Interview: Dr Amod Gupta
Ophthalmologists can make an early diagnosis of many serious diseases through eye examination: Dr Amod Gupta
Gunjan Sharma|
Wednesday, March 6, 2024


The eye examination is often neglected by primary care physicians. But the fact is eyes act as a diagnostic window, revealing signs of systemic disease before symptoms appear. Dr Amod Gupta’s recent book, Ophthalmic Signs in Practice of Medicine, a textbook he co-authored with Prof. Reema Bansal, a professor of Ophthalmology; Prof. Aman Sharma, a professor of Rheumatology and internal medicine and Arun Kapil, an experienced clinical photographers, is a definitive reference book for all medical practitioners on the role eyes play in the practice of medicine.  Dr Gupta talks to Gunjan Sharma on how a careful eye examination can help physicians and ophthalmologists diagnose a number of systemic diseases early.



1. What inspired you to focus on ophthalmic signs in the practice of medicine, and how do you believe this book will bridge the gap between general medicine and ophthalmology?

That ophthalmologists can make an early diagnosis of a myriad of serious systemic diseases is unknown to most lay people and physicians. The common perception of eyes and eye physicians is often limited and underestimated. Many people, including doctors, view the eye as a small and insignificant organ, assuming that as long as one can see, there is no need for concern. Ophthalmologists, or eye physicians, are often seen as professionals who are only useful for prescribing glasses or performing old-age cataract surgery. Their importance is often recognized when eye problems such as irritation from dust or redness due to infections occur. Sometimes, individuals who lose their sight due to conditions like glaucoma understand firsthand the critical role that eye physicians play in diagnosing and preventing blindness. Our focus in the book is not merely on blinding eye ailments, but on how the eye examination can be used to make an early diagnosis of systemic disease.

There is very little captive time in ophthalmology training during the undergraduate MBBS or MD programs. Most of them fail to wield an ophthalmoscope (instrument to look at the back of the eye).


2. Can you share insights on how advancements in diagnostic technologies have influenced the identification and interpretation of ophthalmic signs in recent years?

The Ophthalmic signatures of disease by and large do not require any advanced diagnostic techniques to elicit them but are based on the basic clinical and observational skills of the physicians, something that is rapidly evaporating. This becomes critical in resource-limited regions of the world. Not many people including physicians are aware of the fact that the retina, the most sensitive layer of the eye, is an extension of the brain and is the only part of the body, that allows direct visualization and documentation of blood flow and vessels (arteries, veins, capillaries), as well as non-invasive inspection and measurement of neural tissue and nerve fibers.

Eyes act as a diagnostic window, revealing signs of systemic disease before symptoms appear. Advanced tools like optical coherence tomography (OCT) enable detailed, real-time observation of living tissue without the need for invasive biopsies, providing valuable insights into structural changes over time. The OCT and the non-mydriatic fundus cameras besides the ophthalmology clinics have become essential tools in neurological emergency rooms in the Western world.


3. How do you envision primary care physicians and non-ophthalmology specialists using your book in their daily practice?

The eye examination is often neglected by primary care physicians. Specialists and super specialists do not venture into any other area apart from their area of specialization. We do not expect super specialists to use our book as a reference tool. But it will be a useful reference book for all undergrads, residents, and fellows in internal medicine/ family physicians/ geriatrics, etc. 


4. Why is the resurgence of emphasis on basic eye exams crucial in the context of modern medicine, and how do the visual signatures of diseases observed in the eyes provide valuable insights into a person's health that may be overlooked by highly specialized and technology-dependent medical practices?

Our body is all but a well-connected machine.  Ophthalmoscopic (for examining the back of the eye) skills were as important as that with the stethoscope. In the present day, doctors have become highly specialized, and depend on hugely expensive investigations that may not be easily accessible even in the most advanced economies of the world. While the super specialists are capable of efficiently treating specific and critical health problems, they often miss the early signs of disease.

Eye exams used to be a crucial part of the evaluation of patients until about 50 years ago. Expensive tests have replaced simple eye exams in evaluating health. Doctors today are not trained enough in basic eye exams like looking at the back of the eye, checking how the eyes move, or even how to check for pupillary reactions. By highlighting the signatures of diseases observed in the eyes, we argue for bringing back the training on basic eye exams, which can give important clues about a person's health. Signatures of diseases can be revealed by examination of the retina, pupil reflexes, eye movements, the external eye, and the area around the eye, all of which can reveal a lot about a person's health and disease. These signatures are visible and can be easily learned, documented, and online transported.   Ophthalmology being a visual science is eminently capable of documentation on a variety of imaging devices that can be used for teleconsultation across the globe.


5. How is this book different  from other textbooks in ophthalmology?

Unlike conventional texts that focus on chapter-wise descriptions of diseases, this book emphasizes focusing on the signatures of disease.  This approach is logical when examining a patient without prior knowledge of their condition. Often medical students memorize descriptions of enumerable diseases from the traditional textbooks. We seek to change this learning process. We aim to make eliciting eye signs a central aspect of patient evaluation, challenging the traditional rote-learning approach in medical training.

We discuss various ophthalmic signatures useful for doctors, including general physicians, family physicians, community doctors, internists, physician assistants, and nurses. Part I focuses on 15 intraocular signs detectable on retinal examination, while Part II covers five extraocular signs visible to the naked eye. For example, a single microaneurysm in the retina can indicate longstanding diabetes mellitus, asymptomatic and often undetected until serious complications arise. Other signs like macroaneurysms, cotton-wool spots, retinal hemorrhages, and optic nerve head evaluation provide crucial insights into conditions such as decompensated high blood pressure, renal disease, atherosclerosis, AIDS, brain tumors, multiple sclerosis, and a variety of life-threatening rheumatological disorders. We explain the genesis of these signs, helping trainees understand the underlying mechanisms and emphasizing observation over rote learning.

6. What role does AI play in the field of ophthalmology, particularly in visual interpretation for diagnosing diseases, and how do you envision the relationship between AI and physicians evolving in the future?

AI has become prominent in medical fields requiring visual interpretation, including ophthalmology. AI is trained to recognize patterns and abnormalities, of diseases and helps in making precise diagnoses. However, AI will at best be an assistant to physicians and will not replace doctors in the foreseeable future.  Whenever AI-generated data suggests a potential diagnosis, validation by a physician will be required. As AI tools become more widespread, physicians will need to be familiar with disease signatures for accurate interpretation. This book aims to be a valuable reference for all physicians as far as the eye signatures of diseases are concerned.


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