A Clinical Review on The Holism of Ophthalmology - The Associations Between Systemic Diseases and Ocular Conditions

  • Kah Hie Wong University of Hong Kong (Li Ka Shing Faculty of Medicine)
Keywords: Ophthalmology, Holism, Systemic Diseases


This is an up-to-date review on the holism of ophthalmology, covering the associations between eyes and systemic diseases. 

Ophthalmology teaching in the undergraduate medical curriculum is often very brief, which seems reasonable in view of other specialties such as internal medicine which have many life-and-death issues and numerous diseases across a wide spectrum of subspecialties. By contrast, ophthalmology gives the impression of being more specialized. However, the value which vision holds in people’s hearts is usually underestimated when compared to life or limb. Moreover, the severity of visual impairment in relation to its impact on daily life is also often not proportional; in other words, mild visual impairment may have a detrimental effect on daily life, functionally and emotionally.

This review aims to provide an overview of ocular pathologies that are associated with systemic diseases with emphasis on cardiovascular and autoimmune conditions. In addition, we discuss the potential role of retinal microvascular analysis in the prevention and management of cardiovascular diseases, which has been gaining attention in recent years.

Author Biography

Kah Hie Wong, University of Hong Kong (Li Ka Shing Faculty of Medicine)

I am a final year medical student in the University of Hong Kong (HKU) who plan to devote my future career to ophthalmology. I am a holder of HKU Foundation Scholarships For Outstanding International Students annually from 2010 to 2015. I obtained the highest mark in the world in the November 2009 Cambridge International AS level examinations for Mathematics. I received the Best Student Award in Form 5 (2008).

I collaborated with the department of ophthalmology of Hong Kong Queen Mary Hospital and Hong Kong Eye Hospital in research works regarding central serous chorioretinopathy and Grave's Ophthalmopathy respectively. I frequently participated ophthalmology conferences to expand my exposure. I actively involved in Christianity, ophthalmology-related and other types of voluntary work. 

I participated in hall and church choirs as soprano during my university years.  I was a voluntary Physics student tutor of peer-to-peer programme during my Cambridge A Level's programme from 2009 to 2010. From 2004 to 2008, I was an active scout member and later assistant patrol leader and committee member. 

I obtained the open solo champion of Yamaha Organ Competition and had the chance to perform publicly during Yamaha Music Festival.

During leisure time, I enjoy singing, drawing, wall-climbing, playing organ and learning language (Mandarin, Foochow, English, Malay, Cantonese, Korean, Hokkien). 


1. Bausch + Lomb. Globally, We Are Losing Sight of Our Eye Health, a New Public Opinion Poll Reveals. [Online] Available from http://www.bausch.com/our-company/NewsRoom/2012-archive/barometer [Accessed on 23rd March 2015]

2. World Health Organization. Visual impairment and blindness. [Online] Available from http://www.who.int/mediacentre/factsheets/fs282/en/ [Accessed on 23rd March 2015]

3. Tien Yin Wong, Chelvin Sng, Laurence Lim. The Ophthalmology Examinations Review. Second Edition. Singapore: World Scientific Publishing; 2011.

4. Grauslund J. Eye complications and markers of morbidity and mortality in long-term type 1 diabetes. Acta ophthalmologica. 2011;89 Thesis 1:1-19.

5. Rogers SL, Tikellis G, Cheung N, Tapp R, Shaw J, Zimmet PZ, et al. Retinal arteriolar caliber predicts incident retinopathy: the Australian Diabetes, Obesity and Lifestyle (AusDiab) study. Diabetes Care. 2008;31(4):761-3.

6. Grauslund J, Green A, Kawasaki R, Hodgson L, Sjolie AK, Wong TY. Retinal vascular fractals and microvascular and macrovascular complications in type 1 diabetes. Ophthalmology. 2010;117(7):1400-5.

7. Sun C, Wang JJ, Mackey DA, Wong TY. Retinal vascular caliber: systemic, environmental, and genetic associations. Survey of ophthalmology. 2009;54(1):74-95.

8. World Health Organization. The top 10 causes of death. [Online] Available from http://www.who.int/mediacentre/factsheets/fs310/en/ [Accessed on 23rd March 2015]

9. Flammer J, Konieczka K, Bruno RM, Virdis A, Flammer AJ, Taddei S. The eye and the heart. Eur Heart J. 2013;34(17):1270-8.

10. Kolar P. Risk factors for central and branch retinal vein occlusion: a meta-analysis of published clinical data. Journal of ophthalmology. 2014;2014:724780.

11. Petzold A, Islam N, Hu HH, Plant GT. Embolic and nonembolic transient monocular visual field loss: a clinicopathologic review. Survey of ophthalmology. 2013;58(1):42-62.

12. Flammer AJ, Anderson T, Celermajer DS, Creager MA, Deanfield J, Ganz P, et al. The assessment of endothelial function: from research into clinical practice. Circulation. 2012;126(6):753-67.

13. Pajic B, Pajic-Eggspuchler B, Haefliger I. Continuous IOP fluctuation recording in normal tension glaucoma patients. Current eye research. 2011;36(12):1129-38.

14. Serna-Ojeda JC, Flores-Reyes EM, Hartleben-Matkin C. [Glaucoma: trends in the study of its etiology]. Gaceta medica de Mexico. 2014;150 Suppl 3:317-23.

15. Shi Y, Liu P, Guan J, Lu Y, Su K. Association between Glaucoma and Obstructive Sleep Apnea Syndrome: A Meta-Analysis and Systematic Review. PloS one. 2015;10(2):e0115625.

