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Women's Health Issues in the Optometric Practice

Lesley L. Walls, OD, MD, DOS

 

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INTRODUCTION

 

It is hardly a profound statement to observe that women are different than men, and very frequently the differences makes it important for health care practitioners to be aware of health problems that occur more commonly in the female population.  Awareness of the above will often lead to better and more appropriate care for the female patient.

There are many diseases and disorders which are quite commonly seen in female patients that are much less commonly seen in men, such as the autoimmune diseases, however, women live significantly longer than do men.  Unfortunately for the female population, they do experience more illness and have more "sick time" than do men on average.

In no way is this presentation to be considered "exhaustive" on the subject of female health Issues.  Rather, the following is a discussion of several diseases and disorders which are commonly diagnosed in the optometric practice and which occur more frequently in the female patient than in the male patient.  This is particularly important as optometrists are recognized as independent health care practitioners and are quite often the doctor of first contact when symptoms lead to a doctor's office visit by the patient.

 

LEARNING OBJECTIVES

 

This course will review the signs and symptoms of the various diseases that occur more frequently in women than in men, including specific examples in these classes of diseases:

•Infection

•Tumor

•Trauma

•Allergic

•Autoimmune

•Congenital

•Metabolic

Also, the implications for the practice of optometry are discussed.

 

PRESENTATION BY DISEASE CLASSIFICATION FORMAT

 

 

              There are only a limited number of underlying “causes” of diseases and disorders which affect human tissues and organs.  This course will present eight (8) categories of basic, underlying etiologies for the various diseases and disorders more commonly observed to occur in females than in males.  These are:  infection, tumor, trauma, allergic, auto-immune, congenital, metabolic and “idiopathic” (no known reason for the disease/disorder).

These various diseases and disorders lead to a shortening of the life expectancy.  Theoretically, a human body should live about 120 years, however, women only live on average to about age 80 and men on average to about 75.  So….the various diseases and disorders basically cheat the average person out of 40 years of life!!  It is currently proposed that a genetic predisposition due to abnormalities on the genetic apparatus coupled with environmental insults (viruses, oxidants, toxins, etc.) activate diseases and disorders.

 

 

The optometrist is very often the doctor a patient will see when there is an infectious process affecting the eye.  One question that must be answered is what kind of infection is it that the patient has and is it a sexually transmitted infection.

1.     The various sexually transmitted diseases with ocular presentations are reported to be more common in females than males.  Additionally, for some unexplained reason these diseases are very often asymptomatic in females whereas in males there are usually significant symptoms related to the genitor-urinary system.  The ocular manifestations of these diseases usually do cause symptoms and therefore may be the only reason the patient will seek health care for the problem.  Specifically, genitourinary tract infections due to the Gonococcus and the Chlamydia organism are both often completely asymptomatic in women, therefore, women are less likely to get treatment, however, these diseases lead to symptoms in males who more likely therefore seek treatment.  However, in both these diseases if the eye is involved the patient will seek treatment. See Figure 1.

 

Gonococcal Conjunctivitis

 

Figure 1: Bacterial Conjunctivitis

 

 

Gonococcal Gram Stain

 

Figure 2: Gonococcus

 

3.     Follicular conjunctivitis is commonly due to Chlamydia therefore follicles in the presence of a severe mucopurulent conjunctivitis in a female patient should lead the optometrist to consider a sexually transmitted disease even without other symptoms.  However, when these diseases occur in males there is very commonly a urethra discharge and symptoms of urethritis (dysuria and urethral discharge).  Again, for unexplained reasons, the female patient often has no symptoms of urethritis. See Figure 3.

 

Chlamydia Conjunctivitis

 

Figure 3: Follicular Conjunctivitis

 

 

AIDS devastates the T Lymphocytes of the helper (CD4) cell line leading to severe acquired immunodeficiency.  There are resulting problems such as cancer (lymphoma, Kaposi's sarcoma, etc.), opportunistic infection (cytomegalovirus, pneumocystis carinii pneumonia, cryptococcus neoformans meningitis, etc.), and ultimately death.  The virus must enter the bloodstream in order to have its effect on the immune system and subsequently enters CNS cells, macrophages, T Lymphocytes, and probably most other cells.  The disease AIDS is primary spread by contact with the sexual secretions of infected individuals and by contact with or injections of blood or blood products.

It has also recently been reported that the incidence of AIDS is higher in females than males in places with epidemic HIV infection, like certain countries in Africa.  The reason for this is mostly unclear but one factor is thought to be that it is easier for one infected male can spread the disease to many women than the converse. 

The AIDS virus is known to attack the retina and also to cause the incidence of infections of the eye to increase due to the immune system being depressed in the presence of the HIV virus.  One sign of AIDS is the occurrence of Kaposi’s Sarcoma which is a malignancy of blood vessels.  The eyelid is a site that these cancers may occur. See Figure 4.

Kaposi's Sarcoma of Lid

 

Figure 4: Kaposi’s Sarcoma in AIDS

Thus, while HIV positive patients are regularly encountered in many optometric practices in the U.S., the so-called “cocktail” of medicines most of these patients now take makes progression to AIDS rare. In other countries where access to pharmaceuticals may be more difficult, this may not be the case.

 

 

The definition of “tumor” is abnormal new cell growth which is not subject to normal growth regulation (the cell growth is uncoordinated) and is at the expense of the health of the rest of the body.  Therefore tumor cells are characterized as cells that are autonomous (uncontrolled by normal body growth factors), undergoing rapid reproduction (much faster than normal cells), and that are parasitic (the cells gets their nutrition when the rest of the body is suffering for nutrition). See Figure 5.

 

Breast Cancer to Choroid

 

Figure 5: Non-pigmented cancerous tumor of the retina

 

For demonstration purposes, presentations of Cancer of the Breast, Lung and Malignant Melanoma affecting the eye are presented.

1.     Breast Cancer - breast cancer is almost (but not quite!) exclusively a female disease and therefore this life-threatening cancer is much more commonly diagnosed in women, but that this type of cancer definitely affects men too is well-known.  It is reported that less than ten percent (10%) of breast cancer occurs in males.  One fairly common site for metastasis of breast cancer is to the Choroid and the Cavernous Sinus.  Metastases to both of these areas are associated with symptoms related to vision that may cause the patient to seek optometric care. See Figure 6.

 

Metastatic Tumor to choroid

 

Figure 6: Pigmented cancerous tumor of the retina

 

2.     Lung Cancer - In the past, cigarette related lung cancers were much more common in males but this is no longer true as the percent of men and women who smoke is now virtually identical and, therefore, the incidence of cancer of the lung has dramatically increased in women to the same level of that for men. See Figure 7.

 

Cancer Lung X-RayCancer of the Lung

 

Figure 7: Lung Cancer on X-ray and Autopsy

 

3.     Malignant Melanoma – The incidence for occurrence of this type of cancer on the skin is dramatically increasing.  Malignant Melanoma occurs more frequently with a history of severe or repeated sunburn.  Presently there is concern that Tanning Booths are contributing to this increase in incidence due to the Ultraviolet Light penetrating deeper into the skin than does natural sunlight.  Women utilize artificial tanning more frequently than men and it is feared that more women than men will develop malignant melanoma in the future as a result of utilizing tanning booths.  Malignant Melanoma of the Choroid is a diagnosis commonly made in the optometrists office.  Malignant Melanoma has a genetic predisposition and the genetics are pretty well worked out for its development. See Figure 8.

 

Mal MelanomaKenny Curry also 3-6-06

 

Figure 8: Malignant melanoma of the skin and conjunctiva