Neuro Ophthalmology is a subspecialty of both neurology and ophthalmology. Neuro ophthalmologists specialize in vision problems related to the nervous system. These problems include problems with vision brought on by brain illnesses or trauma, strokes, or infections. These problems can sometimes be minor and not reason for considerable concern, but other times they might result in more severe concerns including vision loss. A neuro ophthalmologist is qualified to identify and manage neurological and systemic conditions that influence eye movement and vision. (1)
Definition and Overview
Neuro-Ophthalmology, as defined by Michigan State University, is a specialized field that focuses on diagnosing and treating visual symptoms caused by diseases of the brain. These visual symptoms can manifest as either vision loss or difficulties with eye movements. The loss of vision can arise from issues with the optic nerve or its connections to the brain's visual areas. The eye acts as a camera, and the images are concentrated on the retina, with the optic nerve functioning as the cable that transports these images to the brain.
Precise control of eye movements is dependent on various parts of the brain, and difficulties in these regions can lead to eye misalignment, frequently resulting in double vision. The optic nerve or its connections can be affected by a multitude of conditions, such as strokes, inflammation, multiple sclerosis, or tumors.
Doctors that specialize in the diagnosis and care of neuro-ophthalmological diseases are known as neuro-ophthalmologists. They undergo extensive training, which includes medical school, followed by a residency in either neurology or ophthalmology and a fellowship in neuro-ophthalmology. (2)
Loss of vision may be caused by problems with the eye or the connections between the eye and the brain. Blurred vision in one eye can be caused by a lens issue (glasses), a cataract or other opacity that prevents light from entering, a retinal issue, an optic nerve condition, or an amblyopic (lazy) eye.
Procedures used in neuro-ophthalmology vary depending on the problem being treated. The following are some of the most typical neuro-ophthalmological procedures:
- Kinetic (Goldmann) Perimetry
- Automated (computerized) Perimetry
- Frequency-Doubling Perimetry
- Critical Flicker Fusion Frequency (CFF)
- Infra-red video pupillography
- The Multi-focal ERG (MERG)
- Multi-focal Visual-Evoked Potentials (MVEP)
- Computer-controlled infra-red sensitive pupillography
- Computer-controlled "Pupil" Perimetry
- Computer recording of eye movements
- Optical Coherence Tomography (OCT)
- Ishihara Color Vision Test Cards
It is crucial to keep in mind that the precise techniques employed will rely on the patient's unique requirements, needs, and the illness being treated. (3)
Neuroophthalmologists diagnose many different types of vision problems. There are the same procedures and treatments for all types of ailments. Patients to be treated must first meet some of the following most common conditions:
- double vision
- improperly moving eyes
- eyelid abnormalities
- microvascular cranial nerve palsy (sometimes called "diabetic palsy")
- myasthenia gravis
- loss of visual acuity
- optic nerve disorders (ischemic neuritis, optic neuritis, Leber optic neuropathy)
- pseudotumor cerebri
- pressure building
- sudden changes in pupils
- pituitary tumors
- thyroid eye disease (4)
It is recommended to prepare well before your scheduled neuro-ophthalmology appointment. Up-to-date eyeglasses and prescriptions, relevant medical records, as well as copies of MRIs, CT scans, or other eye tests that may be relevant should be present at appointments.
Risks and Side Effects
Neuro-ophthalmic treatments can have dangers and adverse effects, just like any medical procedure. These can change based on the precise procedure employed and the particular medical state of the patient. The following are some typical risks and side effects that may be related to neuro-ophthalmic treatment procedures:
- ocular pain,
- visual impairment,
- thyroid-like eye disease
- visual loss,
- visual field defects,
- pupillary abnormalities,
- abnormal optic nerve appearance,
- disturbances in ocular motility,
- and abnormal extraocular appearance. (5,6)
Post-Procedure and Follow-up
Neuro-ophthalmic treatments require post-procedure care and follow-up to ensure the best possible outcomes. Depending on the treatment and individual needs, the healthcare professional may monitor your health status and your progress after the procedure, either face-to-face or remotely.
Doctors usually recommend taking medication after the procedure to manage pain, prevent infection, or treat any underlying condition. It is important to follow the prescribed dosage and schedule to maximize the effectiveness of the drug. Scheduled follow-up appointments with the healthcare provider should be attended without interruption to monitor the healing process, evaluate possible side effects or complications, and make any necessary adjustments to the treatment plan. (7)
Depending on the specific problem being treated, several procedures may be involved in neuro-ophthalmology surgeries. Depending on the procedure type and personal factors, recovery from treatment procedures can also differ. Patients might need to use eye drops or other medications to help heal and manage symptoms, depending on the type of treatment. To get the most out of these meds, it's crucial to take them exactly as recommended. Any changes or concerns during the healing process should be communicated to the healthcare professional. This can lessen the chance of issues and assure the greatest results.
The results of neuro-ophthalmology treatment can vary depending on the specific condition being treated and the type of therapy used. In many cases, treatment can help individuals with neuro-ophthalmic disease see better. It might also mean minimizing eyesight loss or addressing visual abnormalities.
Neuro-ophthalmic conditions are often associated with underlying medical conditions such as multiple sclerosis or thyroid disease. Treatment can lessen the risk of additional difficulties, help control these underlying illnesses, and enhance general health.
1,4- WebMD. What is a Neuro-Ophthalmologist? (https://www.webmd.com/eye-health/what-is-neuro-ophthalmologist)
2,7- Michigan State University College of Osteopathic Medicine College of Human Medicine. Neuro-Ophthalmology. (https://neurology.msu.edu/patient-care/neuro-ophthamology)
3- University of Iowa Health Care. Neuro-Ophthalmology Special Tests. (https://medicine.uiowa.edu/eye/patient-care/clinics/neuro-ophthalmology/special-tests)
5- ScienceDirect. Neuro-Ophthalmic Complications of Raised Intracranial Pressure, Hydrocephalus, and Shunt Malfunction. (https://www.sciencedirect.com/science/article/pii/S1042368018301608)
6- National Library of Medicine. A Review of Neuro-Ophthalmological Manifestations of Human Coronavirus Infection (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7608548/)