by Melissa, a 30-year-old teacher, came to the emergency room with a sudden onset of double vision. She had not had an accident or trauma and had never experienced this symptom before.
However, she noticed that a few months earlier the vision in one of her eyes had become blurry and had returned to normal shortly after. She told herself that it was a sign of fatigue after a period of intense screen work.
After some basic optometry testing, and then more advanced visual perception testing, it was thought that the visual episodes were related to multiple sclerosis. Melissa was then referred to a neuro-ophthalmologist who confirmed the diagnosis, and she was treated promptly.
Is Melissa’s case unique? In the 30 years that I have been working as an optometrist, I have seen many patients with various vision and eye health problems, the cause of which turned out to be a disease they did not know they had.
As a professor in the Faculty of Optometry at the Université de Montréal, I teach students that certain ocular symptoms can be related to general health problems.
Optometrists are trained to recognize the various diseases that can manifest through the eyes and to work with other healthcare professionals to treat these diseases.
Diabetes
With diabetes expected to affect nearly 8 percent of the population by 2030, screening is a critical issue. However, it is estimated that diabetes is not diagnosed until six to 13 years after onset.
An eye exam can shorten this delay, as it is often possible to identify characteristic abnormalities of the disease at the back of the eye before other symptoms of diabetes appear.
Early diagnosis is critical because within five years of diagnosis (i.e., 11 to 15 years after diabetes onset), 25 percent of patients with type 1 (juvenile) diabetes and 40 percent of patients with type 2 (adult) diabetes who are treated with insulin develop eye changes that can have a major impact on their vision.
Early identification and careful monitoring of your eye health significantly reduces the risk of blindness, which can occur if the disease is left untreated.
Unmasking the silent killer
If diabetes affects a significant number of patients without them knowing it, what can be said about high blood pressure and high cholesterol? These two conditions significantly increase the risk of coronary heart disease or stroke in our societies.
The eye is the only place in the human body where blood vessels are visible without the need for an incision or the use of invasive techniques.
In all of these cases, the patient often experiences so few symptoms, or they develop so slowly, that he or she considers them almost normal.
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Normotensive or open angle glaucoma
Absence of symptoms is also the norm for glaucoma. This pathology of the optic nerve is usually associated with excessive production of aqueous humor in the eye or a deficiency in its evacuation.
The pressure in the eye then increases and leads to the loss of nerve fibers in the nerve via various mechanisms. The field of vision narrows very slowly (and can therefore go unnoticed), causing the person to develop tunnel vision after a number of years.
By the time this loss of vision strikes them, it is often too late, so the damage to the optic nerve can be very extensive. This damage is mainly ocular, although it can also be caused by the action of certain medications (such as cortisone).
Normotensive glaucoma is of a completely different nature. In this case, the pressure in the eye remains normal, but the nerve is still damaged. The mechanisms involved are different from those in chronic open-angle glaucoma.
Normotensive glaucoma is often associated with low blood pressure or conditions such as sleep apnea. If present, the patient should be referred to a primary care physician for a thorough evaluation.
The disease of the century
Because cancer becomes so widespread and manifests itself in so many ways, we call it the disease of the century. Cancers that affect the eye (retinoblastoma) can also cause metastases to the lungs and liver.
Here too, the disease often develops without symptoms until it is too late. Early detection is therefore crucial, because the survival of the patient is at stake.
Other types of asymptomatic retinal pigment (bear paw shaped) may be associated with colon cancer, which has a very negative prognosis if treatment is delayed.
A simple visual field test can reveal abnormalities that some patients are unaware of, or consider so innocuous that they do not report them. However, many visual field abnormalities hide brain tumors, such as pituitary adenoma, or nerve fibers compressed by blood vessels.
Abnormal eye movements, asymmetrical pupillary responses, sudden reading difficulty, or the development of diplopia are all yellow flags that require further ocular and neurological examination.
The eyes are no longer the mirror of the soul, but a window to our overall health.
This makes regular visits to an optometrist more important than ever, even if there are no symptoms. Many conditions can be detected and treated to minimize or prevent disease altogether.
Langis Michaud, Professor. School of Optometry. Expertise in eye health and use of specialized contact lenses, University of Montreal
This article is republished from The Conversation under a Creative Commons license. Read the original article.
