The Kaplan Medical Center recently opened an integrated clinic, in which an endocrinologist works side by side with ophthalmologists: neural-ophthalmologist (an expert in neural-related sight impairments) and oculoplastician (plastic surgeon of the eyelids and sockets) treat patients with eye and sight impairments caused by a variety of endocrine situations or diseases, such as a thyroid disease and tumors in the hypophysis.
Thyroid Disease and Eye Involvement
Thyroid disease causes a disruption in the body hormonal system and various side effects such as variations in pulse, sensitivity to climate change, changes in appetite and weight, etc.
Eye involvement might occur in about 40% of the patients suffering from a thyroid disease. Mostly there are patients with hyper-thyroidism (Grave’s Disease), but this condition is also possible in hypo-thyroidism or in the case of an inflammatory disease (Hashimoto).
The damage to the eye creates puffiness and Exophthalmos, dryness, double vision and even loss of sight. This damage causes great suffering, functional damages, cosmetic damages and a significant damage in the patient’s quality of life.
The eye disease can be in various levels of severity, and in some cases, there could be a disease which obliges urgent therapeutic or surgical intervention. Also in cases of a light disease that passes, there could be a chronic condition which sometimes require surgical intervention due to changes in the eyelids, Exophthalmos, or crossed vision. Treating the disease includes endocrine therapy and eye therapy according to the disease’s level of severity and activity. The best treatment integrates the various areas while making an educated decision that regards both the patient’s eye situation and his hormonal situation.
Usually, patients suffering from this disease are followed by an endocrinologist and ophthalmologist, and they are often required to perform many tests and run around between various doctors, which are not always coordinated.
The integrated clinic in the Kaplan Medical Center coordinates the treatment of these patients, and allows them to have a test by an endocrinologist, an ophthalmologist, and other auxiliary tests (field of vision, OCT of the vision nerves) if necessary, all on the same day. After the tests, the doctors discuss all the findings and come to a joint coordinated decisions, in cooperation with the patient, about the best treatment for each stage.
Such a day saves the patient time and trouble and allows doctors from the various disciplines to discuss the patient together and come to the best decision for him.
Tumors in the hypophysis
Tumors in the hypophysis or in its area, which apply pressure on it, may induce extensive hormonal disruptions and even become life-threatening. These tumors may damage your sight, in a way which is sometimes severe and irreversible, due to their proximity with the vision nerves and the optic chasm.
Often, the first sign of a tumor is sight impairments, and therefore it can only be diagnosed following an examination by an ophthalmologist. The ophthalmologist diagnoses the damage and sends the patient to undergo brain imaging (CT/MRI) and also for a consult with an endocrinologist. Sometimes the tumor is first diagnosed by the endocrinologist due to various hormonal disruptions and only after it is discovered in the brain imaging, an ophthalmologist’s opinion is required regarding whether or not the tumor presses and harms the vision nerves.
The regulated follow up after these tumors is very important, as we have to decide on time whether to treat the patients with medications or in a surgical manner. The followup includes endocrine evaluation, brain imaging and also a followup by a neural-ophthalmologist, who is assisted by auxiliary tests of the field of vision and an OCT of the vision nerves.
In these cases, much like in cases of thyroid problems, the integrated clinic followup includes a joint evaluation by an endocrinologist and a neural-ophthalmologist, performing the required tests, such as field of vision, OCT, and optometric, all in one place.
The clinic receives patients who were referred by an endocrinologist or an ophthalmologist, subject to an obligation form.