16. Daniel BS, Orchard D. Ocular side-effects of topical corticosteroids: what a dermatologist needs to know. The Australasian journal of dermatology. 2015.

17. Hayreh SS. Ischemic optic neuropathy. Progress in retinal and eye research. 2009;28(1):34-62.

18. Nordborg E, Nordborg C. Giant cell arteritis: epidemiological clues to its pathogenesis and an update on its treatment. Rheumatology (Oxford, England). 2003;42(3):413-21.

19. Borchers AT, Gershwin ME. Giant cell arteritis: a review of classification, pathophysiology, geoepidemiology and treatment. Autoimmunity reviews. 2012;11(6-7):A544-54.

20. Chen L, Gordon LK. Ocular manifestations of multiple sclerosis. Current opinion in ophthalmology. 2005;16(5):315-20.

21. Simao LM. Ophthalmologic manifestations commonly misdiagnosed as demyelinating events in multiple sclerosis patients. Current opinion in ophthalmology. 2010;21(6):436-41.

22. Pan CW, Cheng CY, Saw SM, Wang JJ, Wong TY. Myopia and age-related cataract: a systematic review and meta-analysis. American journal of ophthalmology. 2013;156(5):1021-33.e1.

23. Ye J, He J, Wang C, Wu H, Shi X, Zhang H, et al. Smoking and risk of age-related cataract: a meta-analysis. Investigative ophthalmology & visual science. 2012;53(7):3885-95.

24. Yu X, Lyu D, Dong X, He J, Yao K. Hypertension and risk of cataract: a meta-analysis. PloS one. 2014;9(12):e114012.

25. International Uveitis Study Group. What is uveitis. [Online] Available from http://www.iusg.net/page7/What_is_Uveitis.html [Assessed on 29th March 2015]

26. UpToDate. Uveitis: Etiology, clinical manifestations and diagnosis. [Online] Available from http://www.uptodate.com.eproxy1.lib.hku.hk/contents/uveitis-etiology-clinical-manifestations-and-diagnosis?source=search_result&search=uveitis+etiology&selectedTitle=1%7E150 [Accessed on 29th March 2015]

27. Zein G, Berta A, Foster CS. Multiple sclerosis-associated uveitis. Ocular immunology and inflammation. 2004;12(2):137-42.

28. Pan D, Hirose T. Vogt-Koyanagi-Harada syndrome: review of clinical features. Seminars in ophthalmology. 2011;26(4-5):312-5.

29. Mat MC, Sevim A, Fresko I, Tuzun Y. Behcet's disease as a systemic disease. Clinics in dermatology. 2014;32(3):435-42.

30. Max R, Lorenz HM, Mackensen F. [Ocular involvement in spondyloarthropathies: HLA B27 associated uveitis]. Zeitschrift fur Rheumatologie. 2010;69(5):397-402.

31. Trikudanathan G, Venkatesh PG, Navaneethan U. Diagnosis and therapeutic management of extra-intestinal manifestations of inflammatory bowel disease. Drugs. 2012;72(18):2333-49.

32. Gomes BA, Santhiago MR, Jorge PA, Kara-Jose N, Moraes HV, Jr., Kara-Junior N. Corneal Involvement in Systemic Inflammatory Diseases. Eye & contact lens. 2015.

33. Nassar A, Tabbara KF, Aljurf M. Ocular manifestations of graft-versus-host disease. Saudi journal of ophthalmology : official journal of the Saudi Ophthalmological Society. 2013;27(3):215-22.

34. Jack J Kanski. Clinical Ophthalmology: A Systematic Approach. Seventh edition. United Kingdom: Elsevier Health Sciences; 2011.

35. UpToDate. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Pathogenesis, clinical manifestations and diagnosis. [Online] Available from http://www.uptodate.com.eproxy1.lib.hku.hk/contents/stevens-johnson-syndrome-and-toxic-epidermal-necrolysis-pathogenesis-clinical-manifestations-and-diagnosis?source=search_result&search=stevens+johnson+syndrome+clinical+manifestation&selectedTitle=1%7E150 [Accessed on 30th March 2015]

36. Tanda ML, Piantanida E, Liparulo L, Veronesi G, Lai A, Sassi L, et al. Prevalence and natural history of Graves' orbitopathy in a large series of patients with newly diagnosed graves' hyperthyroidism seen at a single center. The Journal of clinical endocrinology and metabolism. 2013;98(4):1443-9.

37. Bahn RS. Graves' ophthalmopathy. New England Journal of Medicine. 2010;362(8):726-38+74.

38. Wiersinga WM, Smit T, van der Gaag R, Koornneef L. Temporal relationship between onset of Graves' ophthalmopathy and onset of thyroidal Graves' disease. Journal of endocrinological investigation. 1988;11(8):615-9.

39. Hirbe AC, Gutmann DH. Neurofibromatosis type 1: a multidisciplinary approach to care. The Lancet Neurology. 2014;13(8):834-43.

40. UpToDate. Overview of ptosis. Available from http://www.uptodate.com.eproxy1.lib.hku.hk/contents/overview-of-ptosis?source=search_result&search=ptosis&selectedTitle=1%7E150 [Online] Accessed on 30th March 2015.
How to Cite
Wong, K. H. (2015). A Clinical Review on The Holism of Ophthalmology - The Associations Between Systemic Diseases and Ocular Conditions. Res Medica, 23(1), 38-47. https://doi.org/10.2218/resmedica.v23i1.1240
Clinical Review Article