The eyes are the mirror of health
Svetlana Popović Vujotić
Health
A stressful lifestyle, intensive use of mobile phones and computers, excessive exposure to UV rays, an unhealthy diet, and prolonged inactivity are just some of the causes of numerous diseases, including those affecting the eyes, which are a mirror of our health. Renowned ophthalmologist Dr. Sanja Borović from Podgorica, who acquired her expertise in this field at prestigious eye clinics in Belgrade, Novi Sad, Bologna, and London, spoke for our website about the complexity of the human eye and its ability to alert both individuals and doctors of other specialties to health problems we may have without even being aware of them.
Dr Sanja Borović
Argument: The eyes are a person’s window to the world—are we talking about one of the most complex human organs?
Dr Borović: The structure of the eye—its anatomy and physiology—is highly complex. The eye is an extension of the central nervous system, or a “continuation of the brain.” This connection is established through the relatively short optic nerve and its pathway to the centers in the occipital part of the brain. The eye is moved by ocular muscles innervated by various cranial nerves. From this brief explanation, the close relationship between the eye and the brain becomes clear. Our eye is essentially a hollow organ, lined internally by the retina and filled with a gel-like substance called the vitreous body. The central part of the retina is called the macula, and it is responsible for vision. It acts as a sensor that receives the image, which then travels through the nerve fibers of the optic nerve to the brain…
Argument: Why are the eyes an indicator of a person’s overall health?
Dr Borović: Every emotion and our mental state can be seen in the gaze, but it is also true that vision loss is treated as a 100% disability. By examining the fundus of the eye, an ophthalmologist can detect changes in the optic nerve, assess the condition of the macula, and evaluate the peripheral retina. However, even through a routine examination, they can gain insights that help doctors of other specialties diagnose and treat a wide range of conditions beyond ophthalmology. By studying the state of blood vessels or the quality of nerve tissue, we can learn a great deal about a person’s overall health.
Argument: Cardiovascular diseases, diabetes, cancer, and neurological disorders are at the top of the pyramid of health problems among the population. How can the eye detect some of these diseases, which may develop in our bodies for a long time without clear symptoms?
Dr Borović: You have listed numerous, very different health conditions, to which we must also add very common systemic diseases. Each of them can be associated with findings in the eye. It often happens that an ophthalmologist is the one who discovers diabetes mellitus (DM), kidney insufficiency, multiple sclerosis, or rheumatological diseases. For example, an internist will always refer patients with high blood pressure or diabetes for a fundus examination. This allows insight into the condition of the optic nerve, the so-called macula (the point of the sharpest vision), and the state of the blood vessels. The fundus is the only place in the body where blood vessels can be seen without the use of other diagnostic procedures. Changes in blood vessels are permanent and irreversible. It is important to detect them in time and use appropriate internal medicine therapy to prevent further deterioration. An ophthalmological finding is always just one piece of the puzzle on the basis of which the attending physician will prescribe therapy, determine the frequency of check-ups, and recommend additional tests.
Argument: What are the most dangerous pathological conditions of the eye?
Dr Borović: The most dangerous are glaucoma, or elevated intraocular pressure, and age-related macular degeneration. Glaucoma is a silent killer of vision. In most cases, nothing is felt until significant vision loss occurs. In recent years, this has become less common due to recommendations to measure eye pressure during every check-up. Glaucoma can be successfully treated in its early stages, with medication or surgery, depending on the type of the disease. Senile macular degeneration, or age-related macular degeneration (ARMD), is associated with older age. Unfortunately, we are noticing that it can also occur in middle age. The exact cause of the disease is not known, but it is believed to result from multiple factors: UV radiation, as well as so-called blue light, which has been widely discussed in recent years, along with smoking, stress, staying indoors, and lack of physical activity. There are two types of this degeneration: dry and wet. The dry form progresses more slowly, with limited possibilities for intervention. The wet form is much more severe, with rapid loss of central vision. The disease is treated with medications that are administered directly into the eye in an attempt to slow its progression.
Argument: Should ophthalmological examinations be part of screening programs in Montenegro, and should eye check-ups be mandatory for children from an early age?
Dr Borović: Given that my field is pediatric ophthalmology and strabismus, I always feel compelled to advocate for vision screening in children. The fact is that at birth, every organ of a child is examined—except the eyes. It is assumed that the eyes are healthy unless pediatricians or parents themselves notice a problem. The first vision check in our country is performed before starting school, at around six years of age. The European standard is the age of three. I believe that is truly the right time for an ophthalmological examination, unless there is a reason to conduct it even earlier. Vision screening in children is important for the prevention of amblyopia. Vision problems detected in time, such as high refractive error in one or both eyes or the presence of strabismus, can be successfully treated in early childhood. When diagnosed later—after the age of 6 or 7, depending on the condition—they are much more difficult to treat or may not be treatable at all.
Argument: Is surgical, laser correction of refractive error really as necessary as it is commonly practiced both here and worldwide?
Dr Borović: Refractive surgery has become very popular over the past twenty years. It is not a procedure that must be performed. We are dealing with healthy eyes, without disease, that simply have a certain refractive error. Young people mostly do not want to wear glasses or contact lenses, so they opt for surgery. There are strict guidelines, based on examination and prior monitoring, that determine when the procedure can be performed and which type of intervention is appropriate.
An eye and fundus examination is painless, and the benefits for our health are significant. Regular check-ups are always invaluable in the prevention of disease.