高血壓與眼睛

高血壓是現代社會一種常見但不可輕視的心血管疾病。高血壓的定義為上壓達到140 mmHg 或以上 及下壓達到90或以上。研究顯示, 在東亞人口中有57%中風致死的個案跟高血壓有關。高血壓能影響身體多個器官和組織, 而眼睛, 尤其是視網膜, 就是其中之一。高血壓視網膜病變一方面作為高血壓的併發症, 另一方面它的病情對處理高血壓甚至評估中風風險都十分有用。換句話說, 接受全面眼科視光檢查檢查視網膜, 甚至可提供有用的資訊拯救高血壓病人的生命。現在就樣我們來多了解高血壓跟眼睛的關係吧。

高血壓視網膜病變有多常見?

高血壓能影響血管和循環系統的健康, 而視網膜則佈滿血管以維持視網膜細胞正常運作, 因此, 視膜網容易受高血壓破壞, 形成高血壓視網膜病變。研究顯示, 在40歲或以上人口中, 有3-14%的人有高血壓視網膜病變, 而高血壓病人平均患病6年後就會開始出現視網膜變化。不過, 高血壓視膜網病變反映血管的健康狀況, 而病情不一定跟血壓水平成正比, 即使未被確診高血壓的人士都可以出現視網膜變化。因此每一個人都不應忽視檢查視網膜的重要性。

高血壓視網膜病變有甚麼徵狀?

高血壓視網膜病變可跟據視網膜徵狀分為4期。在第1期的高血壓視網膜病變中, 病人視網膜中的小動脈會收窄。而第2期的病人視網膜除了小動脈收窄外,靜脈亦會被硬化的動脈擠壓。第3期的病人視網膜血管開始出現滲漏, 滲出血液和液體, 同時視網膜亦可能出現缺氧情況。第4期的高血壓視網膜病變較常出現在血壓非常高的惡性高血壓病人身上, 患者除了第3期的病徵外, 連視神經和黃班點都會出現水腫。因惡性高血壓隨時致命, 所以第4期高血壓視網膜病變患者需要緊急轉介控制血壓。以上的視網膜病徵只有通過全面眼科視光檢查以檢查視網膜健康才能得知, 而病人在早期的高血壓視網膜病變中一般沒有感到異樣, 只有在病情中後期波及黃班點附近組織才會開始影響視力。

高血壓導致的眼睛併發症

高血壓視網膜病變是指視網膜血管因高血壓出現變化, 而另一方面高血壓亦可誘發其他可以致盲的眼睛疾病, 包括缺血性視網膜疾病、視網膜動脈式靜脈阻塞等俗稱眼中風的眼疾。眼中風的發病過程跟腦中風相近, 因而得名, 病人視力可能出現突發性或逐漸視力下降, 甚至是永久視力喪失。高血壓也可增加大腦神經麻痺的風險, 導致突然出現的斜線和重影。

全面眼科視光檢查的重要性

視網膜就像一扇窗, 可以讓眼科專業人士以簡單及非入侵性的方式觀察血管健康, 甚至得悉病人的身體健康資訊。研究顯示, 不論當時的體重和血壓水平如何, 出現視網膜動脈收窄但沒有高血壓的病人在3年內被診斷高血壓的機會比沒有視網膜徵狀的高60%。同時, 視網膜動脈收窄和動靜脈交疊擠壓反映過去6-8年血管被高血壓破壞, 有助評估病人過往的血壓水平。而最重要的是, 由於視網膜血管系統的生理結構跟大腦的相近, 全面眼科視光檢查不單有助發現致盲眼疾, 更可能幫忙拯救病人的性命。患有第3期高血壓視網膜病變的患者, 在未來3年出現中風的機會比其他人高2-4倍, 如磁力共振顯示病人同時有相關大腦損傷, 中風風險更會升至18倍。第3期高血壓視網膜病變的患者患有心臟病的機會也比其他人高2-3倍。因此, 通過檢測出這些病人的視網膜徵狀, 就能及時轉介作進一步心臟病和中風評估, 令病人受惠。

全面眼科視光檢查對眼睛和身體健康都至關重要。眼科視光師建議, 所有人都應該最少每年進行一次全面眼科視光檢查。為了更全面照顧您的眼睛和身體健康, 現在就聯絡您的眼科視光師檢查吧!

註冊眼科視光師(第一部份) 鄧光佑


以上護眼資訊由瑞士寶視光中心提供

地址 : 香港新界荃灣海盛路11號 One Midtown 23樓全層

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參考資料:

  1. Klein, R., Klein, B. E., & Moss, S. E. (1997). The relation of systemic hypertension to changes in the retinal vasculature: the Beaver Dam Eye Study. Transactions of the American Ophthalmological Society, 95, 329.
  2. Wong, T. Y., & Mitchell, P. (2004). Hypertensive retinopathy. New England Journal of Medicine, 351(22), 2310-2317.
  3. Grosso, A., Veglio, F., Porta, M., Grignolo, F. M., & Wong, T. Y. (2005). Hypertensive retinopathy revisited: some answers, more questions. British Journal of Ophthalmology, 89(12), 1646-1654.
  4. T.Y., Wong. (2007, March 16). Hypertensive Retinopathy: The Cardiovascular Connection. Review of Ophthalmology. Retrieved August 27, 2017, from https://www.reviewofophthalmology.com/article/hypertensive-retinopathy-the-cardiovascular-connection
  5. Nguyen, U. T., Bhuiyan, A., Park, L. A., Kawasaki, R., Wong, T. Y., Wang, J. J., … & Ramamohanarao, K. (2013). An automated method for retinal arteriovenous nicking quantification from color fundus images. IEEE Transactions on Biomedical Engineering, 60(11), 3194-3203.
  6. J., Kim. (2014, December 21). Hypertensive retinopathy. Eye Wiki. American Academy of Ophthalmology. Retrieved August 27, 2017, from http://eyewiki.aao.org/Hypertensive_retinopathy
  7. K.T., Oh. (2017, January 06). Ophthalmologic Manifestations of Hypertension. Medscape. Retrieved August 27, 2017, from http://emedicine.medscape.com/article/1201779-overview#showall
  8. M., Alexander. (2017, June 07). Hypertension. Medscape. Retrieved August 27, 2017, from http://emedicine.medscape.com/article/241381-overview
  9. Mondal, R. N., Matin, M. A., Rani, M., Hossain, M. Z., Shaha, A. C., Singh, R. B., . . . Das, A. (2017). Prevalence and Risk Factors of Hypertensive Retinopathy in Hypertensive Patients. Journal of Hypertension: Open Access,06(02). doi:10.4172/2167-1095.1000241
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