By Alan L. Wagner, MD, FACS
Whether during the 1600s when English miners searched for coal, or on some Stardate in the far distant future, the canary signals whether or not the atmosphere is safe for the people in it. The eye, and its fragile vasculature, plays the same role for the major organs of the body.
Several of our articles in this column have outlined the importance of the eye, and in particular the retina, as a leading indicator regarding risk factors for major organ system compromise, morbidity, and mortality. It is appropriate – since this issue focuses on pulmonary disease – that we once again highlight the importance of recognizing and successfully intervening with Obstructive Sleep Apnea (OSA).
Just as the canary needs a certain amount of oxygen to survive, the same is true of the retinal vasculature. If you also take into account the additional challenges placed by a diabetic patient’s activated immune system with the retinal endothelium and its pericytes being immune targets, the already disadvantaged retinal stroma is precariously close to the ischemic threshold, bringing about the complications what we know so well–macular edema, progressive capillary non-perfusion, neovascularization, vitreous cavity hemorrhage, tractional retinal detachment, and blindness. When OSA drops the dissolved serum oxygen concentration as low as one would find if you were climbing to the top of a mountain without oxygen for several hours a night, the complications present themselves and multiply quickly.
The first article pointing to sleep apnea and its role with causing accelerated vascular disease within the eye came from our very own Eastern Virginia Medical School’s Department of Ophthalmology 30 years ago. Since then, our understanding has increased dramatically, relating both pulmonary function compromise and immunology to the eye. We now know that untreated OSA dramatically increases a patient’s risk for complications, ranging from both venous and arterial occlusion to macro vascular disease with its associated embolic phenomena.
I encourage all of our colleagues to become familiar with the recommended screening parameters for all of our patients, and to make the quality-of-life assessments and appropriate physical examinations necessary to help protect patients from these preventable complications. The eye may be the canary, but the heart and the brain aren’t far behind.
Alan L. Wagner, MD, FACS founded the Wagner Macula & Retina Center in 1987. A Board certified ophthalmologist specializing in vitreoretinal surgery, Dr. Wagner received his medical degree from Vanderbilt University School of Medicine. He completed his residency in Ophthalmology at EVMS, and furthered his training as the Dyson Fellow in vitreoretinal disease and surgery at Weill Cornell University Medical Center. wagnerretina.com
