I've been asking a lot of questions lately...questions of myself, of my profession, of the health care industry. I guess this is par for the course. As an eye doctor, it's my job to ask a lot of questions. In fact, the better I am at this, the easier it is to do my job. It's said that careful history-taking ( i.e., questioning) can determine the diagnosis most of the time. This 1975 study reported a correct diagnosis made by case history alone in 80% of the cases (physical examination wasn't needed!): http://www.jstor.org/discover/10.2307/20473216?uid=3739560&uid=2&uid=4&uid=3739256&sid=21102585650647
So, each workday, I ask a lot of questions. Whether it be to determine which prescription is the right one for my patient ("which lens is better, 1 or 2?") or to help in the assessment of a patient's health ("do you have hypertension?" or "do you smoke?" or "do you have any family history of glaucoma?"), I try to ask the right questions and listen effectively to what my patient tells me. If I see diabetes or hypertension in the eyes, I generally have a game plan. If I see macular degeneration or glaucoma, I know what I am supposed to do. But, what do I do when I see cholesterol in the eye?
From the front of the eye (corneal arcus)...
...to the back of the eye in the retina (emboli; Hollenhorst plaque),
it seems I am seeing, more and more each new year, evidence of cholesterol in the eyes of my patients. Indeed, even if there truly is more cholesterol seen nowadays in peoples' eyes (i.e., five years ago an eye doctor would see only 1 patient a day with cholesterol in their eyes, now they would see 3-5 patients a day with cholesterol in their eyes), what would that mean? What would it matter? Sure, if an embolism is present in a retinal artery, this can have a disastrous effect on ocular health and vision. But, if cholesterol is building up in the cornea ( arcus), does it mean anything? Does it matter?
Lastly, one more group of related questions- and this is probably where I'm trying to go- do I believe in the cholesterol-heart disease hypothesis or the lipid hypothesis? Do I follow along with the health, food and political industries (among others, these last few decades) that say we all need to eat low-fat, high-carb diets to keep heart-healthy? Do I really agree with these same industries that say we are fat or obese because we are lazy (don't exercise enough) and we have no self-control (eat too much)? Is "a calorie a calorie" and is saturated fat to blame for everything un-"healthy"?
Well, I think there are many more questions to ask ( and much deeper ones as well) but let's start there. Maybe we in the health care field are too busy to talk about eating REAL FOOD while cutting down on or eliminating processed foods and sugars......too busy to discuss the possibility that maybe what we feed our bodies-what we eat- does have a tremendous affect on our health. Let's continue the discussion and continue asking questions...
CAUTION = POST UNDER CONSTRUCTION (more questions to ask)!!!