Dr. Jennifer Li on heart health and the eyes
Taking care of your heart is important year-round. While most people associate heart health with cholesterol levels and blood pressure, few realize that the eyes can offer important clues about cardiovascular conditions. In fact, an eye exam can sometimes detect early signs of heart disease before other symptoms appear.
How can an optometrist see signs of circulatory health in the eyes?
The eye is the only place in the body where blood vessels can be viewed directly. During a comprehensive eye exam, an optometrist examines the retina along with its arteries and veins. The arrangement of blood vessels at the back of the eye, known as the retina vasculature, is closely connected to the health of your heart. Any irregularity in retina vasculature can indicate a problem with the cardiovascular system.
There is a connection between diseases in the eye and cardiovascular conditions. For example, patients who have atherosclerosis or cholesterol deposits in their arteries can also have them in their retinal blood vessels. Cardiovascular diseases can also increase the risk of developing age-related macular degeneration later in life.
Here are some key ways that eye health can reveal underlying heart issues:
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Retinal artery or vein occlusions, which are blockages in the retinal arteries or veins, can indicate poor circulation that may be linked to high blood pressure, diabetes, or other cardiovascular conditions. These blockages can cause sudden vision loss or changes in vision.
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High blood pressure can damage the blood vessels in the retina, leading to hypertensive retinopathy. This condition can cause narrowed arteries, bleeding in the eye, and swelling of the optic nerve.
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Cholesterol deposits in the eye can appear as changes in the retinal blood vessels during an eye exam, and their presence may signal plaque buildup in the carotid arteries, which is associated with an increased risk of stroke.
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Diabetic retinopathy is a condition that causes damage to the retina’s small blood vessels and, if untreated, can cause bleeding/scarring and swelling that may lead to serious vision loss.
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Optic nerve swelling may be linked to cardiovascular circulation issues. This condition can cause blurred vision, headaches, and even serious neurological problems if left untreated.
Why is healthy circulation important for vision?
Your eyes do more than help you see the world; they can also provide important clues about your overall health. Changes to the small blood vessels in the eye can sometimes reflect conditions affecting the rest of the body. By maintaining good cardiovascular health and seeing an eye care professional regularly, you are taking an important step toward protecting your overall well-being.
Healthy circulation is essential for good vision. Blood flow delivers oxygen and nutrients to important eye structures such as the retina and optic nerve. When circulation is reduced or blood vessels become damaged, these tissues may not function properly. Many eye conditions related to circulation develop quietly, often without pain or early warning signs. By the time vision changes are noticeable, some damage may already have occurred. This is why routine eye examinations, including careful evaluation of the retina, are important for early detection.
Visual symptoms such as blurred vision or the sudden appearance of dark spots or floaters should never be ignored, particularly if they occur suddenly. In some cases, these symptoms may be associated with problems affecting blood flow to the eye and, occasionally, the brain.
Protecting your heart and blood vessels therefore also helps protect your eyes and your vision.
Ways to protect your eyes and health
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Manage your blood pressure and cholesterol.
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Adopt a heart-healthy diet
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Exercise regularly
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Don't smoke.
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Schedule regular checkups with your physician.
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Schedule regular eye exams with your optometrist.
What parts of the eye are examined?
During a comprehensive eye exam, an optometrist evaluates both the
Anterior segment: The front structures of the eye, including the tear film, cornea, and lens, are carefully examined during an eye exam. The tear film is the thin layer of moisture covering the eye that keeps the surface smooth and comfortable. The cornea is the clear front surface of the eye that helps focus light, and the lens is evaluated for clarity to check for cataracts.
Posterior segment: The back of the eye, where the retina and optic nerve are located. The retina is the light-sensitive tissue responsible for converting light into signals sent to the brain. Within the retina, special attention is given to the macula, the central area responsible for sharp, detailed vision. The optic nerve is carefully assessed for signs of damage or swelling. The network of retinal blood vessels is examined for any narrowing, bleeding, leakage, or other circulatory changes that may reflect systemic conditions such as hypertension or diabetes.
Why are dilation drops used?
An optometrist may use medicated eye drops to dilate (widen) your pupils during an eye exam. This allows a clearer and more detailed view of the retina and optic nerve at the back of the eye. Because many eye diseases become more common with age and can develop without noticeable symptoms, dilation can help detect problems early before they affect vision. The procedure is simple and usually causes little to no discomfort.
