BLOG: Optometry’s expanding role in medical care
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I recently read an interesting article that came in on my Healio news feed, which featured research by Wendy Harrison, OD, PhD, and colleagues on corneal hysteresis as a biomarker for prediabetes.
It was a small study but underscores the importance of the human eye in the early diagnosis and management of systemic pathology. Likewise, it is yet another example of how optometry, the profession that routinely monitors eye health, can provide important data for the overall health of our patients.
In my early days of writing blogs for Healio, I penned a piece called “Primary health care data points are optometry’s future,” in which I spoke about vital signs and the opportunity to provide them for the patient’s medical record. Since then, other unique findings that are only attenable during an eye examination have become even more important in the early diagnosis and management of systemic disease.
One of our unique tools is OCT, which is almost exclusively found in an eye doctor’s office and is primarily used to manage glaucoma and retinal problems. New studies, however, have found that thinning of the nerve fiber layer and ganglion cells will be present in a number of neurologic disorders.
I personally first noted this in a patient with a brain injury that affected the optic track in the occipital lobe. The patient initially presented with a hemianopia. At the 6-month follow-up, the OCT showed a complete flattening of the parafoveal ganglion cells consistent with the field loss.
In a Spanish study published this year in NPJ Parkinson’s Disease, Ane Murueta-Goyena, MS, PhD, and colleagues evaluated whether patients with Parkinson’s disease showed accelerated thinning of parafoveal ganglion cells and the peripapillary nerve fiber layer. The longitudinal study suggested that thinning in the temporal sector of the parafoveal ganglion cell layer may precede cognitive decline.
The practical interpretation of this work suggests that the optometrist who performs a routine wellness OCT of the macula may be the first to notice thinning of the ganglion cell layer without glaucoma risk or other ocular factors. This important piece of data should encourage the optometrist to refer this patient to a neurologist for a comprehensive workup.
In addition, optometrists who work closely with neurologists for concussion and other neuro-eye problems may want to conduct serial OCT testing among patients with Parkinson’s disease to assist in the risk assessment of cognitive decline.
Most of the newer OCT instruments also have the ability to perform OCT angiography, or OCTA. With this tool, the optometrist can visualize the retinal microvasculature and choriocapillaris based on the motion contrast of circulating blood cells.
In another study published in Eye, the authors state, “... the capability of OCTA to detect clinical onset of DR and prediction for its progression may become useful toward individualized management of diabetic eye disease.” Once again, the optometrist has a tool that is not readily available to physicians but can provide important data to manage systemic medical conditions.
It is important for optometrists to understand their role in systemic medical care and to establish relationships with physicians, hospitals, health insurers and managed care to become an integral part of the overall health care team.
References:
- Harrison W, et al. Corneal hysteresis increases in prediabetes and type 2 diabetes. Presented at: Academy 2024; Nov. 6-9; Indianapolis.
- Murueta-Goyena A, et al. NPJ Parkinsons Dis. 2024;doi:10.1038/s41531-024-00637-x.
- Sun Z, et al. Eye (Lond). 2021;doi:10.1038/s41433-020-01233-y.
For more information:
Scott A. Edmonds, OD, FAAO, specializes in vision-based neurorehabilitation at Edmonds Eye Associates in Philadelphia. He can be reached at [email protected].
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