Early diagnosis by doctors of optometry can provide a jump on IBD treatment

Doctors of optometry add value to the team of health professionals who manage cases of inflammatory bowel diseases (IBDs) and colonic malignancies.

Extraintestinal manifestations of these conditions in the eye present a unique opportunity to doctors of optometry to identify exacerbations of IBDs during comprehensive eye examinations, reports a newly released AOA Health Policy Institute (HPI) brief. Given that comprehensive eye examinations can lead to earlier, definitive diagnosis of IBD, patient outcomes improve with earlier treatment.

Read "The Role of Doctors of Optometry in Team-based Care of Inflammatory Bowel Disease and Colonic Malignancies.

"The clinical manifestations of common inflammatory bowel diseases (IBDs), including Crohn's disease and ulcerative colitis, are not restricted to the gastrointestinal tract," the HPI paper states. "IBDs have impact to other organs in a significant number of patients, including the eyes in 72.1% of patients with IBDs.

"These manifestations, known as extraintestinal manifestations (EIMs), associated with the eyes, include inflammatory changes in blood vessels of the conjunctiva and sclera (i.e., white part of the eye), and ciliary body (i.e., underbody to the iris, the colored part of the eye)," the authors write. "Left untreated, these manifestations can cause temporary and/or permanent vision loss."

HPI is the thought leader in public policy research and analysis focused on eye health and vision care. Drawing on its expertise, HPI develops creative, innovative and educational resources and tools to inform policymakers, health care professionals, patients and the public. Its solutions illuminate best policies for efficient access to and delivery of high-quality, comprehensive eye health and vision care.

Prevalence of IBD

According to the Centers for Disease Control and Prevention (CDC), a growing number of Americans have been diagnosed with IBD.

In 1999, IBD prevalence was 2 million American adults, according to the CDC. In 2015, using a more nationally representative study population, about 3.1 million adults reported receiving a diagnosis of IBD. 

The brief links IBD's inflammation to a variety of ophthalmic conditions, including:

• Episcleritis
• Scleritis
• Keratoconjunctivitis sicca (dry eye)
• Retinal edema
• Optic neuritis (swelling of the optic nerve)
• Extraocular muscle nerve palsies.

"All of these manifestations can range in severity from mild to severe, can be temporary or permanent, and can cause significant loss of quality of life and be visually disabling," the HPI brief reads. "The most common ocular complication associated with bowel disease is dry eye syndrome, one of the most common diseases of the human eye.

"Evaluation of the eye should be a routine component of care in patients with IBD just as it is with similar chronic co-morbid systemic conditions like diabetes," the brief adds. "The doctor of optometry has the ability to provide personalized feedback to both the patient and the interprofessional health care team regarding any IBD prescribed drug therapies (i.e., aminosalicylates). This feedback is important as these therapies may cause several ocular side effects, including, but not limited to change in distance and near vision."

Further, a dilated eye examination can detect colonic malignancies with extracolonic manifestations (such as familial adenomatous polyposis or FAP) in the form of congenital hypertrophy of the retinal pigment epithelium, the brief says.

Comprehensive eye examinations

Optometry's capacity to diagnose IBD early, via comprehensive eye exams, underscores its capacity to improve health outcomes in team-based medical management.

"A comprehensive eye examination must consider the whole patient and that is precisely why the first two years of medical, osteopathic and optometry school curricula are the same," says Michael Dueñas, O.D., AOA chief public health officer, "The gastroenterological conditions presented in this HPI brief represent just a sample of over 276 systemic diseases that have ocular involvement."

He adds, "This reinforces the need for the comprehensive eye exam, offered by a doctor of optometry, to be viewed as an integral part of a patient's essential episodic primary care experience."