After dilation, your eyes may be more sensitive to light for about two to four hours, and your near vision may be blurry, making reading more difficult during that time. Since the pupils are temporarily enlarged, more light enters the eye, which can cause glare outdoors. Some people may feel uncomfortable driving after dilation, so it is best to use caution and wait until your vision feels comfortable before driving.
Even if your eyes feel healthy, regular dilated eye examinations are important because many eye diseases have no early warning signs. Dilated exams can help detect conditions such as diabetic retinopathy, glaucoma, and age-related macular degeneration, as well as other changes inside the eye.
It is important to follow your eye doctor’s recommendations about dilation so that eye health can be properly monitored.
How often should you have an eye exam?
The frequency of eye exams depends on factors such as age, health history, and existing eye conditions.
For healthy individuals with no evidence of circulatory or retinal abnormalities, routine comprehensive eye examinations are generally recommended every two years. However, if changes are detected in the retinal blood vessels or other parts of the eye, more frequent follow-ups may be necessary. Regular eye examinations are extremely important for maintaining good vision. Many people only visit an eye doctor when they notice a problem, but routine check-ups play a critical role in early detection and prevention.
Routine eye exams allow these conditions to be detected early, helping to prevent permanent damage. Since eyes can reveal signs of other health conditions, it enables timely treatment and better health outcomes. Regular examinations are also important for individuals who wear glasses or contact lenses, as prescriptions can change over time, and outdated lenses may cause headaches, eye strain, or blurred vision.
What happens if a problem is detected?
If a problem is detected during a comprehensive eye examination, the next steps depend on the type and severity of the issue. In many cases, early detection allows the optometrist to intervene before significant vision loss occurs.
If mild changes are found, such as slight early signs of leakage, the optometrist may schedule more frequent follow-up appointments to closely monitor the condition. This helps determine whether the issue is stable, improving, or progressing. Patients may also be advised to see their family doctor to evaluate related health factors such as blood pressure, cholesterol, or blood sugar levels.
If more serious findings are observed, such as significant bleeding in the retina, the optometrist may initiate treatment within their scope of practice or refer the patient to an ophthalmologist for further evaluation.
In urgent situations such as a retinal tear, immediate referral is made to prevent permanent vision damage. Early treatment in these cases can be sight-saving.
Overall, detecting a problem during an eye exam is not something to fear but actually a positive step. It means the issue has been identified, often before noticeable symptoms develop. With proper monitoring, timely referrals, and coordinated care, many eye and systemic conditions can be effectively managed, preserving both vision and overall health.
Info for Waterloo Eye Institute patients
At the Waterloo Eye Institute, if signs of systemic health concerns are detected during an eye exam:
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Patients are informed clearly and professionally about any findings.
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Additional non-invasive imaging (such as retinal photography or OCT) can often be performed on the same day or as soon as possible to further assess results.
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If needed, a detailed report may be sent to the patient’s family physician or appropriate specialist to support coordinated care.
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Urgent concerns are referred promptly when indicated.
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Patients receive clear communication and follow-up aimed at supporting both vision and overall health.
Research
The University of Waterloo School of Optometry and Vision Science is ranked fifth worldwide in research output for schools of optometry.
Dr. Hudson's research focuses on developing and refining non-invasive clinical and imaging techniques to better detect and monitor retinal and systemic diseases. They examine how early changes in visual function relate to structural changes in the retina, particularly in conditions such as diabetic retinopathy, macular edema, age-related macular degeneration, and primary open-angle glaucoma. The work also explores how the eye may reflect broader neurological and vascular conditions, including Alzheimer’s disease, Parkinson’s disease, amyotrophic lateral sclerosis, and cerebrovascular disease. Using advanced visual testing methods and modern ocular imaging technologies, the research investigates retinal structure, blood flow, oxygen delivery, and vascular regulation to improve early diagnosis, disease monitoring, and clinical decision-making.
https://uwaterloo.ca/optometry-vision-science/profile/chudson
If you are interested in participating in research related to advancing eye and vision care, explore our current studies that are actively looking for volunteers.
Article and video by Naisha Mithani
Reviewed by Dr. Jennifer Li, BSc, MSc, OD, ocular disease and glaucoma residency, FAAO and Dr. Tammy Labreche, OD, FAAO, residency diploma in low vision and geriatrics