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Window to Your Health

Dr. Kerry Gelb - one of the nation's top optometrists - presents on proper ocular (eye) health. He also explains how eye health IS whole body health.

Here is the link to the video of Dr. Gelb presenting:


Here is an excerpt from my book "Quarterback Your Own Health."

The eye is the only place a doctor can “see” disease real-time, non-invasively, and at low cost.

Here is what the experts say about the eye as a window to your health:

“The eyes truly are unique real estate,” says Andrew Iwach, MD, associate clinical professor of ophthalmology at the University of California San Francisco and executive director of the Glaucoma Center of San Francisco. “They’re the only place in the body where you can see a bare nerve, a bare artery, and a bare vein without doing any cutting. And the disease processes we see occurring in the eye are probably occurring in the rest of the body.” [i]

“Ever-increasing specialization is made necessary and inevitable by the information explosion of our times. It is, under these circumstances, easy to lose sight of the underlying interconnectedness of things. This same information explosion has, somewhat paradoxically, also enabled us to see a more fundamental unity within the diversity. We find that medical problems that may seem different or independent when viewed at a superficial level are actually manifestations of a common underlying pathophysiologic mechanism acting simultaneously at different sites throughout the body.” [ii]

- Daniel H. Gold in “The Eye in Systemic Disease”

Clayton Christensen, the author of “The Innovators Dilemma” [iii] wrote an article about 10 years ago in the Harvard Business Review titled, “Will Disruptive Innovations Cure Health Care?[iv] His fundamental lesson is that disruptive innovation takes complex ideas and makes them available to regular folks. Examples he cites are: the computer mainframes and punch card evolving to the laptop (or iPad); or George Eastman’s inventions making amateur photography widespread.

In the context of medicine, disruptive innovation brings technology to low-level healthcare workers who are then able to create a sophisticated diagnosis that leads to proper treatments. Nurses, medical assistants, technicians, and physicians assistants meet this requirement. Technology should be bringing elegant yet simple methods to the clinic. What has happened instead is that specialization has grown stronger in medicine, and the diagnosis is layers upon layers away from the patient, the treating doctor, and their staff. This model does not work; it hampers innovation, and allows specialists to sit in an “ivory tower” without adequate accountability to patient outcomes.

There is disruption on the horizon and you can use it today, to help you Quarterback Your Own Health. Whence does this new innovation come?

It comes through the eye.

There are many systemic diseases we see in the eye,” said Dr. Roy Chuck, chair of the department of ophthalmology and visual sciences at Albert Einstein College of Medicine and Montefiore Medical Center in New York City. [v]

The eye is quite literally a "real window" to the rest of the body,” according to Dr. Noel Bairey Merz, director of the Women's Heart Center at Cedars Sinai Heart Institute in Los Angeles. "The vitreous fluid is clear and we can look through the opening in the iris and see the blood vessels quite easily," she said. "They taught us in medical school to look with the ophthalmoscope as part of the general exam. Sadly, it's not done by most practitioners and they have lost the skill set." [vi]

Diagnosing illness through the eye, is nothing new,” according to Dr. Marco Zarbin, chief of ophthalmology at the University of Medicine, Dentistry, New Jersey. "It happens all the time," he said,” from rare conditions to diseases like multiple sclerosis, leukemia, and brain tumors.” "If you look at your brain, two-thirds of it is dedicated to some aspect of vision," said Zarbin. "It's a big deal." [1]

The retina is actually a piece of the brain that has grown into the eye and processes neural signals when it detects light say University of Pennsylvania researchers. [vii] Ganglion cells carry information from the retina to the higher brain centers. Other nerve cells within the retina perform the first stages of analysis of the visual world. The axons of the retinal ganglion cells, with the support of other types of cells, form the optic nerve and carry these signals to the brain. [viii]

The Eye tells us about aging and, most importantly, our rate of aging, according to a study sponsored by the National Institutes of Health (NIH) and other organizations from around the world. The NIH sponsored a formal trial on eye diseases in the 1990s. That trial was called the AREDS, short for the Age-Related Eye Disease Study. The goal of the Age-Related Eye Disease Study was to learn about macular degeneration and cataract, two leading causes of vision loss in older adults. The study looked at how these two diseases progress and what their causes may be.

