Eye Exam and General Health

The eyes aren’t just windows to the soul; they also provide a peek at the state of our health. An eye exam is often when serious conditions such as diabetes and impending stroke are detected, says MUSC Health optometrist Dr. James F. Hill, associate professor and director of Primary Eye Care and Low Vision Services at the Storm Eye Institute. “Many people assume they’re healthy if they feel OK, and that their eyes are healthy if they’re seeing fine. Many times, however, that’s not the case, especially if someone has a family history of health or eye problems. The eyes are truly a gateway to our systemic health, and if we catch something early enough, we can prevent systemic disease and vision loss.” We talked with Dr. Hill, an optometrist, about the importance of regular eye exams. Read on to learn at what age we should begin getting our eyes examined, what someone can expect during an exam, and what an exam can tell us about our health.

At what age should we begin getting eye exams?

Eye health should begin in infancy. The American Optometric Association recommends an eye exam with pupil dilation between the ages of 6 and 12 months to check for refractive error, eye muscle movements, retinal health, and other abnormalities. A second eye exam is recommended before a child starts first grade. From age 6 to 17, children and teens should have eye exams every 2 years unless they are nearsighted or farsighted, or have astigmatism, congenital cataracts, or any risk factors for eye disease. Adults can continue the same schedule, getting an eye exam with dilation every 2 years if they have no family history of eye disease, are not taking any special medications and are in good health. After age 65, regardless of their health, people should have their eyes examined every year because the risk for eye diseases such as diabetic retinopathy, cataracts and macular degeneration increases with age.

What happens during an eye exam?

During a thorough eye exam, the doctor will get a patient’s personal and family history and inquire about prescription medications and if the patients is experiencing any health issues. We check for visual acuity without corrective eyewear and look for signs of nearsightedness, farsightedness, astigmatism, and presbyopia, the condition when the eyes can’t focus on objects up close. We examine the pupils, check color vision, visual fields, eye muscle movement and depth perception, and check the lens and cornea as well as tear film in the front of the eye. We also check the pressure in the eye. That’s important because an elevated eye pressure has no symptoms but can damage the optic nerve and cause glaucoma. We dilate the eyes to examine the back of the eye, the optic nerve, the retina, and the vascular system to make sure everything is healthy.

Why are the eyes dilated? What is the doctor looking for?

We use drops to relax the muscle in the eye and open the pupil so we can get a full view of the structures inside the eye. The drops prevent the pupil from closing when the bright light is shone into the eye. After the drops are put in, it takes about 20 minutes for the pupil to dilate fully, and vision is blurred. In addition to the optic nerve, we’re looking at blood vessels and examining the macula and checking for any holes, breaks or tears.

Does a patient need to do anything to prepare for an eye exam?

No. If we dilate the eyes, we provide sunglasses for the patient to wear in sunlight. If this is a patient’s first exam and the eyes have never been dilated, we recommend bringing someone who can drive home because of the extra sensitive to light.

What kinds of diseases can be detected during an eye exam?

An exam of the retinal vessels can show the systemic vascular supply and whether the patient has hypertension, which often has no symptoms. We can also see if plaque has built up in the retinal artery, which causes a bifurcation of the retina. When that occurs, the patient has a 99-percent chance of having a blockage in the carotid artery, which causes stroke. Blurry vision is one of the first symptoms of diabetes and diabetic retinopathy, an eye condition associated with diabetic eye disease.

How prevalent is eye disease? Should someone in good health be concerned about developing an eye disease?

The 4 big eye diseases are glaucoma, diabetic retinopathy, macular degeneration, and cataracts. As the population ages, the CDC predicts that more than 76 million Americans will develop one of these diseases in the next 20 years and that the incidence of these diseases will double or nearly double by 2050. For example, the number of Americans with macular degeneration is predicted to increase from 2 million in 2022 to more than 6 million; glaucoma cases are expected to jump from 2.7 currently to more than 7 million, and diabetic retinopathy is predicted to double from 7.7 million to 14.6 million by 2050. The number of cataract diagnoses is also expected to swell.

What would you tell readers about vision care?

Eighty percent of Americans say vision is their most important sense and that they don’t want to lose it. There are many reasons to get regular eye exams and to protect our eye health and maximize our vision potential. Good vision is important for schooling, vocations, and our daily activities. Everyone deserves to have good eye care and good eye health.

For more information, visit MUSC Health’s Optometry Services. To make an appointment, call 843-792-2020.