Anthony DeMaria, MD, Professor of Cardiology, University of California, San Diego, Judy and Jack White Chair in Cardiology, talks about how a new technology can look into the eye and see if there is any problems in the heart
What is the connection between the heart and the eye?
DEMARIA: Actually, the eye is an organ, which often is the first sign of cardiovascular disease. Hypertension can cause major changes in the eyeground. Atherosclerosis, when it affects smaller blood vessels can be detected in the eyegrounds. There’s a number of other findings that sometimes occur with infections of the heart. The eyegrounds are a very, very important area for cardiologists to examine to detect cardiovascular disease.
And you say eyegrounds? I don’t think I’ve ever heard of that.
DEMARIA: I use the term eyegrounds in general to refer to the retina.
Can you look at someone’s retina and just see immediately or do you have to be under a microscope?
DEMARIA: Well, you can’t see the retina without some form of device. The usual device is an ophthalmoscope if you’re a cardiologist. If you’re an ophthalmologist, you’re more apt to use a slit lamp examination or something of that type. The retina is in the back of the eye. It contains a number of blood vessels, both arteries and veins. These arteries and veins are frequently affected by systemic diseases. Diseases, say, of the cardiovascular system or the kidneys, etc. So by looking at the small blood vessels in the eye, you can get a clue to the presence of disease in other parts of the body.
So as a cardiologist before, would you always go to the eye for one of your first, like telltale signs?
DEMARIA: Looking at the eyegrounds, looking at the retina of the eye, has traditionally been part of the standard physical examination regardless of what. If you’re doing a physical exam, you listen to the lungs, you listen to the heart, feel the abdomen, etc. Part of the exam is to examine the retina. For most physicians, they will examine the retina on a selective basis. If there’s some clue or some reason to look at the retina, then they’ll definitely go and do that. I think over the years, the examination of the retina has not become as standard as it was some years ago.
It’s not an expensive thing to do, right?
DEMARIA: Oh, it’s free. There is no additional cost for examining the retina in a standard physical examination. It’s like listening to the heart. There’s no specific cost for listening to the heart or for feeling an arterial pulse or for palpating the abdomen.
Can you explain kind of like what you can see. Like, if I see this going on in the retina, that means this kind of heart disease. If I see this going in the retina, this means this is happening.
DEMARIA: I think that from a cardiologist standpoint, examination of the retina is most commonly done and most valuable for high blood pressure, because as the blood pressure goes up, you can get spasm of some of the blood vessels in in the eye and then the arteries can begin to encroach upon the veins and you’ll get what we call crossing defects. For hypertension, it can be valuable for detecting early stage changes of what we call end organ disease. In high blood pressure, we always look for evidence of disease in the heart, kidneys and the circulation to the brain and the eyegrounds, the retina is of fundamental importance there and if hypertension is very severe, very aggressive, what we call malignant hypertension, sometimes you can get hemorrhage in the retina or you can get small little exit dates. Now, if someone has an infection of a heart valve, oftentimes one can get similar kinds of lesions in the eyegrounds as a clue to that.
Is it exciting for you that now there’s research coming out that maybe we should even do this on eye exams when you’re going to get new glasses?
DEMARIA: I’m sure Matthew will explain it. Is that what we detected in this research was not something that a cardiologist or an ophthalmologist can detect with a standard examination. It requires a special examination.
Is that with the OCT?
DEMARIA: Optical Coherence Tomography. OCT. Requires a special kind of examination and it requires special equipment. And you are not looking at the surface of the retina, which is what I could see if I looked in your eye. But rather, this examination is looking beneath the very surface of the retina at the mid-portion of the retina that can only be examined by tomography, which is like creating a slice of the retina and looking inside.
So is this a new type of technology?
DEMARIA: The technology is well-established and utilized on a relatively regular basis. For instance, over a period of several years there were 13,000 such examinations done here, just at UCSD.
What is the most exciting part of this study for you and this new technology?
DEMARIA: I think the most exciting part of this technology is that the potential exists for a finding in the eye to indicate the presence of disease in the heart. Now, I could think of two scenarios where that would be really important. One could say that in every single examination of the eye done with this technique, that not only do you examine for disease of the eye itself, but you can get a clue that there’s heart disease, even if the patient may be unaware of it. A second potential application, and one that would be very exciting, is if you’re seeing a patient and the question is, is heart disease, is cardiovascular disease present or not, then perhaps this relatively simple, non-invasive test could be done to give evidence that, in fact, heart disease is or is not present.
So it’s not intrusive at all, it’s just looking like a mirror into your heart, through your eyes.
DEMARIA: This is totally non-invasive technique. It’s just looking into the eyegrounds and using this technology of optical coherence tomography to see the inner layers of the retina, not just the surface of the retina, but from my vantage point, I’m a cardiologist. Matthew is going to be able to tell you so much more about the technique itself. From my standpoint, the excitement is, as I said, and the message I think that would be exciting, is that this is kind of a freebie to the ophthalmologic examination. You go to the eye doctor and in addition to have them checking whether or not there’s eye disease, they may be able to detect heart disease for free, part and parcel of a simple, non-invasive examination.
And getting then to you a lot earlier. So you can…
DEMARIA: Absolutely. Early identification in asymptomatic individuals. The detection of the so-called ripples in the eye might be the clue that a patient needs to see a cardiologist who can then detect some problem and intervene earlier before an event occurs. As I said, there is the potential that the detection of these ripples could be a technique to establish whether or not heart disease is present in the patient in whom you’re uncertain. Does the patient need to have a certain drug, for instance, to lower cholesterol? Well, if we’re uncertain, we turn to other kinds of tests, like detecting calcium in the blood vessels. This could be an alternative and didn’t require radiation.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
JEANNA VAZQUEZ
858-249-0428
Sign up for a free weekly e-mail on Medical Breakthroughs called First to Know by clicking here
