Neuro-Ophthalmology

Neuro-ophthalmology is a medical subspecialty that merges neurology and ophthalmology. Neuro-ophthalmologists specialize in conditions that cause vision disruptions due to neurological disorders caused by genes, injury, infection or illness. Neuro-ophthalmologists are board-certified in both neurology and ophthalmology, and therefore qualified to diagnose and treat neurological problems that impact the eyes and visual system.

What Conditions Do Neuro-Ophthalmologists Treat?

There are many conditions that require in-depth knowledge of the eyes and the visual and nervous systems. The most common are:

• Vision loss – due to a stroke, head injury or cranial infections and inflammation
• Double vision, eye turns or lazy eye – due to reduced function of the ocular nerves
• Brain [tumors] that impact the vision or eye health
• Optic neuritis – inflammation of the optic nerve
• Papilledema – optic nerve swelling
• Nerve palsies that affect the facial or eye muscles
• Irregular eye movements – resulting from strabismus or nystagmus
• Ptosis – drooping eyelids
• Eyelid disorders – from damage to nerves
• Involuntary eye twitching or blinking caused by blepharospasm
• Thyroid eye disease
• Optic atrophy – thinning of the optic nerve fibers
• Myasthenia gravis – a chronic autoimmune disorder that damages the communication between the nerves and muscles of the eye

What to Expect from a Neuro-Ophthalmology Exam

A neuro-ophthalmology exam is a comprehensive assessment of both the patient’s ocular and nerve health. Specific tests may include electroretinography, optical coherence tomography, and multi-focal EGRs. Patients should be prepared to provide medical history and documentation, including:

• Up-to-date eyeglass or contact lens prescription
• Relevant medical records
• Results from recent eye exams, MRIs and CT scans (if required)
• A list of current medications
• Family medical history

The neuro-ophthalmologist will administer any or all of the following tests:

Mental Status Evaluation

The neuro-ophthalmologist will typically begin the session by asking a few simple questions. If the patient does not respond or seems confused, the eye doctor may administer a MMSE or mini-mental status exam to assess the brain’s functioning and cognitive skills, such as language, memory and orientation.

Cranial Nerve Tests

Cranial nerves connect the brain to the rest of the body. In particular, the 3rd, 4th and 6th cranial nerves control the functioning of the eyes and visual system. Malfunctioning of any of these cranial nerves can indicate a problem in the brain and help pinpoint the affected region.

Motor Reflex and Coordination Tests

The neuro-ophthalmologist will perform a range of tests to examine the health and functioning of nerves in various parts of the body by asking the patient to perform simple activities like touching their own nose repeatedly. These tests also look for tremors, tics or weakness in the muscles that could be signs of a neurological problem.

General Sensory Evaluation

To get a sense of overall neurological health, the neuro-ophthalmologist will assess how well the patient detects and responds to pressure, touch and other stimuli.

Eye Health Exam

To assess eye health, you’ll likely have your eyes dilated during your visit, so you should have someone come with you who can drive you home.

The neuro-ophthalmologist’s eye exam may include:

• Visual acuity and eye movement assessment
• Color vision and visual field assessment
• An external and internal eye exam
• Digital imaging of the eye
• Measurement of eye pressure
• Neurological exam of nerves of the eyes and face

A complete neuro-ophthalmology exam may take up to a few hours.

When to Schedule an Appointment with a Neuro-Ophthalmologist

Patients are often referred to a neuro-ophthalmologist by their eye doctor when there appears to be an underlying neurological cause of their vision problems. Patients with ocular neurological problems may experience a variety of symptoms, including:

• Eye strain, headaches or migraines
• Eye turn or blurry vision
• Reading or attention problems
• Difficulty moving the eyes
• Involuntary eye movements
• Pressure in the eyes or head
• Uneven pupils
• Double vision
• Droopy eyelids
• Facial distortion

If you have any of the above-mentioned symptoms, or any other visual problem due to damage to the nerves or brain, you may require a neuro-ophthalmology examination. Speak to Opthalmology Doctor Name at Opthalmology Practice Name in LOCATION1 to see if you need an appointment with a neuro-ophthalmologist.

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