The AREDS study involved 11 medical centers with more than 4,700 people enrolled across the country. The study was supported by the National Eye Institute, part of the Federal government's National Institutes of Health. An unexpected result came out of AREDS. Certain eye diseases are predictors of premature or early death (mortality). In other words, what this study revealed is that a rapidly aging eye occurs in a rapidly (accelerated) aging body.

Eye diseases are not isolated from the rest of the body.

They serve as biomarkers for whole body disease.

During follow-up of 6.5 years, 11 percent in the AREDS study with eye conditions died. Note that this rate of death is more than 10 times higher compared to breast cancer. Has anyone sponsored a cataract or macular degeneration walk for these deadly diseases? Participants who had advanced age-related macular degeneration (AMD) compared with those who had few, if any, drusen (a precursor to AMD), had increased mortality, and advanced AMD was associated with excessive cardiovascular deaths compared to people without advanced AMD. Is it possible that Mr. Russert (the famous “Meet the Press” host) had AMD but no doctor knew the connection between this presumed “eye only” disease and heart disease?

In addition to AMD, people with deteriorating vision (loss of visual acuity) died sooner compared to those people with perfect vision. The cause of death was often cardiovascular in nature.

Your Eyes are Your Health “Quarterback”! They can tell if you have undiagnosed cardiovascular disease!

Authors of one part of the AREDS studies stated: “Nuclear opacity and cataract surgery were associated with increased all-cause mortality and cancer deaths.” The authors concluded that, “the decreased survival of AREDS participants with AMD and cataract suggests these conditions may reflect systemic processes rather than only localized disease.” [ix]

Why isn’t this information reaching the clinic and the public?

Figure 4.1 below shows the Age-Related Eye Disease Study data illustrating the high mortality associated with eye diseases.

Figure 4.1. Age-Related Eye Disease Study (AREDS) data.

The higher the curve above the baseline of zero, the higher the death rate associated with the eye condition.

We now know that the eye is a predictor of cardiovascular disease. It is also a strong predictor of Alzheimer’s disease. [2] Several other studies corroborate the eye/disease connection discovered in the AREDS study:

The Priverno Eye Study. This was a population-based cohort study of incidence of blindness, low vision, and survival. Lens opacities are associated with a higher risk of death. The purpose of this study was to further investigate the relationships between different types of lens opacity and patient survival. The analysis of the Priverno data confirms an association between lower survival and cataracts, particularly those confined to the lens nucleus and those that had already prompted surgery. An example research article is titled, “Association between lens opacities and mortality in the Priverno Eye Study.” [x]

The Barbados Eye Study. The purpose of this study was to determine incidence and risk factors for each main cause of visual loss in an African-Caribbean population. Incidence of visual impairment was high and significantly affected quality of life and was a marker of early cardiovascular death. Age-related cataract and open angle glaucoma caused ~ 75% of blindness, indicating the need for early detection and treatment. The connection between metabolic and cardiovascular disease and ocular indications and diseases is strong. An example of a research paper that resulted from the Barbados Eye Study is, “Lens opacities and mortality: The Barbados Eye Studies.” [xi]

The Blue Mountain Eye Study. This was the first large population-based assessment of visual impairment and common eye diseases of a representative older Australian community sample. The findings demonstrate the connection between eye and systemic diseases. In particular, cardiovascular risk factors were prominent for eye diseases including: Cataract, macular degeneration, Glaucoma, and retinopathy. An example of a research paper that resulted from the Blue Mountain Eye Study is, “Open-angle glaucoma and cardiovascular mortality: the Blue Mountains Eye Study.” [xii]

The Beijing Eye Study. The Beijing Eye Study is a population-based study that included 4439 subjects who were initially examined in 2001 through blood tests and ocular assessment. The data suggest that glaucoma, particularly angle-closure glaucoma, may be associated with an increased rate of mortality in adult Chinese in Greater Beijing. An example of a research paper that resulted from the Beijing Eye Study is, “Mortality and ocular diseases: the Beijing Eye Study.” [xiii]

