The Dallas Morning News
Windows to more than the soul
Routine eye exams can reveal a lot about a patient’s overall health, including warnings of future problems
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.”
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.”
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.