健康諮詢:眼睛揭示的健康問題

As an ophthalmologist, David Ingvoldstad sees much more about his patients' health than just their eyes. Thanks to the clues the eyes provide, he regularly alerts patients to possible autoimmune diseases like rheumatoid arthritis and lupus, monitors progression of their Diabetes and once even suspected - correctly, as it turned out - that a patient had a brain tumor on the basis of the pattern of her vision changes.

戴維•英沃斯塔德（David Ingvoldstad）是內布拉斯加州奧馬哈市（Omaha）Midwest Eye Care的私人執業醫師，身爲眼科醫生，他從病人身上看到的健康問題遠遠不止眼睛本身。根據眼睛提供的線索，他會經常提醒病人注意風溼性關節炎和狼瘡等可能患上的自身免疫系統疾病，監測糖尿病進程，他甚至曾經根據一位病人的視力變化模式懷疑她患上腦腫瘤──結果證明他的懷疑是正確的。

Because the body's systems are interconnected, changes in the eye can reflect those in the vascular, nervous and immune system, among others. And because the eyes are see-through in a way other organs aren't, they offer a unique glimpse into the body. Blood vessels, nerves and tissue can all be viewed directly through the eye with specialized equipment.

由於人體系統是相互關聯的，因此眼睛的病變可以反映出血管、神經和免疫系統等處的病變。由於眼睛在某種程度上是透明的，而其它器官則不是，因此通過眼睛可以從一個獨特的視角瞭解身體簡況。藉助專用設備，血管、神經和組織都可以通過眼睛進行直接觀察。

With regular monitoring, eye doctors can be the first to spot certain medical conditions and can usher patients for further evaluation, potentially leading to earlier diagnosis and treatment. Clots in the tiny blood vessels of the retina can signal a risk for stroke, for example, and thickened blood-vessel walls along with narrowing of the vessels can signal high blood pressure. In some cases, examining the eye can help confirm some of the diagnoses or help differentiate disorders from each other.

使用常規監測，眼科醫生可能是第一個發現某些健康問題的人，並能引導病人進行進一步檢查，這可以幫助病人提前診斷和治療。例如，視網膜毛細血管中的凝塊表明可能存在中風危險，而血管壁增厚連同血管變窄表明可能有高血壓。在某些情況下，眼科檢查可以幫助確診某些疾病，或幫助區分不同的病症。

'There's no question the eye has always been the window to the body,' says Emily Chew, deputy director of the epidemiology division at the National Eye Institute. She adds, 'Anybody with any visual changes . . . should be seeing someone right away.'

美國國家眼科研究所（National Eye Institute）流行病學部副主任埃米莉•周（Emily Chew）說，“毫無疑問，眼睛一直是身體的窗戶。”她補充說，“任何視覺發生變化的人……都應該馬上看醫生。”

Scientists are working to advance their knowledge of what the eye can reveal about diseases. For instance, researchers are studying how dark spots on the back of the eye known as CHRPE, or congenital hypertrophy of the retinal pigment epithelium, are associated with certain forms of colon cancer, and how dementia-related changes are signaled in the eye, such as how the eye reacts to light. Other scientists, like Dr. Chew, are studying how to keep the eye healthier for longer, which could be good for the health of the eye as well as the rest of the body.

科學家們正在努力增進對眼睛所能揭示的疾病的瞭解。例如，研究人員正在研究眼球后部被稱爲CHRPE（即先天性視網膜色素上皮細胞肥大）的黑斑與某些類型的結腸癌的關係，以及與癡呆症相關的病變在眼睛中的徵兆，例如眼睛對光線的反應。也有些科學家，例如周博士，正在研究如何更長久地保持眼睛健康，這對眼睛健康和身體其他部分的健康都有好處。

Companies are building enhanced technology that allow for better viewing of the eye. Scotland-based Optos, for example, created a machine that allows for better screening of the periphery of the retina. The machines can now be found in doctors' offices and research clinics. Instead of the typical 30-degree view of the eye, it offers a 200-degree view. Being able to see more of the periphery could mean earlier or more accurate diagnosis of various diseases and may also be coupled with intervention tools to improve treatment. Optos is currently funding a study of the use of retinal imaging to diagnose heart disease, according to Anne Marie Cairns, head of its clinical development.

許多公司正在開發更高級的技術，以更好地檢查眼睛。例如，蘇格蘭的Optos公司發明了一種機器，它可以更好地掃描視網膜邊緣。現在，醫生診室和臨牀研究診室中都能看到這種機器。它提供了200度視野，而不是通常的30度視野。可以看到更多邊緣意味着能更早或更準確地診斷各種疾病，並可以與干預工具共同使用以提高治療效果。據Optos臨牀開發部主任安妮•瑪麗•凱恩斯（Anne Marie Cairns）稱，該公司目前正投資開展一項使用視網膜成像技術診斷心臟病的研究。

The eye's job is to deliver vision by converting incoming light information into messages that the brain can understand. But problems in vision can indicate a problem outside of the eye itself.

眼睛的功能是將入射光信息轉化爲大腦能理解的訊號，從而產生視覺。但視覺問題可能顯示出眼睛本身以外的問題。

One critical structure in the eye is the retina, which allows us to experience vision. It is made of brain tissue and contains many blood vessels. Changes in vessels in other parts of the body are reflected in the retina as well, sometimes more noticeably or sooner than elsewhere in the body.