The Beaver Dam Eye Study. This study is funded by the National Eye Institute, one of the 20 National Institutes of Health. The purpose of the Study is to collect information on the prevalence and incidence of age-related cataract, macular degeneration and diabetic retinopathy, which are all common eye diseases causing loss of vision in an aging population. The study was designed to discover (or detect) causes of these conditions. The study also has examined other aging problems, such as decline in overall health and quality of life and development of kidney and heart disease. The Study revealed that after controlling for age and sex - nuclear sclerotic cataract severity, cataract surgery, and visual impairment are risk indicators for poorer survival (unexpected early mortality from vascular complications). [xiv]

The Rotterdam Eye study. This study started in 1990 in a suburb of Rotterdam, among 10,994, men and women aged 55 and over. Major risk factors that were found for macular degeneration included atherosclerosis (cardiovascular disease). Retinal venular (micro-vessel) diameters play a role in predicting cardiovascular disorders. Dilated retinal venules at baseline were predictive for stroke, cerebral infarction, dementia, white brain matter lesions, impaired glucose tolerance, diabetes mellitus and mortality. Inflammation is part of these diseases. An example of a research paper that resulted from the Rotterdam Eye Study is, “Is there a direct association between age-related eye diseases and mortality?: The Rotterdam Study." [xv]

This paper concluded with this statement, “Both ARM and cataract are predictors of shorter survival because they have risk factors that also affect mortality.”

This is just the tip-of-the-iceberg on the emerging and growing connection between the eye and our overall health. The Beaver Dam Eye Study results were published over 20 years ago. Why doesn’t the public know about this information and why aren’t doctors telling patients about risks? We have already explained how medicine is highly siloed. If a doctor finds something that is outside of their specialty, it generally goes unreported and untreated.

In addition, medical researchers are reluctant to share their information other than through publications that do not always present all the data. I called Drs. Klein, who did much of the work in the Beaver Dam Study. This study was sponsored and paid for by our government. I asked them for the “raw data.” They basically refused to send me the data unless I was involved in a funded clinical trial. This type of protectionism will NOT help us treat patients.

[1] Dr Trempe showed that certain eye pathologies predict specific types of cancer. [2] Lewis, Thomas J., Trempe, Clement L. “The End of Alzheimer’s? A Differential Diagnosis Toward a Cure.”

[i], August 09, 2011. [ii] Gold, Daniel H., and Thomas A. Weingeist, eds. The eye in systemic disease. Philadelphia: JB Lippincott, p. vii, 1990. [iii] Christensen, Clayton M. The innovator's dilemma: the revolutionary book that will change the way you do business. New York: HarperCollins, 2003. [iv] Christensen, Clayton M., Richard Bohmer, and John Kenagy. "Will disruptive innovations cure health care?." Harvard business review 78.5 (2000): 102-112. [v], April 11, 2012 [vi], April 10, 2012. [vii], July 26, 2006. [viii], July 26, 2006. [ix] Grigorian, Adriana Paula. "Associations of Mortality With Ocular Disorders and An Intervention of High-Dose Antioxidants and Zinc in the Age-Related Eye Disease Study." Evidence-Based Ophthalmology 5.4 (2004): 230-231. [x] Nucci, Carlo, et al. "Association between lens opacities and mortality in the Priverno Eye Study." Graefe's Archive for Clinical and Experimental Ophthalmology 242.4 (2004): 289-294. [xi] Pizzarello, Louis P. "Lens Opacities and Mortality: The Barbados Eye Studies." Evidence-Based Ophthalmology 2.4 (2001): 226-227. [xii] Lee, Anne J., et al. "Open-angle glaucoma and cardiovascular mortality: the Blue Mountains Eye Study." Ophthalmology 113.7 (2006): 1069-1076. [xiii] Xu, Liang, et al. "Mortality and ocular diseases: the Beijing Eye Study." Ophthalmology 116.4 (2009): 732-738. [xiv] Klein, Ronald, Barbara EK Klein, and Scot E. Moss. "Age-related eye disease and survival: the Beaver Dam Eye Study." Archives of ophthalmology 113.3 (1995): 333-339. [xv] Borger, Petra H., et al. "Is there a direct association between age-related eye diseases and mortality?: The Rotterdam Study." Ophthalmology 110.7 (2003): 1292-1296.


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