When people come to the Reisterstown office of Drs. Eickhoff & Rowe for eye exams, the optometrists do more than simply ask which line of letters they can read on the eye chart.
Like other eye doctors, James Eickhoff starts with a "complete case history," he said, which includes a rundown of family illnesses. If there's cancer or heart disease in your family, he wants to know about it. Of course, he tests your vision, but the eye exam also includes eye dilation, which allows him to see the back of the retina, where signs of hypertension and diabetes can be detected.
A deposit on the cornea, called arcus senilis and detected with an instrument called a slit lamp, often indicates high cholesterol.
"It's very common to see signs of systemic conditions when doing an eye exam," Eickhoff said. When he sees signs of chronic disease, he tells his patients and urges them to follow up with their physicians.
Sometimes they are surprised to hear they might have more serious health problems than an inability to read menus in dimly lit restaurants.
A recent study commissioned by the insurer VSP Vision Care confirms what Eickhoff and other optometrists already knew anecdotally: That eye exams can be valuable tools for detecting the chronic diseases that are taking an increasing toll on Americans' health and health care dollars.
While many people put off visits to regular physicians, they tend to visit eye doctors on a regular basis, though probably not quite once a year as recommended. Eye exams are generally pleasant experiences. They typically take less than an hour, and patients keep their clothes on, don't get weighed, and emerge from the experience with spiffy new eyeglasses or better contact lenses.
"We understood we had a very important story to tell," said Michael Ammerman, team leader for eye health management with VSP, a company with an estimated 27,000 vision care providers and 56 million members. He said the company tapped Human Capital Management Services, a firm that uses data to help companies cut health benefit costs, to come up with the numbers.
"We found some very compelling information that suggests that people who are using their vision benefit or getting their eye exam are finding out information about their health they might not otherwise have had," Ammerman said.
According to the study, "eye care providers often detected signs of chronic disease before other healthcare providers — 65 percent of the time for high cholesterol, 20 percent of the time for diabetes, and 30 percent of the time for hypertension."
The study, conducted between July 1, 2006, and March 31, 2008, divided some 212,000 VSP users (excluding those over age 65) into two groups: those with chronic conditions detected during eye exams; and those with chronic conditions detected by other means.
The study found conditions were detected earlier in the eye exam group, so patients were healthier when they began treatment.
"On average, the study group incurred fewer health plan costs, fewer lost-time costs (such as missed work days), had a lower overall job turnover rate, and had lower rates of emergency room visits and hospital admissions," according to the study. Every dollar employers spent on eye exams reaped savings of $1.27 over two years.
The eyes may or may not be windows into the soul, but they do provide a good view into a patient's health.
"I tell my patients this is the only part of the body where we can actually see nerves and blood vessels without having to cut you," explained Justin Bazan, an optometrist at Vision Source Park Slope Eye, in Brooklyn, N.Y., which he opened in 2008.
Optometrists don't need medical school degrees, he explained, but receive four years of specialized training that includes management of ocular disease "and ocular manifestations of systemic disease."
That means they are trained to see signs of problems. Though the VSP study looked only at hypertension, high cholesterol and diabetes, eye exams can also detect cancer, multiple sclerosis and other ailments, he said. Cancer detected in the eye has sometimes metastasized from other parts of the body, he said.
Even in patients already diagnosed with chronic diseases, eye exams can provide key information, Eickhoff said. Patients with diabetes, for example, need a dilated eye exam once a year, he said, and information from that exam is sent to the patient's primary-care physician.
Eickhoff said some patients don't like having their pupils dilated, even though it is painless, but the procedure is important for detecting both chronic and ocular problems. One patient, he said, came in for a routine exam but said he couldn't do the dilation that day. Eickhoff pressed him to come back the next week. During that exam, Eickhoff discovered bleeding on the retina, leading to a diagnosis of macular degeneration.
Sometimes an exam finds both. Recently, said Bazan, a 27-year-old came in with "very nonspecific visual complaints," including "graying of his vision in his left eye." Though the patient appeared healthy, "when we took pictures of his eye, we saw not only high blood pressure, but undiagnosed glaucoma." Bazan was so concerned about his high blood pressure, he sent the patient to an emergency room, and he was subsequently admitted to the hospital for two days.
"By him coming in for an eye exam, we found a systemic condition that can now be treated and an ocular condition that can now be treated," Bazan said.
"The eye exam is the perfect complement to your health care," said Bazan. "It's a key component in making sure your overall health stays as good as it can be."