August 21, 2016

From arthritis and cancer to high cholesterol: Eyes often serve as the body’s early warning system - U.S. researchers are working on retinal scans for early Alzheimer’s detection

By Katja Ridderbusch

Atlanta, Ga. – When Tracie Howard first discovered the little bump under her left upper eyelid she thought it was a mundane chalazion, a form of a sty. She tried ointments and compresses. When those didn’t help, she decided to see an eye doctor. The physician removed the lump and took a biopsy. The result: non-Hodgkin lymphoma, a cancer of the lymphatic system.

“I was shocked,” says Howard, a 55-year-old Atlanta novelist and marketing professional. “This was the last thing I expected to hear.” She had been worried, she admits, but at this point it was more about the look of her eye.

The physician who detected her cancer was less surprised. “I see this all the time in my practice,” says Dr. Kenneth Neufeld, an ophthalmologist and oculoplastic surgeon at the Thomas Eye Group in Atlanta. “Small symptoms can trigger an extensive evaluation, which can reveal systemic, potentially fatal diseases.”

Eye doctors are frequently among the first to spot underlying health problems, which also gives them “the opportunity to intervene at an early stage,” says Neufeld.

The eyes may be the proverbial windows to the soul, but for physicians, they are also windows to the brain, the heart, the blood stream, the nervous and immune systems. Eyes are a sensitive and highly efficient early warning mechanism for the human body.

Cancer is just one of the diseases that can show up on the eyes’ radar. Lymphomas of the kind that Tracie Howard was diagnosed with often manifest on the inside of the eyelids or on the sclera, the white, protective outer layer of the eye.

“They typically look like little pinkish patches sitting on top of the eyeball,” says Neufeld, a Long Island native who completed his medical specialty training at Cornell Medical Center in New York City and his fellowship at Duke University in North Carolina.

Many other cancers, including melanomas, can first turn up in, or around the eyes as well.

However, the systemic disease that’s most commonly detected during a routine eye exam is diabetes, which has become a major public health problem in the industrialized world. According to the World Health Organization (WHO), the number of people diagnosed with the disease rose over the past 35 year from 108 million to 422 million worldwide.

A swollen lens, damaged or fragile blood vessels, bleeding into the retina, the back of the eye – all those findings can be signs of diabetes. Quite often it is during a visit to the ophthalmologist “that patients for the first time learn they may have diabetes,” says Neufeld.

Diabetic retinopathy, a group of eye conditions that affect the retina and are caused by diabetes, is the leading cause of blindness in the industrialized world.

Cardio-vascular diseases also tend to send early warning signs to the eyes. Using magnifying instrumentation allows an eye doctor “to get as close to a direct view into the circulatory system as you can anywhere in the body,” says Neufeld. “You can see the blood vessels bounce and pulsate with every heartbeat.”

Patients with high blood pressure often have blood vessels that are tortuous, twisted or malformed like tiny varicose veins, Neufeld says. Sometimes there’s also swelling at the base of the optic nerve.

An eye exam can also reveal high cholesterol, in the form of yellow chalky deposits at the inner top and bottom parts of the eyelids. Once they spot those deposits, eye doctors usually send their patients to their primary care physician or an internist for further testing, and in most cases the blood work confirms the suspicion.

A mini stroke, or transient ischemic attack (TIA), can announce itself in the eye, too. If the vision suddenly gets blurred or impaired, or one eye goes temporarily blind, the patient may be suffering from a blood clot or cardiac arrhythmia.

In any case, and even if the symptoms only last for a brief moment, “the patient must undergo further evaluation,” Neufeld says, “because it may help prevent a massive stroke with lifelong effects.”

Many autoimmune diseases also go along with eye and vision related problems. Burning, watery and infected eyes can be precursors or side effects of conditions such as rheumatoid arthritis and lupus.

Graves’ disease, another autoimmune disorder, primarily causes an overactive thyroid, but some patients can also develop “bug eyes” - bulging and misaligned eyes, leading to vision as well as aesthetic problems. “Certainly, this is one of the most obvious eye symptoms of a systemic disease,” says Neufeld.

Multiple Sclerosis is yet another condition that often shows first in the eyes. Many times, the disease begins with optic neuritis, an inflammation of the optic nerve, which is part of the brain. The most common symptom is eye pain; sometimes, the movement of the eye muscles is affected as well. “Many people are diagnosed with MS only when they develop optic neuritis and see an eye doctor,” says Dr. Julia Haller, a retina specialist and ophthalmologist-in-chief at Wills Eye Hospital in Philadelphia, the oldest and largest eye hospital in the United States.

Neurodegenerative diseases like Parkinson and Alzheimer’s can have early manifestations in the eyes. Dry eyes, decreased eyelid movement and, as a result, inflammation of the eyelids can be early yet unspecific symptoms of Parkinson.

In the case of Alzheimer’s, recent studies have found that beta-amyloid -- the protein causing the plaques in the brain associated with Alzheimer’s – also deposits on the lens and the retina, long before the patient shows any symptoms. “This is a very exciting area of research, which holds a huge potential for patients,” says Haller.   

Worldwide, 47 million people are living with Alzheimer’s. By 2030, the numbers will probably rise to 76 million, according to the Alzheimer’s Association. There’s no cure for Alzheimer’s yet, but early detection and improved treatment can help slow the progress of the disease.

Researchers in the United States, but also in Australia and Europe, are currently developing fast, affordable, easy to handle, and noninvasive imaging technologies, such as retinal scans, that would make Alzheimer’s screening part of a routine eye exam, sometime in the future.

“I’m hoping that it will be a five-year frontier rather than a 10-year one,” says Haller. “Five years would be the best case scenario."

By then, Kenneth Neufeld and his colleagues could be offering standard Alzheimer screenings in their practice. Neufeld has been an ophthalmologist for 12 years, yet every day, he says, he’s still amazed by what the organ he’s specialized on is capable of. “The eyes are just an enormously intricate and influential piece of machinery.”

He pauses, tilts his head, and then adds, “A big part of the input we receive from the outside comes through our eyes. At the same time, the eyes can reveal so much about what's inside of us, not only our emotions, but also our health.”

Neufeld’s patient Tracie Howard had extensive chemotherapy following her lymphoma diagnoses. Today, three years later, she’s cancer free, and there are no visible signs of her eye surgery. She’s glad she was vain back then, and watchful. “If I hadn’t gone to the eye doctor, I probably would be dead by now.”


This is the translation of an article that was published in the German Sunday paper "Welt am Sonntag" on August 21, 2016

©  Katja Ridderbusch