Win­dows to more than the soul

Rou­tine eye ex­ams can re­veal a lot about a pa­tient’s over­all health, in­clud­ing warn­ings of fu­ture prob­lems

The Dallas Morning News - - HEALTHY LIVING - By KATH­LEEN GREEN Spe­cial Con­trib­u­tor

There’s more to an op­ti­cal exam than meets the eye. Our eyes can of­fer amaz­ing in­sight into our over­all health.

Go­ing be­yond glasses and con­tact lenses, eye doc­tors are look­ing for signs of mul­ti­ple scle­ro­sis, lu­pus, di­a­betes, brain tu­mors and nu­mer­ous other af­flic­tions.

“We have an im­por­tant job in terms of screen­ing peo­ple for all sorts of sys­temic dis­eases, not just eye dis­eases,” says Dr. Karen Sa­land, a Dal­las oph­thal­mol­o­gist. Most peo­ple as­sume that an an­nual trip to the fam­ily doc­tor is suf­fi­cient. Un­for­tu­nately, eyes of­ten are over­looked un­til some­thing goes wrong. And that’s a risk that no one should take. Wait­ing un­til some­thing is blurry or an eye is painful can be ex­tremely risky, es­pe­cially as we age.

“Peo­ple think that just be­cause they have good eye­sight that they don’t have to worry,” Dr. Sa­land says. “They just as­sume that they’re healthy. With dis­eases like glau­coma and age-re­lated mac­u­lar de­gen­er­a­tion, you don’t feel th­ese dis­eases. You don’t even know you have them. By the time you no­tice you have glau­coma, it’s usu­ally too late.”

Other than eye dis­eases, di­a­betes is one of the most preva­lent con­di­tions de­tected in Steven Kurtin’s Plano prac­tice.

Ahand­ful of pa­tients ar­rive in his of­fice each month with not only blurry vi­sion but signs of di­a­betes, he says. Th­ese episodes, which in­clude out-of-fo­cus dis­tance vi­sion, may last a few hours, some­times not re­cur­ring for months or even years.

Eye doc­tors serve as de­tec­tives, ask­ing ques­tions and run­ning down a list that helps rule out cer­tain con­di­tions. With di­a­betes, those clues some­times show up af­ter eat­ing.

“Pretty sud­denly, af­ter a meal, the blood sugar rises, and the body doesn’t take care of the blood sugar too well and dumps it off into the eye, more or less,” says Dr. Kurtin, an op­tometrist with Kurtin Eye Care Cen­ter.

“In the long term, the lit­tle blood ves­sels are un­der so much stress and don’t hold up too well for peo­ple who are di­a­bet­ics. Those lit­tle blood ves­sels break on the retina.”

The reti­nas, op­tic nerves and corneas of­ten hold huge clues to how healthy a body re­ally is.

“There are a ton of things we’re look­ing for,” he says. “I’m kind of a sleuth fig­ur­ing out if some­body has an is­sue or not. I don’t want to be an alarmist ei­ther, but I like to rule things out.”

Red flags

Upon ex­am­i­na­tion, if any­thing raises a red flag, eye ex­perts rec­om­mend fol­low-up blood work at a pa­tient’s physi­cian’s of­fice. One ad­van­tage of an eye exam is that it’s non­in­va­sive.

“When you’re ex­am­in­ing any­thing else on the body, if you wanted to see the inside of the or­gan, you’d ac­tu­ally have to cut the body open or do an imag­ing tech­nique like a CT, X-ray or MRI,” Dr. Sa­land says.

Bob Li­nen­schmidt wishes he had known that last Jan­uary when his wife rushed him to an emer­gency room think­ing he was hav­ing a stroke. A bat­tery of tests, in­clud­ing nu­mer­ous scans, re­vealed noth­ing over the next sev­eral months.

The North­east Dal­las res­i­dent had al­ways taken great eye­sight for granted. He didn’t even need glasses un­til his mid-40s. Yet, two days af­ter his trip to the ER, he woke up in to­tal dark­ness. Clear vi­sion has been a bat­tle ever since.

“Some­times, I could see real good, and some­times I couldn’t see worth a flip,” says Mr. Li­nen­schmidt, 61, a re­tired com­puter-ap­pli­ca­tions teacher with the Dal­las In­de­pen­dent School Dis­trict.

He­saw nearly a dozen spe­cial­ists be­fore Dr. Sa­land pin­pointed his con­di­tion last fall. She found sig­nif­i­cant swelling of his op­tic nerve, di­ag­nos­ing him with hy­per­ho­mo­cys­teine­mia, a rare “blood dis­or­der that puts pa­tients at in­creased risk for clot­ting,” she says. “They’re at high risk for stroke or heart dis­ease.”

Mr. Li­nen­schmidt’s wife com­pared a pic­ture of his eye to the sur­face of Mars. And his op­tic nerve, in­stead of be­ing a round, flat disc, had ruf­fles around the edges, he says. An­other spe­cial­ist found small blood clots in his brain with a backup of blood in his eye­ball.

He’s now tak­ing the an­ti­co­ag­u­lant Lovenox, a blood thin­ner, which should help break up the clots. He says he will never take great eye­sight for granted again.

“Ev­ery now and then, I see per­fectly,” he says. “I’m hav­ing more good days than bad days.”

Ag­ing prob­lems

Al­though cases like Mr. Li­nen­schmidt’s are un­com­mon, as baby boomers age, more eye-exam pa­tients are be­ing di­ag­nosed with all sorts of con­di­tions, both doc­tors say. High choles­terol, rheumatoid arthri­tis and au­toim­mune prob­lems can be de­tected with a look at the cornea.

“De­posits of fatty acid-type ma­te­rial can be found in the blood­stream,” Dr. Kurtin says. “When the body can’t me­tab­o­lize, it dumps it off, usu­ally in the blood ves­sels. Some of that gets caught up in the cornea.” This sign of high choles­terol is not un­com­mon in older pa­tients, “but when we see it in 20- to 40-year-olds, that’s un­usual.”

Some­times, the cornea has trou­ble keep­ing it­self clear and gets cloudy, which can point to rheumatoid arthri­tis or au­toim­mune prob­lems.

Dr. Sa­land says she of­ten sees pa­tients com­plain­ing of headaches. A lot of the time, those pound­ing dis­trac­tions are not eye-re­lated. In worst-case sce­nar­ios, disc edema, a dis­ease of the op­tic nerve that causes swelling, can point to a brain tu­mor.

But per­haps the tough­est puzzle to put to­gether is mul­ti­ple scle­ro­sis. Dr. Kurtin says he some­times no­tices a pupil that doesn’t re­spond cor­rectly dur­ing ex­ams. Or the pupil is slow to ad­just to changes in light. That could be an in­di­ca­tor, but much more in-depth re­search is needed.

“There are even can­cers that present them­selves in the eye,” Dr. Sa­land says. “Melanomas, all sorts of hor­ri­ble things. It’s so im­por­tant to catch th­ese things. A lot of the eye dis­eases are silent.”

How of­ten should eyes be ex­am­ined? If an ini­tial eye exam re­veals a healthy eye and op­tic nerve, then the pa­tient won’t need to be seen again for a cou­ple of years, she says. But wait­ing too long and pro­cras­ti­nat­ing is not an op­tion, es­pe­cially at mid­dle age.

Kath­leen Green is a Plano free­lance writer.

Mod­el­ing by HAN­NAH DE LOS REYES/Kim Daw­son Agency; styling by SHARON KILDAY/Staff Artist; KYE R. LEE/Staff Pho­tog­ra­pher

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