Occipital AVMs can cause headaches and visual symptoms similar to migraine auras. 1ĪVMs in or near the visual pathway can cause visual field defects associated with both mass effect from the AVM itself or from its bleeding, or from ischemia related to stroke. They can hemorrhage and cause significant morbidity and mortality associated with hemorrhagic stroke (cerebrovascular accident, CVA) in fact, they account for 2% of all hemorrhagic strokes. These are a complex knot of directly fistulating arteries and veins, without a normal capillary bed in between. Here are four of the more common ones:Ĭerebral arteriovenous malformations (AVMs). It’s important that you educate these patients about cardiovascular optimization, including smoking cessation, and symptoms warranting emergency evaluation. However, many other pertinent cardiovascular abnormalities might show up in your patient’s medical record and give you pause. Every optometrist should already be well-versed in caring for patients with these comorbidities. These are so routine in my daily practice that it’s almost surprising when patients don’t have at least one of them, but their ever-increasing frequency doesn’t negate their importance. This includes the common metabolic trifecta: diabetes, hypertension and hyperlipidemia. Click image to enlarge.Ĭardiovascular & Cerebrovascular Disorders He underwent right carotid endarterectomy.

He had 70% to 99% stenosis of the right carotid artery and insignificant disease on the left. This patient had a Hollenhorst plaque in the superior-temporal arcade of each eye and a cotton-wool spot inferior-temporal to the right optic nerve. Even when the subsequent exam shows that the ocular system remains unaffected, we should ensure our patients are acquainted with the possible systemic and ocular manifestations that they need to watch for. When we notice these less-obvious flags in the medical history or during the review of systems, we should adjust our approach to ensure we are looking more closely for the (sometimes subtle) ocular associations.

While the more common systemic issues become second nature (think diabetes), other details in the medical chart are easily overlooked because they may not immediately seem related to the eyes. Many of our patients are being treated for a systemic condition, and either the disease itself or its treatment regimen-or both-could come with ocular manifestations the patient may not be aware of. During every comprehensive eye examination, perusing the patient’s medical history is a crucial first step, even when they present without any visual complaints.

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