眼睛的一個關鍵結構是視網膜，它讓我們能夠體驗視覺。它是由腦組織構成的，幷包含許多血管。人體其它部位的血管病變也反映在視網膜中，有時比身體任何其它部位都更明顯或更早。

The eyes can help predict stroke risk, particularly important to people with heart disease and other stroke risk factors. That is because blood clots in the arteries of the neck and head that might lead to stroke are often visible as retinal emboli, or clots, in the tiny blood vessels of the eye, according to the National Eye Institute.

眼睛可以幫助預測中風風險，這對有心臟病和其他中風風險因素的人尤爲重要。據美國國家眼科研究所稱，這是因爲頸部和頭部動脈中可能導致中風的血塊通常會在眼睛的毛細血管中顯現爲可以看到的視網膜栓塞或凝塊。

The immune system's interaction with the eyes can be telling, too, yielding information about autoimmune diseases or infections in the rest of the body. Sometimes eye symptoms may appear before others, like joint pain, in patients.

從免疫系統與眼睛的相互影響中也可以得出關於身體其他部分自身免疫系統疾病或感染的信息。有時，眼科症狀可能在病人出現其他症狀（例如關節疼痛）之前顯現出來。

For instance, inflammation in the optic nerve can signal problems in an otherwise healthy, young person. Along with decreased vision and sometimes pain, it can suggest multiple sclerosis. If the optic disc, a portion of the optic nerve, is swollen, and the patient has symmetrical decreased field of vision, such as a decreased right visual field in both eyes, they may need an evaluation for a brain tumor - a rare circumstance.

例如，視神經發炎可能表明其他方面健康的年輕人身體出了問題。視力減退且眼睛時而疼痛可能表明患有多發性硬化。如果視神經盤──視神經的一部分──腫大，且病人有對稱視野縮小，例如雙眼右視野縮小，那麼他們可能需要檢查是否有腦腫瘤──這是一種罕見的情況。

If immune cells like white blood cells are seen floating in the vitreous of the eye, it could signal a local eye infection or one that is spread throughout the body.

如果在眼球玻璃體中看到漂浮的白血球等免疫細胞，那麼可能表明存在局部眼球感染，或者遍佈全身的感染。

Diabetes is one disease that can cause major changes in the eye. In diabetic retinopathy, a common cause of blindness, blood vessels hemorrhage and leak blood and fluid. When blood vessels don't function properly, they can potentially cause eye tissue to be deprived of oxygen and to die, leaving permanent vision damage.

糖尿病是一種可能導致重大眼睛病變的疾病。在糖尿病視網膜病變這種常見的致盲疾病中，血管會出血並滲出血液和液體。當血管無法正常發揮功能時，可能導致眼組織缺氧並死亡，造成永久性視力損傷。

Also, in diabetic patients additional blood vessels may grow in the eye, anchoring themselves into the sticky gel known as the vitreous, which fills a cavity near the retina. This condition can cause further problems if the retina tears when it tries to separate from the vitreous - a common occurrence as people age - but is tangled by growth of new blood vessels.

而且，糖尿病病人的眼睛還會有血管增生，這些血管將纏在玻璃體（粘稠的膠狀物，充滿於視網膜旁的空腔體裏）中。當視網膜和玻璃體要分離──人們年老時常會發生的情況──但被長出的新血管纏住時，視網膜會破裂，導致更多的問題。

Usually diabetic patients who come in for eye exams already know they have the disease, and the primary purpose of an eye exam is to make sure they don't have diabetic retinopathy or, if they did have it, that the condition hasn't progressed, say eye doctors like Dr. Ingvoldstad, a private practitioner at Midwest Eye Care in Omaha, Neb. But once in a while there is a patient who has noticed vision changes but didn't realize he or she had diabetes until alerted during an eye exam that there were signs of the eye disease that is consistent with the condition, he says.

英沃斯塔德等眼科醫生說，通常，進行眼科檢查的糖尿病病人已經知道他們有病，而眼科檢查的主要目的是確保他們沒有糖尿病視網膜病變，或者當他們患上這種疾病時，確保情況沒有惡化。但他說，偶爾會有病人出現明顯的視力變化，但沒有意識到自己有糖尿病，直到在眼科檢查中被警告出現了與這種病症一致的眼科疾病跡象。

The American Academy of Ophthalmology recommends eye examinations whenever individuals notice any vision changes or injury. Adults with no symptoms or known risk factors for eye disease should get a base line exam by age 40 and return every two to four years for evaluations until their mid-50s. From 55 to 64, the AAO recommends exams every one to three years, and every one to two years for those 65 and older.

美國眼科學會（American Academy of Ophthalmology）建議，只要發現任何視力變化或損傷，就應進行眼科檢查。沒有眼科疾病症狀或已知風險因素的成年人應在40歲時進行基礎檢查，且每2-4年進行一次複查，直到55歲左右。對於55歲到64歲的人，美國眼科學會建議每1-3年進行一次檢查，對於65歲以上的人，美國眼科學會建議每1-2年進行一次檢查。