Neuro-Ophthalmology

Neuro-ophthalmology services treat conditions that are related to the nervous system. We use almost half of the brain for vision-related activities, including sight and moving the eyes.

Neuro-ophthalmology, a subspecialty of both neurology and ophthalmology, requires specialized training and expertise in problems of the eye, brain, nerves and muscles. Neuro-ophthalmologists complete at least five years of clinical training after medical school and are usually board certified in neurology, ophthalmology or both.

Although some problems seen by a neuro-ophthalmologist are not worrisome, other conditions can worsen and cause permanent visual loss, or become life threatening. Sometimes your problem is confined to the optic nerve or the nervous system and other times it is related to a general medical condition.

Neuro-ophthalmologists have unique abilities to evaluate you from the neurologic, ophthalmologic and medical standpoints to diagnose and treat a wide variety of problems.

Some of the common problems evaluated by neuro-ophthalmologists include:

• Optic nerve problems (optic neuritis and ischemic optic neuropathy)
  
• Visual field loss
  
• Unexplained visual loss
  
• Transient visual loss
  
• Visual disturbances
  
• Double vision
  
• Abnormal eye movements
  
• Thyroid eye disease
  
• Myasthenia gravis
  
• Unequal pupil size
  
• Eyelid abnormalities

How should I prepare for a neuro-ophthalmology evaluation?

• Request that your referring physicians send all relevant information to the neuro-ophthalmologist prior to your appointment, including office notes, results of laboratory tests and reports of CT and MRI scans.
  
• If you have had a CT or MRI scan performed, arrange to pick up the actual films and bring them with you.
  
• Have someone else drive you to the appointment and bring your sunglasses. You probably will have your pupils dilated during the visit. The eye drops last about four hours and will make things look bright and blurry up close.
  
• We recommend that eye make-up is not worn to the visit.
  
• Bring a complete list of medications with you, including the name and dosage of prescription and over-the-counter medications.

What will happen during an exam?

• The neuro-ophthalmologic evaluation may take a few hours to complete. You will be asked to give an account of your current problem and relate your entire medical history, including previous hospitalizations, operations, serious illnesses, medical problems in your family members and medication allergies.
  
• You will have a complete eye examination. This may include testing of your peripheral vision (visual field test).
  
• You may have a partial or complete neurologic exam to test your strength, sensation and coordination.
  
• The neuro-ophthalmologist will review the records and scans from previous evaluations, if applicable.
  
• After the examination, the neuro-ophthalmologist will discuss the diagnosis (or possible diagnoses), the need for any additional testing and possible treatment.