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What to do when your eye doctor asks more than just "which is better, 1 or 2?"

If your optometrist asks you if you have recently had your cholesterol and lipid levels checked, they may not be just making conversation. Did you know that during an eye exam the eye doctor is looking for cholesterol?

(They might even be able to spot it in the waiting room. Yellowish, fatty deposits of cholesterol can appear on the skin of and around the eyelids. These deposits are called Xanthelasma and can be seen with the naked eye. If your eye doctor spots and identifies these plaques on the skin as Xanthelasma, it will be necessary to get your cholesterol checked. Now, let’s go into the exam room…)

With the biomicroscope, your doctor searches for cholesterol in your eyes in two more places, one of which is the cornea where cholesterol can deposit in an arc-like formation, circling the outer cornea resembling a white, gray or yellowish ring around the normally clear corneal tissue.  This ring is called Arcus Senilis in those over 60 years of age and is often considered a normal finding as the cornea is one of the places in the body where cholesterol can naturally accumulate over the course of one’s lifetime. Have you ever seen this in your grandparents’ eyes? It almost looks like a halo in front of their iris and I have had some patients with it tell me that their eye color ‘has gotten lighter’ which of course isn’t the case, it just may appear that way through the white veil of cholesterol.

If you are under 60 or even more strikingly under 40, and corneal arcus is noted by your doctor then they may ask about your lipid levels, the last time you had blood work done and also may note any family history of high cholesterol or other cardiovascular conditions.

Cholesterol is an essential component in cell structures and as you have probably heard sometimes cholesterol isn’t such a bad guy. If your optometrist sees cholesterol deposited on your cornea, further testing is needed to determine whether or not the cholesterol there is a sign of something you should be worried about. To learn more about lighter side of cholesterol and why we absolutely need it in our lives (and our cells), check out this awesomely cute article by Jeanne Garbarino and video by Perrin Ireland!

The second place cholesterol can show up is inside the eye in the arteries of the retina. A piece of cholesterol may even be seen stuck in one of the retinal arteries usually at a bifurcation or branching point of an artery. When this happens that once free-floating piece of cholesterol now momentarily lodged  in the retinal artery is referred to as a hollenhorst plaque. If your eye doctor sees this, they will quickly refer you to your general physician for additional evaluation and testing to determine from where this embolus originated. In other words, if there are small plaques of cholesterol lodged in small arteries of the body there may be larger plaques in larger arteries of the body. These larger plaques put you at risk for heart attacks and strokes. Since the presence of hollenhorst plaques is a sign of severe atherosclerosis,  if cholesterol is seen in the retinal arteries inside the eye, your doctor will take it very seriously. And so should you.

The eyes can tell you a lot about your health so the next time your eye doctor asks you about your medical history or your family medical history, be honest, be open and tell them all about it. It may turn into one of the most important conversations of your life, one that can save it.

Keep the Conversation with your Eye Doctor going. There is a reason why they are asking each question.

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