By Darby Kendall
The eyes aren’t just a window to the soul — they’re also a mirror to overall health. Eye doctors can detect signs and symptoms for a variety of health conditions, from heart disease to cancers, through an ordinary vision exam.
When other symptoms aren’t presenting, an eye exam may be the only way such ailments are caught. Lehua Yoshioka experienced this firsthand when her daughter Waiaka, an otherwise healthy and active 10-year-old, began complaining she couldn’t see the board at school.
An urgent diagnosis
Lehua took Waiaka to Visionworks for an exam, assuming a routine glasses prescription would be given. Their provider did the exam, but he was hesitant to make a diagnosis after he’d noticed what appeared to be cataracts in Waiaka’s eyes.
“I asked, ‘Cataracts, aren’t those normally just for the elderly?’ He said no, that he had actually seen another child with cataracts last week,” Lehua remembered. “He had Waiaka sit down while I was standing, and he let me see from his point of view. He asked, ‘Do you see the cloud?’ And I could see the cataract.”
Wasting no time to get a diagnosis, their provider referred them to the Elks Children’s Eye Clinic at the OHSU Casey Eye Institute, where they met with Allison Loh, M.D. Loh was able to confirm Waiaka had cataracts in both eyes, but she also ordered blood work for Waiaka given her mother’s history with diabetes.
“Dr. Loh was caring and awesome with everything,” Lehua said. “Because she was asking more questions, she knew that I was type 1 diabetic, so that’s when she wanted to get lab work done for Waiaka.”
As Lehua was driving her daughter home after getting labs done at OHSU Doernbecher Children’s Hospital that same day, she received an urgent call saying Waiaka’s results had come back, and her blood sugar level was dangerously high at 400 mg/dL.
“We told them to turn around and go to the emergency department at Doernbecher, where they would be admitted and helped with the identification of Waiaka’s diabetes,” remembered Loh. “They were really lucky. Because we were able to see them quickly and diagnose the cataracts, Waiaka hadn’t suffered any serious consequences of being too sick from the diabetes.”
Before taking her daughter to the Elks Children’s Eye Clinic, Lehua had no inkling that diabetes could be the source of Waiaka’s vision problems.
“At the ER, the doctors asked if she was tired and all the other diabetic diagnosis type of questions. I said, ‘No, she wasn’t.’ She was acting normal,” Lehua said. “I know when I was diagnosed, I was lethargic to the point that I couldn’t even walk. But for her, she was fine, she was up, so we couldn’t even tell.”
Thankfully, Loh knew that diabetes can sometimes cause cataracts and followed her gut to confirm the diagnosis. Waiaka’s diabetes was caught before it caused harm to any other organs or left irreversible damage.
Why the eye
Eye doctors’ detections of disease are often lifesaving, as symptoms like blurry vision and droopy eyelids can be indicators of much more serious health conditions. Loh explained that the eye is a good gateway to catching other diseases because of its anatomy. The pupil is the one place where you can see the brain from the outside, as the optic nerve is visible when looking into it.
“That can give us a lot of clues about what’s going on in the brain,” Loh said. “There’s so much information that we can gain from the muscles and nerves of the eyes, because of how they move. I think it’s one of the most rewarding and fun parts of pediatric ophthalmology; it really is a window to bigger things that are happening in kids’ bodies and especially their brains.”
This view into health that the eyes provide is relevant to both children and adults across a variety of conditions. Loh stated that using eyes as indicators for wellness happens almost daily in her role.
“Recently, I saw a 17-month-old little girl whose eyes didn’t move well. They were kind of pointed inward, and she also had trouble swallowing and had other things going on,” she said. “But with the eyes, because it’s so specific and only two things could cause the inward pointing, we were able to diagnose her with the syndrome that caused all her problems. Nobody was able to put a name to it before that.”
Whole-body care
One unique benefit of visiting an ophthalmologist at the Casey Eye Institute is the immediate availability of a hospital next door if a condition is diagnosed, regardless of whether you’re a child or an adult. This applies to both urgent conditions like Waiaka’s that require the ER, or if a specialist is needed down the line.
“It’s so helpful to have Doernbecher right there. For diabetes, it’s really valuable to have Child Life services, to have experts in nutrition and all the collaborators that will help make this transition in Waiaka’s care the best it could possibly be,” Loh said. “For kids who have different syndromes that involve lots of different specialists, it’s nice for me to know those doctors and providers, and to be able to send the kids to specific clinics. Families really appreciate it.”
Since Waiaka’s diagnoses of cataracts and type 1 diabetes in March, she has successfully undergone surgery to remove the cataracts and is now seeing well again. Lehua credits Loh with helping her daughter feel comfortable throughout the entire process.
“Dr. Loh was amazing. She made the experience stress-free for me as the parent. Watching my daughter, I knew she was very nervous when she first went in, but on the first visit with Dr. Loh, I noticed she was calming to her. My daughter wasn’t as anxious and wasn’t fidgety,” Lehua said.
Lehua and Loh are both grateful that Waiaka’s health remains strong after that stressful spring day. Loh reflected that it’s a joy for her to work in an institution where integrated wellness is emphasized, setting her and her patients up for success.
“In this field, we get to be impactful at a really meaningful time in these kids’ lives, and our help can make a huge difference in their vision for their whole life,” Loh said. “Eye care is so integrated with the whole body, so it’s really nice to work here where it can all be done in one place.”
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