on television for many months. A physician in the standard white lab coat says: “If you could see what I see …” He is talking to a patient with high cholesterol, and it is an advertisement for Crestor (rosuvastatin calcium, AstraZeneca). I am not quite sure what this physician wants the patient to see, but I know what I, as an optometrist, want my patient to see.
Fundus photography has been an integral part of my comprehensive exam for years. I have found nothing more effective at demonstrating to a patient the health of their eyes and how it relates to their overall health than a nice photo, enlarged and in color.
Each examination ends with a discussion of the patient’s fundus photo and how the vessels relate to hypertension, cholesterol, obesity and smoking.
Here is an example of what I may say to the patient:
“Thin vessels are the arteries (arterioles) within the muscular cell wall. Larger ones are the veins (venules) within the thinner cell wall. See how they are redder? You can see the blood through that thin wall. See the thinning of the arteries? See the plaque build-up on that muscular wall? See the compression of that ‘hard’ artery on that vein? See the deflection of the vein?”
This image shows: arteriole tortuosity, plaque build-up, vein deflection, vein compression, branch
vein occlusion, hemorrhage, exudate and subsequent scarring. Patients can help themselves
with proper diet, smoking cessation, blood pressure and cholesterol (lipid) control, and diabetes
prevention and control.
Image: Spangler J
I may continue with this:
“This is why we took your blood pressure earlier. Are you being treated for hypertension or high cholesterol? Are you compliant with your treatment plan? Do you smoke? Did you smoke? Are you concerned about your weight? What is happening with these vessels in your eyes is happening elsewhere in your body. The vein occlusion in the retina can happen elsewhere – leading to numbness or pain in legs, heart disease or even stroke.”
I will advise the patient to take charge of their health and discuss hypertension and cholesterol with their primary care physician. I ask if they need help with diet or smoking cessation.
I know for a fact that I have many patients on medications because of my recommendation to follow up with their primary care physician. I know many patients who have quit smoking after seeing how smoking damages their lives.
I called AstraZeneca one day and asked if they knew optometrists had this ability to show patients the damage their product treated, but there was little interest. I am not sure why they are not more involved with optometry, but they should be.
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Disclosure: Spangler has no relevant financial disclosures.