Why you, yes YOU, need an eye exam.
Recently, I was on a group run and a fellow runner posed the following question: “When do I need to get my eyes checked?”
My response: "Every year."
Fellow runner: "But I see fine."
Me: "But an eye examination is necessary to check not just your vision, but also the health of your eyes, and can lead to early detection of sight-threatening diseases like glaucoma. I have also found a few patients with significant issues like diabetes to have eye trouble, and I have seen a few patients with scary issues like pituitary tumors who were unaware of any vision problems. In these cases, we were able to detect these tumors before significant damage was done."
Fellow runner: "You have drunk the Kool-Aid. You definitely have the spiel down. Seriously though, when should I get my eyes checked?”
This conversation is often repeated in social settings once people find out what I do for a living. Every other optometrist in the world has had this conversation. Then of course, once I have defended my case for an annual eye exam -- or at least a FIRST eye exam for those that have never had one -- The follow up is: "Do you take my insurance?" or "How much does that cost?"
The intention of my eye health advocacy is not to drum up business. My intention is to stress the importance of preventive medicine. I am surrounded in my personal life by seemingly health-conscious individuals, yet most only see an eye exam as a luxury of health care. Like most health care professionals in Western medicine, we use scare tactics and fear to motivate. I often have to remind teenagers to not sleep in their contacts, or they will go blind. Not every teenager that is an active contact lens abuser goes blind, but most of us have seen some very serious complications, preventable problems. We are not invincible, and as we age this statement turns from an old-person declaration to a reality. Blindness applies to this as well.
What about young children? Recently the American Optometric Association released a joint statement at the School Readiness Summit. A copy of this is available at (as a PDF) http://www.aoa.org/documents/Joint_Statement.pdf. The statement, signed by members of over 30 organizations including doctors, nurses, teachers and parents, emphasizes the importance of comprehensive eye examinations.
We as optometrists recommend annual eye examinations for children, not to sell extra glasses as some assert, but to prevent and treat conditions like lazy eye and eye turns, which are often not detected at screenings. Your pediatrician may be good, but small eye turns and high prescriptions are often difficult to detect without specialized equipment.
Back to adults:
Let me highlight a couple of cases to make my point.
AS is a 38-year-old woman whose parents began bringing her to our office when she was 10. She is returns every year for a comprehensive eye examination. She’s never worn glasses and has always had "perfect" eyesight. This year she noticed her vision fluctuating, especially at night. For all of you eye docs out there, that symptom screams dry eyes. But she had no symptoms of flashes or floaters, headaches or eyestrain. Her medical history had not changed and was unremarkable to begin with. Upon examination she was 20/20 out of each eye. The front of her eyes looked healthy, and I did a Humphrey Visual Field (I do this with every adult exam) while her dilating drops were taking effect. This young lady was missing several points on both sides of her visual field (we call this a bi-temporal heminanopsia). Her’s was incomplete and not all of her "side vision" was missing. This field loss was textbook pituitary adenoma. We sent her to the emergency room where she received an MRI. The MRI confirmed our suspicious, it was a pituitary tumor. The growth was small enough less invasive, extensive surgery was required.
Strangely enough, a gentleman a few years older and a few years later had almost exactly the same examination and results. The only difference in his case was that he had been diagnosed with hyperthroidism. He had extensive blood work done including an evaluation for markers involving the pituitary gland. Those markers were normal, despite there being a problem. We sent him back to his endocrinologist, and she ordered an MRI. His MRI also indicated a pituitary ademona that was detected early and removed easily.
Neither patient had symptoms. They only came in for routine annual eye examinations.
I have a lot of other stories to share, from eye tumors, mini-strokes and diabetic complications in adults and many more cases of treatable lazy eye early in children.
The point is, I’m not recommending annual eye examinations as a way to increase revenue. I recommend them as a way to catch disease early and treat the whole patient – not just their vision.
I convinced convinced my running buddy to visit the office for his exam. While we didn’t find any health-threatening issues, we did notice a little dry eye. With a dry eye treatment regimen he sees the road ahead much more clearly – and he also sees my point: annual eye exams are necessary.
