Neuro-ophthalmology
Encyclopedia
Neuro-ophthalmology is the subspecialty of both neurology
and ophthalmology
concerning visual
problems that are related to the nervous system
http://www.nanosweb.org/patient_info/whatisano.htm.
A neuro-ophthalmologist is a physician (neurologist
or ophthalmologist) specializing in diseases affecting vision
that originate from the nervous system
.
Some commonly seen diseases that a neuro-ophthalmologist may see include optic neuritis
, optic neuropathy
, papilledema
, ocular myasthenia gravis
, brain tumors or stroke
affecting vision, idiopathic intracranial hypertension
, unexplained visual loss, headaches
, diplopia
, blepharospasm
or hemifacial spasm
. Some surgical neuro-ophthalmologist may treat strabismus and perform eye muscle surgeries or optic nerve fenestration surgery for the treatment of idiopathic intracranial hypertension (pseudotumor cerebri]. Other neuro-ophthalmologist may treat blephrospam or hemifacial spasm using botulinum toxin injections. Neuro-ophthalmologists are medical doctors who initially specialize in either neurology, ophthalmology, or both, then do subspecialty training, through fellowships, in the complementary field. They are usually full-time faculty at large university-based medical centers, where they also do research and teach but may be engaged in private practice. Their referrals may come from neurologists, ophthalmologists, endocrinologists, neurosurgeons and cardiologists. Neuro-ophthalmologists typically attend to diseases of the afferent visual system (most often involving the optic nerve), the efferent visual system (that controls eye movements), or the pupillary reflexes.
The largest international society of neuro-ophthalmologists is the North American Neuro-Ophthalmological Society (NANOS), which organizes an annual meeting and publish the specialized Journal of Neuro-Ophthalmology. It is estimated that the United States requires at least ten to fourteen new neuro-ophthalmology graduates a year. However, approximately five ophthalmology residents enter the field of neuro-ophthalmology per year. This has been attributed to decreased compensation in neuro-ophthalmology as an ophthalmic subspecialty. Only the most complex and difficult cases get referred to neuro-ophthalmology. Hence, a neuro-ophthalmic visit requires an intensive work-up and time commitment which is not recognized in the current climate of medical reimbursements. Other suggested reasons for a decline in neuro-ophthalmology sub-specialists include the difficulty of the specialty, time involved in practicing, and the perception that jobs in the field are lacking. [1] Combining subspecialty fellowship training programs such that highly procedural fields are combined with more cerebral specialties such as occuloplastics with neuro-ophthalmology or uveitis with retina, have been proposed as solutions to this disparity. However, this may limit mastery in one discipline. It is important that residency training programs emphasize “endangered” fields such as neuro-ophthalmology, uveitis and pediatrics with early exposure, and commit to training residents with an interest in these fields. [2]
Neurology
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...
and ophthalmology
Ophthalmology
Ophthalmology is the branch of medicine that deals with the anatomy, physiology and diseases of the eye. An ophthalmologist is a specialist in medical and surgical eye problems...
concerning visual
Visual perception
Visual perception is the ability to interpret information and surroundings from the effects of visible light reaching the eye. The resulting perception is also known as eyesight, sight, or vision...
problems that are related to the nervous system
Nervous system
The nervous system is an organ system containing a network of specialized cells called neurons that coordinate the actions of an animal and transmit signals between different parts of its body. In most animals the nervous system consists of two parts, central and peripheral. The central nervous...
http://www.nanosweb.org/patient_info/whatisano.htm.
A neuro-ophthalmologist is a physician (neurologist
Neurologist
A neurologist is a physician who specializes in neurology, and is trained to investigate, or diagnose and treat neurological disorders.Neurology is the medical specialty related to the human nervous system. The nervous system encompasses the brain, spinal cord, and peripheral nerves. A specialist...
or ophthalmologist) specializing in diseases affecting vision
Visual perception
Visual perception is the ability to interpret information and surroundings from the effects of visible light reaching the eye. The resulting perception is also known as eyesight, sight, or vision...
that originate from the nervous system
Nervous system
The nervous system is an organ system containing a network of specialized cells called neurons that coordinate the actions of an animal and transmit signals between different parts of its body. In most animals the nervous system consists of two parts, central and peripheral. The central nervous...
