Not too many people think of their annual visit to their optometrist as an opportunity to save their life, but when a dilated retinal exam is performed there is the possibility of finding warning signs for potentially life-threatening health issues. This is the case when an optometrist finds a retinal embolism or plaque within one of the arteries in the retina.
To the right is a picture of a person’s retina. As you can see, there is vast array of arteries and veins in the retina. The optometrist is in the unique position of being able 
to physically see the quality of the local blood vessels without surgery or complex imaging tests. In the picture, you can see a yellow waxy-like object within the artery. This is a retinal embolism called a Hollenhorst plaque. It’s made mostly of cholesterol and it’s origins are from blood vessels somewhere else in the body.
Sometimes the plaque can disrupt blood flow to parts of the retina. In that case, temporary or permanent vision loss may occur. But this is not always the case. Many times, a person can have this plaque in their retinal artery and have absolutely no visual symptoms.
However, the bigger concern may be where this plaque came from. There is a risk that cholesterol deposits are collecting and blocking the carotid artery, which is the main lifeline of blood flow to the head region. If plaques have broken off from here and entered the eye, there is a significant risk for similar plaques to break off and enter small but crucial arteries surrounding the brain. This could cause stroke or even death.
If a retinal plaque or embolism is seen during a dilated eye exam, the next step is notifying the primary care physician to rule out carotid artery occlusion as well as other potential sources of the plaque. Such steps, which may include carotid artery ultrasound, could be instrumental in identifying and treating issues which have potentially life-threatening complications.
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Dr. Beach.
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