Your Eye Is a Window to Your Brain

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Alvin B. Lin, MD, FAAFP

Associate Professor of Family and Community Medicine, University of Nevada School of Medicine

Adjunct Professor of Family Medicine and Geriatrics, Touro University Nevada College of Medicine

Advisory Medical Director, Infinity Hospice Care

Medical Director, Lions HealthFirst Foundation

Dr. Lin maintains a small private practice in Las Vegas, NV. The posts represent the views of Dr. Lin, and in no way are to be construed as representative of the above listed organizations. Dr. Lin blogs about current medical literature and news at

Disclaimer: My sister-in-law is an optometrist (Golden Vision Optometry in Irvine, CA) and I serve as medical advisor to HeartSmart Technologies Eye Care Division.

Now that we're finished with the pleasantries, do you remember the phrase, "The eyes are the window to the soul", that's been attributed to many authors? Last fall, in preparing for a presentation on heart disease to optometry students, I alluded to the number of studies demonstrating a link between eye health, as defined by retinal vascular changes, hypertensive retinopathy, retinal vascular branching, and/or age-related macular degeneration, and an increase risk of heart disease, stroke, and mortality.

Well, in a study published early online prior to print next week in Neurology, the authors followed 511 female participants average 69 years of age in the Women's Health Initiative who underwent annual evaluation of their cognitive function for 10 years and underwent a retinal exam approximately 4 years prior to a structural MRI of their brain at the end of the study. Their conclusion? Retinopathy was associated with lower/poorer cognitive function as denoted by serial test scores and more ischemic changes in their brain.

Unfortunately, as the editorialists pointed out, this study only proves correlation but not causation. In fact, the authors can't be clear whether cognitive decline preceded retinopathy or vice versa. But for now, I would point out once more that symptom-free, otherwise healthy adults typically see their optometrist much more frequently, often annually for vision acuity correction, than they do their family physician for screening and counseling. And since the eyes appear to serve as a window to both the heart and the brain, I would ask the optometry community to work with my family medicine colleagues by referring patients at risk for heart disease, stroke, and dementia on the base of retinal findings.