Neuro-ophthalmology is the specialty that is concerned with visual symptoms
resulting from brain diseases. The visual symptoms can be divided into visual
loss, or problems with eye movements. Visual loss may result from problems
within the optic nerve or its connections to the visual portions of the brain.
The eye is like a camera, and images are focused on the retina. The optic nerve
is the cable that takes these images to the brain. There are several parts
of the brain that are involved with precise control of eye movements. Difficulty
within these regions often produces misalignment of the eyes with resultant
double vision. Any of several processes may affect the optic nerve or its connections,
including strokes, inflammation, multiple sclerosis or tumors.
Neuro-ophthalmologists are physicians involved in the field of neuro-ophthalmology.
Neuro-ophthalmologists have completed medical school, and either a neurology
or ophthalmology residency, followed by a neuro-ophthalmology fellowship.
Causes of Vision Loss
Visual loss may result from a problem within the eye or its connections to
the brain. Blurred vision in one eye may be the result of a lens problem (glasses),
cataract or other opacities blocking light’s entrance, a retinal problem,
optic nerve disease or a lazy eye (amblyopia).
Causes of Double Vision (diplopia)
Double vision may be divided into two general categories: monocular or binocular.
Monocular double vision affects one eye at a time. If the unaffected eye is
closed, the double vision persists. Monocular double vision results from eye
disease, usually a lens problem or cataract changes. Binocular double vision
is only present when both eyes are open and goes away when either eye is closed.
Binocular double vision results from misalignment of the eyes. When the eyes
are pointed in different directions, the brain perceives two separate images
(one from each eye).
The eyes are kept aligned by the muscles that control eye movements,
which in turn are controlled by three nerves from the brain. Misalignment (causing
binocular double vision) is most commonly due to a problem with one of three
areas: the nerves that connect to the eye muscles, the connection between the
nerves and the eye muscles, or the eye muscles themselves. There are several
things that can affect the nerves going to the eye muscles including strokes
or tumors pressing on the nerves. The most common disease to affect the connection
between the nerves and eye muscles is myasthenia gravis. There are several
muscle diseases that may affect the eye muscles.
Diseases Treated by a Neuro-Ophthalmologist
Pseudotumor cerebri (PTC) is a disease primarily of young females. For
reasons that are not understood, obesity appears to play a role in the disease.
PTC results in elevated pressure inside the head (elevated intracranial pressure).
This pressure typically produces headaches and swelling of the optic nerve
heads. The swelling of the optic nerve heads may result in visual loss, and
this is the most feared complication of the disease. The disease is diagnosed
by excluding other causes of elevated pressure within the head through imaging
(CAT/CT scan or magnetic resonance imaging) and lumbar puncture (spinal tap).
Treatment begins with weight loss when appropriate, and may also include
diuretics or surgery if medical means fail.
Optic neuritis refers to inflammation of the optic nerve. Optic neuritis
typically produces blurred vision in one eye with pain or discomfort around
the eye. The visual blur progresses over the first week, then stabilizes for
several weeks before spontaneous improvement in most cases. Most patients regain
vision of 20/40 (within three lines of 20/20 vision) by six months. The exam
can help localize the blur to the optic nerve. Optic neuritis may occur without
other disease, or can be associated with systemic diseases, such as multiple
sclerosis (MS). Evaluation often includes an MRI scan to rule out other causes
of optic nerve dysfunction, and to look for other evidence of MS. Treatment
may include steroids (intravenous Solu-Medrol followed by oral prednisone),
which increases the rate of recovery of vision.
What to expect from your first visit to a neuro-ophthalmologist
When your referring physician contacts our office, an appointment will be
set up for you with the appropriate provider in our office. If the appointment
day/time that we have set for you does not fit with your schedule, you may
contact our office directly and change the appointment, but please understand
that a cancellation may result in a substantial delay in your being seen and
treated (we are often booking three months or more in advance)
We will mail to your home a set of directions, instructions and a questionnaire.
We ask that you review all of these materials and complete the questionnaire
and bring it with you to your office visit. If you do not receive these materials,
please contact our office and we will get the packet to you. You will need
to be certain that all relevant medical records have been forwarded to us directly
or you may hand carry them when you come to your appointment. We will need
to see the films of any MRI's or CT scans you have had done as well as reports
in order to properly evaluate you, so please bring the films with you or arrange
to have them sent prior to your appointment.
If you are new to the Clinical Center, you will be asked to arrive 30
minutes prior to your appointment in order to register at New Patient Registration
on the first floor of the Clinical Center. There you will be asked to provide
your insurance information and identification, and a clinical chart will be
made for you. You can then come up to our office in Suite A217 and check in
at the registration window. We will collect your chart, questionnaire and medical
records and confirm your insurance information.
Please note that the patient is ultimately responsible for obtaining
the proper insurance authorizations prior to arrival at the appointment. If
your visit is not authorized appropriately your appointment may be rescheduled
(resulting in long delays in being seen) or you will be asked to pay for your
visit, and then you can seek reimbursement from your insurance carrier.
You will be seen initially by a clinical fellow or staff member who will
obtain a medical history with you, confirm the questionnaire and evaluate your
visual function. Your pupils will be dilated at your first and perhaps subsequent
visits. If you are unable to drive safely while dilated, please bring a driver
with you. As you will probably still be dilated when you leave our office,
you may be more comfortable if you bring with you a pair of sunglasses. If
corrective lenses have been prescribed for you, whether or not you typically
wear them, please bring them to your visit. If you wear contact lenses, please
bring your contacts case with you and a pair of glasses if you have them.
Your examination will be tailored to your specific complaint but will
likely include a visual field evaluation, examination of the structures of
the eye itself, evaluation of your visual function, and inspection of your
retina and optic nerve.
After your examination, the examiner will leave the room to discuss your
case with the attending physician (Dr. Kaufman, Dr. Eggenberger or Dr. Yedavally).
Your doctor will then come into the room and confirm certain aspects of your
exam and history and will discuss with you his/her impressions and recommendations
for your condition. You will have the opportunity to ask questions and together
you and he/she will develop a treatment strategy. After your discussion with
the doctor, you will be directed to the reception desk where the tests/evaluations
your doctor has suggested will be scheduled. If your insurance prohibits our
office from scheduling these evaluations, we will contact your primary care
physician and request that he/she carry out the "plan" which may
include MRI, lab work, Dopplers, cardiac testing and/or evaluation with other
Our evaluations are very extensive and thorough. If this is your first
evaluation, please plan to be here at least 3 hours (perhaps as long as 4 hours)
so that we may properly assess your problem.
Additional information can be found on these websites: