Optometry

Seeing the metabolic connection in eye disease

Background in Optometry

After qualifying in the UK (Cardiff University), there followed a brief period in private practice before moving to the NHS hospital eye service. This offered the opportunity to work in more diverse clinical areas – ocular ultrasound, medical contact lenses, paediatric clinics, cataract post-op, and low vision support services. This experience, which included working with those whose vision had been impacted by metabolic disease, has shaped my passion for communicating the benefits of TCR for metabolic disease.

The eye as a window

Optometry provides a perfect backdrop for understanding the effects of metabolism on the body. We can look into the eye and directly examine blood vessels in the eye in a non-invasive way. Imaging can now capture this, and we can observe progression and improvement more easily.

Ocular Health is Metabolic Health

The eye is unique in structure as an end organ sensitive to metabolic dysregulation and containing neural tissue as an extension of the brain. Insulin resistance may present in the eye in a number of ways.

Diabetes and Hypertension

Ocular health translates to metabolic health. The calibre of the blood vessels reflects vascular health throughout the body and may reflect cardiovascular disease risk. Diabetes and hypertension, two key features of metabolic dysregulation, can cause retinal changes.

Neurology

The optic nerve head also provides a window into neurological diseases. Nerve fibre layer imaging can show changes predictive of the development of Alzheimer's disease, and metabolic syndrome is associated with neurodegeneration of the retinal nerve fibre layer.

Promising case study

This case highlights the power of a nutritional intervention leading to remission of type 2 diabetes in an insulin-dependent case where the patient had mild macular oedema causing visual impairment. Within 2 weeks of commencing a ketogenic diet, the patient was able to stop insulin, and follow-up appointments showed improvements in macula oedema. At 18 months, macula oedema was reported as resolved in both eyes.

Hains, L.R. et al. (2022) ‘Diet-induced Resolution of Macular Oedema following Remission of Type 2 Diabetes Mellitus in a patient undergoing Therapeutic Carbohydrate Reduction’, Retinal Cases and Brief Reports, p. 10.1097/ICB.0000000000001614. Available at: https://doi.org/10.1097/ICB.0000000000001614.

Therapeutic carbohydrate reduction and ocular health

Coming soon.....

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