reflections THE HUMAN SIDE OF OPTOMETRY
Check Their BP
Optometrists should screen every patient for systemic diseases -- not just eye and vision problems.
ROBERT D. NEWCOMB, O.D., M.P.H., F.A.A.O., COLUMBUS, OHIO

The recently-released Seventh Report of the Joint National Committee (JNC 7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, published in the April 2003 issue of the Journal of the American Medical Association made me remember a favorite patient I had examined many years ago.

I'll call him Mr. Santa Claus, not only because he was an obese 55-year-old white male with a white beard, but also because he had an outgoing personality and a big laugh that brought smiles to my co-workers and me when he came in for his annual exams. His medical history was positive only for arthritis and penicillin allergy. He'd always enjoyed healthy eyes and clear corrected visual acuity at far and near. His IOP was consistently in the low 20s in each eye, but his optic nerves and visual fields were fine. Then one day he called to report a sudden loss of vision in his right eye.

ILLUSTRATION BY TOM NICK COCOTOS

Taking action

I worked him into my schedule that day. He reported no pain, but very blurred vision in his right eye. He said his left eye was fine. But Mr. Claus now had a corrected visual acuity of 20/80 at far and near OD -- I suspected a retinal problem right away.

His angles were open and IOPs unchanged from previous visits; I dilated him and found a large, bright red central retinal vein occlusion in his right eye. I asked him about new medical diagnoses since my last exam; he said no. I took out my stethoscope and blood pressure cuff and found a BP of 220/105.

I worked in a Veterans' Affairs clinic at the time, so I walked him to the internal medicine clinic and shared my finding with a nurse. She had Mr. Claus seen that day by an internist who prescribed several systemic medications for hypertension.

Mr. Claus returned for a follow-up eye exam the next week and said the vision in his right eye was gradually improving. The blood did eventually resolve without requiring any laser treatment. His OD acuity stabilized at 20/30 with mild metamorphopsia; however, he was glad that his hypertension had been diagnosed and treated before he might have had a stroke or a heart attack.

I continued to follow him annually -- he's still doing well today. But what I remember most about Mr. Claus is him telling my students and residents over the years that "Dr. Newcomb saved my life" by diagnosing high blood pressure and walking him down to the medical clinic.

Come on, optometry!

The JNC 7 report provides new guidance for hypertension prevention and management:

"Cardiovascular risk from systolic hypertension begins at 115 mm Hg and risk from diastolic hypertension begins at 75 mm Hg. Individuals who are normotensive at 55 years have a 90% likelihood of developing high blood pressure during the next twenty five years, and lowering blood pressure toward the new goal of 120/80 mm Hg will decrease heart attacks, heart failure, stroke, kidney disease, and will save lives."

So get a stethoscope and blood pressure cuff and use it on every adult patient! You'll not only save eyes, you'll also save lives.

DO YOU HAVE A MEMORABLE EXPERIENCE YOU'D LIKE TO SHARE? DISCUSS YOUR STORY WITH RENÉ LUTHE, SENIOR ASSOCIATE EDITOR OF OPTOMETRIC MANAGEMENT, AT (215) 643-8132 OR LUTHER@BOUCHER1.COM.