–A Guest Column by Helene D. Clayton-Jeter, OD–
Cardiovascular disease has a significant public health impact. Cardiovascular disease, including high blood pressure, heart disease and stroke, is the leading cause of death in the United States. About one in three U.S. adults (29%) has high blood pressure. Only about half (54%) of these people have their high blood pressure under control. High blood pressure affects nearly 75 million people and blood pressure control has been proven by many studies to significantly reduce serious cardiovascular events.
It is estimated that about 11 million U.S. adults with high blood pressure are not even aware they have it and are not receiving treatment to control their blood pressure. Nearly one in three American adults have prehypertension – blood pressure numbers that are higher than normal, but not yet in the high blood pressure range.
Since high blood pressure usually does not have any symptoms, people do not think they need to get their blood pressure checked. The lack of symptoms also holds true for many eye diseases and conditions that go undetected, such as glaucoma. The only way to know if you have high blood pressure or an eye problem is to have regular check-ups.
The eyes are a window to overall health for you can detect signs of medical conditions through them. While everyone should have a primary care provider who they see for routine check-ups, some patients may actually visit their eye doctor more frequently than their primary care provider. While this may be for a variety of reasons, in my clinical experience, eye doctors are often seen as the “pain free” doctor. Thus, there may be less anxiety around scheduling a routine eye examination appointment.
When someone notices a change in their vision, they typically think they need an eye exam for a new prescription for eyeglasses or contact lenses. High blood pressure may be detected during an eye exam where past medical history, chief complaint, vital signs and ocular screening tests for glaucoma and other eye diseases are gathered routinely as part of a comprehensive eye examination. A dilated fundus exam or dilated-pupil fundus examination (DFE) is a diagnostic procedure that uses eye drops to dilate or enlarge the pupil in order to obtain a better view of the fundus of the eye. A DFE, as part of a comprehensive eye examination, enables us to detect changes in blood vessels and tissues within the eye. Therefore, the inclusion of blood pressure testing in the vital sign measurements during an eye examination is essential for the detection of high blood pressure. Monitoring and management of high blood pressure is critical for reducing the risk of heart attack, heart failure, and stroke among patients.
The Food and Drug Administration (FDA) is an active participant in the U.S. Department of Health and Human Services Million Hearts initiative, joining 120 official partner organizations, including the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, and 20 other federal agencies. This initiative successfully aligns national cardiovascular disease prevention efforts to increase public awareness of the health benefits of improving blood pressure control.
A collaborative effort, the Enhanced Medication Adherence Strategic Initiative (EASi), was created by the FDA to establish key objectives aligned with the Million Hearts initiative. One of FDA’s key objectives focuses on improving medication adherence to prevent further complications of high blood pressure.
The FDA regulates medical devices and drugs used by eye doctors to diagnose and treat eye diseases and conditions. A routine eye examination may provide the view necessary to detect and learn about other health-related signals. So, if the eyes are the window to overall health, you can see that routine eye care by an eye doctor (optometrist or ophthalmologist), along with regular visits to a primary health care provider, should be a part of your overall health care regimen.
The connection to good overall health starts with each healthcare provider-patient interaction!
1. Merai R, Siegel C, Rakotz M, Basch P, Wright J, Wong B; DHSc., Thorpe P. CDC Grand Rounds: A Public Health Approach to Detect and Control Hypertension. MMWR Morb Mortal Wkly Rep. 2016 Nov 18; 65(45): 1261-1264.
2. CDC. Vital signs: prevalence, treatment, and control of hypertension. United States, 1999-2002 and 2005-2008 MMWR 2011; 60(4): 103–8.
Helene D. Clayton-Jeter, O.D.
Director, Cardiovascular and Endocrine Liaison Program
Office of Health and Constituent Affairs
Office of the Commissioner
U.S. Food and Drug Administration
Dr. Clayton-Jeter is the Director of the Cardiovascular and Endocrine Liaison Program in the Commissioner’s Office of Health and Constituent Affairs (OHCA) at the U.S. Food and Drug Administration. She assists in planning, developing, and evaluating FDA policies and programs related to patients and health care professionals. In her role at OHCA, she serves as a channel through which health professional and patient issues and viewpoints can be brought to the attention of FDA medical and regulatory staff. Dr. Clayton-Jeter serves as the OHCA subject-matter-expert in the optometry/ophthalmology, cardiovascular and diabetes topic areas. She is the primary liaison to the Center for Devices and Radiological Health, sits on the Department of Health and Human Services Health (HHS) Disparities Council and the Million Hearts All HHS Agency Council. Two 2014 gubernatorial appointments to the Commonwealth of Virginia Board of Optometry and Board of Health Professions is a testament to her past and current dedication to public service. Dr. Clayton-Jeter has a B.S. degree in Visual Science and O.D. (Doctor of Optometry) degree from Pennsylvania College of Optometry at Salus University and holds a B.S. degree from Virginia Commonwealth University. She practiced clinical optometry in a variety of healthcare settings for over 20 years prior to joining the staff at the Office of Health and Constituent Affairs.
Dr. Clayton-Jeter acknowledges her OHCA colleagues for their contribution to this article.