If the eyes are a window into the soul, they’re also a window into our health.
“In general many people have the misconception that their eyes are disconnected from their bodies. That’s a myth that is perpetuated by insurance carriers who continue to offer vision plans separate and apart from general health plans,” says Dr. Gregory Schultz, an optometrist who has been specializing in ocular disease for 21 years.
“People don’t understand the importance of a dilated pupil exam. I ask my patients: ‘Do you want me to examine 25% of your eye or 100%?’ There are so many diseases that can be seen and diagnosed through a proper comprehensive examination. It can be the tip of the iceberg in diagnosing a disease that is unknown to them and unknown to their primary care physician.”
Dr. Schultz, who is the President and Medical Director of Eye Center of Virginia in Williamsburg, says patients don’t realize that diagnostic testing, such as a visual field test, can reveal as much as an MRI.
“We call the visual field test the poor man’s MRI,” he explains. “Someone who’s highly trained in evaluating the visual field can look at it and diagnose brain tumors or stroke. Not only can you tell if there’s a brain lesion, but you can tell where in the visual pathway it is.” We routinely order MRIs on our patients that confirm our suspected findings.
Dr. Schultz recalls a woman who came to see him while he was working as an eye specialist at the Sentara Careplex in Hampton, Virginia. She was initially referred to him for glaucoma. “She, to the credit of the doctor, did have glaucoma,” he says. “She had all of the signs of glaucoma, which includes elevated intraocular pressure and cupping of the optic nerve.”
But Dr. Schultz saw something else. There was a paleness to her optic nerves that concerned him. It was something the other doctor had missed. “It prompted me to order an MRI,” he remembers. “There are three reasons people get this type of pallor. One is inflammation in the eye from an inflammatory disease such as Multiple Sclerosis. Another reason is a lack of blood flow getting to the nerve, akin to a stroke. That happens when not enough blood is getting to the nerve for whatever reason—hypertension, diabetes, high cholesterol, or a combination of these things. The third reason is a compressive lesion or a tumor.”
After he ordered the MRI, Dr. Schultz discovered the woman did in fact have a pituitary tumor, which is a brain tumor. Dr. Schultz referred her to a neurosurgeon at University of Virginia Hospital who specializes in such complex cases.
Days before her visit with the neurosurgeon, she called Dr. Schultz early one morning. She was vomiting and told him she had the worst headache of her life. Dr. Schultz had her immediately come to his office, which at the time conveniently sat above an emergency room.
“I saw her and she had every symptom in the book of a condition called pituitary apoplexy,” he remembers. Schultz escorted her to the emergency room where she was then medevaced by helicopter to another hospital in Norfolk. Later that day, doctors performed emergency brain surgery.
It was a case where Dr. Schultz saved her life. Dr. Schultz’s specialized training enabled him to recognize these symptoms.
“Many of my patients come in with unknown problems and they’re completely asymptomatic. If your doctor is not experienced in these matters and doesn’t pick up on that, the tumor grows for another year,” he says.
The patient recovered 100 percent and kept her 20/20 vision. “I get a card every year from this patient thanking me for saving her life,” he says.
Dr. Schultz, unlike 85 percent of practicing optometrists, did residency training before going into private practice. He also worked in highly specialized medical practices for 20 years, cultivating his expert clinical experience. His passion for understanding ocular diseases led him to a medical residency in the management of ocular disease and surgical care.
“We had every kind of ophthalmology subspecialty in our practice,” he says of OMNI Eye Services, where he worked in New York and New Jersey as a resident and staff consultative optometrist for six years.
“We had a glaucoma specialist, a retinal specialist, a neuro-ophthalmologist, a plastic surgeon, and a cataract refractive surgeon.”
Dr. Schultz trained under all of these subspecialists. “In that setting, I would see anywhere from 40 to 60 patients a day. Every single patient had an eye problem or an eye disease,” he remembers. “I either managed them myself, or if they needed surgery I triaged them to the appropriate surgeon. Most optometrists don’t have that level of experience.”
It’s why for Dr. Schultz, optometry is so much more than providing a prescription for glasses or contact lenses. He believes one grossly underdiagnosed ocular disease is glaucoma which is why Dr. Schultz is particularly passionate about detecting the disease in patients early. Glaucoma is the second leading cause of blindness in the world and the leading cause of blindness for people under 65 in the United States.
“People think that if they see reasonably well everything’s fine. That is not the case,” he says. “You can have advanced glaucoma and still have 20/20 vision on the eye chart.”
Since last April, Dr. Schultz says he has seen over 100 patients newly diagnosed with glaucoma. If left untreated, glaucoma slowly blinds you, but is entirely preventable with proper diagnosis and treatment.
Yearly eye exams can also be a window into cancer diagnosis and management. As part of his 21 years of experience, Dr. Schultz worked in an eye clinic at Sentara Careplex that was located above a cancer clinic. There, he worked closely with the clinic’s oncologists to manage the vision of patients going through chemotherapy and other treatments.
“I’ve initiated the diagnosis of breast cancer numerous times by looking into the eye,” he says. He adds that for patients with a history of breast cancer, he has been able to help oncologists manage treatment better by monitoring how the cancer is metastasizing, if at all, in the eye.
In addition to medical eye exams, Dr. Schultz performs routine eye care exams to help patients find their best vision correction with contact lenses and glasses. “ I have focused my efforts on researching the latest, best contact and eye glass lenses available for vision correction, such as astigmatism and presbyopia,” he says.
“The belief at Eye Center of Virginia is that we provide the best eye health and refractive care a patient could ever want or need.”