Recently I saw a picture on the wall in the doctor’s office. The picture showed the eyes and the brain with all the nerve endings. The doctor pointed out that the eyes are actually a part of the brain, an outgrowth of the brain, which is really noticeable in this picture. Sometimes doctors can look so deep into the eye that they can see part of the brain, which allows them to see vascular changes and other aspects within the eye. The retina of the eye is made up of 10 layers and plays an important role in the perception of light and the transmission of information through the optic nerve to the brain.
The ocular fundus is perfectly visualized when there are no opacities in the lens, cornea, and vitreous that can hide internal structures. For this reason, specialists in related fields often refer patients to an ophthalmologist. The optic nerve is clearly visible and a diagnosis can be made.
What general medical conditions can an ophthalmologist diagnose?
Doctors most often refer patients with suspected diabetes, as ophthalmologists are sometimes the first to detect or confirm this diagnosis. Patients have elevated glucose levels but are unaware of it because they are accustomed to it and do not feel the change; there are no symptoms or manifestations.
They come in, maybe for an eyeglass fitting, and the doctor says, “Let’s take a look, just in case. We find vascular changes that are characteristic of diabetes – microaneurysms on the vessels. We see hard and soft exudates (lipid deposits from leaky blood vessels), drusen (waste products: proteins, lipids, trace elements such as zinc), and more. The range of changes is quite extensive and depends on the stage of diabetes.
2. High blood pressure
High blood pressure can affect the blood vessels of the eye, which can be seen on fundus examination. Hypertensive changes can be detected by an ophthalmologist.
Typically, other specialists refer patients for fundus and retinal examinations to determine the stage of the disease. The same thing happens with hypertension: many patients, especially those on medication, do not feel their blood pressure rising, stop measuring it regularly, and the cardiologist refers them to an ophthalmologist. When the eye is examined, it turns out that the stage of hypertension is already different due to changes in the blood vessels.
3. Autoimmune diseases
General pathology of hematopoiesis, such as leukemia and anemia, also have characteristic manifestations. Even HIV can be seen, with it it is possible to see a wide range of changes in patients. Some patients who deny their diagnosis go to different clinics, and then they may hear that they have been diagnosed with the obscure “chorioretinitis” – inflammation of the retina and vasculature of the eye – and they seek a second opinion. We see specific changes in this pathology.
Here is a clinical example. A girl, a teenager of about 14 years old, came to the appointment with her mother, complaining of sudden loss of vision in one eye. Upon examination, the ophthalmologist noticed specific changes in the optic disc, such as a growing and small edema. For a more detailed analysis, optical coherence tomography was performed, which the clinic is equipped with. The results showed the presence of optic nerve edema similar to retrobulbar neuritis. The girl was referred to a neurologist for an MRI of the head to determine the cause. She was eventually found to have multiple sclerosis, which is sometimes seen at such a young age.
4. Neurological problems
Neurologists often refer patients to an ophthalmologist for objective reasons. Some myths spread on the Internet underestimate this practice, assuming that the referral to an ophthalmologist is just a formality or a way for the clinic to make money. This is far from the case. Ophthalmologists are able to analyze not only blood vessels and their spasms, because in the head, even when using MRI with contrast, it is not always possible to see changes clearly enough. In the ophthalmologist’s office we can detect a variety of changes, including the condition of the optic nerve.
In oncology, ophthalmologists can detect metastases from cancerous tumors in various parts of the eye, such as the macula or retina, as well as identify primary tumors in the eye. For example, a tumor of the ciliary body or iris.
In summary, ophthalmologists can help identify various diseases that are not directly related to the eyes, as the eyes can be affected by general body conditions. Note that a coordinated approach between doctors of different specialties plays an important role in diagnosis and treatment, and you should not be afraid of such consultations.
Eye exams can be an important tool for detecting a number of conditions in their early stages, allowing treatment to begin or referring the patient to other specialists for further evaluation and treatment.