What do diabetes, Graves’ eye disease, thyroid problems, cardiovascular disease, rheumatoid arthritis, multiple sclerosis, sickle cell anemia and several other medical conditions have in common?
They can all be detected during a careful eye examination.
Obviously, during an eye exam, your eyes are being checked for vision (farsightedness, nearsightedness, etc.), glaucoma, cataracts and macular degeneration. But other diseases that are located elsewhere in your body can be detected in your eyes, too. That’s because your eye is the only place where a doctor can have an unobstructed view of your blood vessels, nerves and connecting tissue, without any need for surgery.
The eye has the same microscopic tissue as your other major organs and is an important part of your larger nervous system. Abnormalities spotted in the eye may signal the same changes in other parts of your body.
Signs of Possible Problems
What do doctors look for and what might those signs mean?
Elizabeth Klunk, senior vice president of medical management at Versant Health, a managed vision care company, says 20% of people with diabetes learn they are diabetic through an eye exam. If the exam detects traces of blood and other yellowish fluids seeping out of the retinas, it’s a sign of diabetic retinopathy which could lead to blindness. In fact, diabetes is the leading cause of blindness in the United States.
When the doctor asks you to look right, left, up and down, and your eyes can’t do that satisfactorily, it could be a sign of a neurological problem.
The eye has the same microscopic tissue as your other major organs and is an important part of your larger nervous system.
If you have dry and irritated eyes, cloudiness and blurriness, with light sensitivity, the doctor may also see an inflamed retina that might indicate such autoimmune diseases as lupus, rheumatoid arthritis or multiple sclerosis.
Dr. Lisa Mihora, of Peoria, Ariz., says she “takes care of patients with thyroid eye disease, melanomas and eyelids affected by sleep apnea. In my practice, I also diagnose inflammatory conditions (such as lupus and rheumatoid arthritis) and, sadly, I even diagnosed my own mother’s brain tumor through papilledema (optic nerve swelling). The eye truly is a window into systemic conditions.”
Graves’ disease and hyperthyroidism can be detected by bulging and inflamed eyes and excessive tearing.
Thin white or gray rings around the edge of your corneas could indicate high cholesterol and triglycerides. Nashville ophthalmologist, Dr. Ming Wang has several patients who had other diseases diagnosed because of an eye exam.
“I once had a front desk staff member who was convinced her eyes were turning blue,” Wang says. “Due to her African American heritage, the likeliness of this happening was extremely rare. Evaluation of her corneas (normally clear) showed a clear grayish-blue ring around the outer edges.”
That condition is called arcus, where cholesterol buildup in the body can be visible in the eyes. “Over the age of fifty, this is not all uncommon. However, since she was in her twenties, I advised her to get blood work done,” Wang says. “The phlebotomist who drew her blood laughed at the request. But sure enough, her cholesterol levels were sky high and she was put on a medication to control her cholesterol.”
Signs of Alzheimer’s and Cardiovascular Disease
Another example comes from Dr. Faisal Haq, of Key-Whitman Eye Center in Dallas-Fort Worth. “During an annual eye exam last year, one patient complained about seeing flashes of light while shopping,” Haq says. “He described it as ‘a curtain over the left eye.’ The condition worsened. He remembers the curtain seeming to be electrified, with electricity covering two-thirds of his eye. He could only see on the exterior. Ten minutes later, his sight returned to normal.”
Haq immediately sent the patient to his primary care physician. Tests revealed his carotid arteries were almost fully blocked and the man had suffered a transient ischemic attack — a brief stroke. Two weeks later, he had surgery to have his arteries repaired.
The eyes may also provide clues to the development of Alzheimer’s disease, and retinal imaging technology is being studied as an early detector. The technology “would identify Alzheimer’s biomarkers years before symptoms are otherwise presented, says Dr. Howard Fillit, a geriatrician and neuroscientist at the Icahn School of Medicine at Mount Sinai in New York, and chief science officer at the Alzheimer’s Drug Discovery Foundation.
How Often to Have a Comprehensive Eye Exam
The American Academy of Ophthalmology advises that every adult, even people without signs or risk factors for eye disease, should have a baseline comprehensive eye evaluation at age 40, when early signs of disease and vision changes may start to occur.
People with an eye disease or a risk factor for developing one, such as diabetes, high blood pressure or a family history of eye disease, should see an ophthalmologist even if younger than 40.
Why is 40 considered the age to start yearly eye exams? “This is when the proteins in your eye’s natural lens begins to break down and clump together, leading to the development of cataracts,” says optometrist Dr. Charissa Lee, director of education at Johnson & Johnson Vision Care in Jacksonville, Fla. “Though this is a natural aging process of the eye, it can worsen in severity over time. So, it’s important to be consistent with your eye exams.”
Finding Coverage for Eye Exams
Due to the lack of eye care coverage in Medicare and other insurance plans, some people are reluctant to have an annual exam or don’t feel the need to unless they’re experiencing a problem.
But, according to the American Academy of Ophthalmology, older adults may be eligible to receive an eye exam at no out-of-pocket cost from the Academy’s EyeCare America program.
Klunk says, “Original Medicare Part A and Part B does not cover routine eye exams, glasses or contact lenses. However, Medicare Part B will cover an annual eye exam once every twelve months if the individual has diabetes or is at high risk for glaucoma.”
An increasing number of Medicare Advantage Plans are offering vision coverage as part of their overall Medicare Advantage benefit, and the extent of coverage varies by managed care organization.
“Individuals who choose to keep original Medicare must purchase a Medicare Supplemental Plan, which can include routine vision services,” Klunk says. “Commercial health plans offer vision benefits, typically as an add-on benefit, which carries its own premium.”
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