.
Some commonly seen diseases that a neuro-ophthalmologist may see include optic neuritis
Optic neuritis
Optic neuritis is the inflammation of the optic nerve that may cause a complete or partial loss of vision.-Causes:The optic nerve comprises axons that emerge from the retina of the eye and carry visual information to the primary visual nuclei, most of which is relayed to the occipital cortex of the...
, optic neuropathy
Optic neuropathy
The optic nerve contains axons of nerve cells that emerge from the retina, leave the eye at the optic disc, and go to the visual cortex where input from the eye is processed into vision. There are 1.2 million optic nerve fibers that derive from the retinal ganglion cells of the inner retina. Optic...
, papilledema
Papilledema
Papilledema is optic disc swelling that is caused by increased intracranial pressure. The swelling is usually bilateral and can occur over a period of hours to weeks. Unilateral presentation is extremely rare....
, ocular myasthenia gravis
Myasthenia gravis
Myasthenia gravis is an autoimmune neuromuscular disease leading to fluctuating muscle weakness and fatiguability...
, brain tumors or stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
affecting vision, idiopathic intracranial hypertension
Idiopathic intracranial hypertension
Idiopathic intracranial hypertension , sometimes called by the older names benign intracranial hypertension or pseudotumor cerebri , is a neurological disorder that is characterized by increased intracranial pressure in the absence of a tumor or other diseases...
, unexplained visual loss, headaches
Headache
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...
, diplopia
Diplopia
Diplopia, commonly known as double vision, is the simultaneous perception of two images of a single object that may be displaced horizontally, vertically, or diagonally in relation to each other...
, blepharospasm
Blepharospasm
A blepharospasm , is any abnormal contraction or twitch of the eyelid....
or hemifacial spasm
Hemifacial spasm
Hemifacial spasm or HFS is a neurological disorder in which blood vessels constrict the seventh cranial nerve and cause varying degrees of facial spasm, typically originating around the eye of the afflicted side of the face...
. Some surgical neuro-ophthalmologist may treat strabismus and perform eye muscle surgeries or optic nerve fenestration surgery for the treatment of idiopathic intracranial hypertension (pseudotumor cerebri]. Other neuro-ophthalmologist may treat blephrospam or hemifacial spasm using botulinum toxin injections. Neuro-ophthalmologists are medical doctors who initially specialize in either neurology, ophthalmology, or both, then do subspecialty training, through fellowships, in the complementary field. They are usually full-time faculty at large university-based medical centers, where they also do research and teach but may be engaged in private practice. Their referrals may come from neurologists, ophthalmologists, endocrinologists, neurosurgeons and cardiologists. Neuro-ophthalmologists typically attend to diseases of the afferent visual system (most often involving the optic nerve), the efferent visual system (that controls eye movements), or the pupillary reflexes.
The largest international society of neuro-ophthalmologists is the North American Neuro-Ophthalmological Society (NANOS), which organizes an annual meeting and publish the specialized Journal of Neuro-Ophthalmology. It is estimated that the United States requires at least ten to fourteen new neuro-ophthalmology graduates a year. However, approximately five ophthalmology residents enter the field of neuro-ophthalmology per year. This has been attributed to decreased compensation in neuro-ophthalmology as an ophthalmic subspecialty. Only the most complex and difficult cases get referred to neuro-ophthalmology. Hence, a neuro-ophthalmic visit requires an intensive work-up and time commitment which is not recognized in the current climate of medical reimbursements. Other suggested reasons for a decline in neuro-ophthalmology sub-specialists include the difficulty of the specialty, time involved in practicing, and the perception that jobs in the field are lacking. [1] Combining subspecialty fellowship training programs such that highly procedural fields are combined with more cerebral specialties such as occuloplastics with neuro-ophthalmology or uveitis with retina, have been proposed as solutions to this disparity. However, this may limit mastery in one discipline. It is important that residency training programs emphasize “endangered” fields such as neuro-ophthalmology, uveitis and pediatrics with early exposure, and commit to training residents with an interest in these fields. [2]