Neuro-ophthalmology is a subspecialty of ophthalmology that deals with the visual
pathways from the eye to the visual cortex of the brain. The optic nerves carry
the message of vision from the retina to the occipital cortex of the brain as an
electrical current. This pathway, if damaged, results in visual loss. Many processes
can affect this visual pathway.
If visual loss cannot be explained with a routine eye exam, it is often the job
of the neuro-ophthalmologist to determine if there is a problem with the nerves
and visual pathway behind the eye and within the brain. This is a challenging specialty
and unique within the domain of ophthalmology.
Neuro-ophthalmologists also diagnose and treat the diseases that affect the nerves
that control the eye muscles, eyelids and pupil. The University of Florida Eye Institute’s
neuro-ophthalmology clinic offers patients the latest treatments by a fellowship-trained,
Common conditions treated by neuro-ophthalmologists include:
- Double vision
- Eye movement disorders
- Eye-related migraines
- Myasthenia gravis
- Multiple sclerosis
- Optic neuritis (inflammation of the optic nerves)
- Papilledema (swollen optic nerves due to increased intracranial pressure)
- Pseudotumor cerebri
- Pupil abnormalities
- Thyroid eye disease
- Visual system neoplasia and tumors
Evaluation and Diagnosis
Evaluation includes a detailed history and physical examination. From this initial
examination, the neuro-ophthalmologist is often able to formulate a list of possible
diagnoses and may order additional testing aimed at identifying a specific disease
process or abnormality. Tests commonly ordered include:
- Cerebral angiography
- Electrophysiologic testing of the retina or optic nerve
- Laboratory blood studies
- Neuro-imaging (MRI or CT Scan)
- Ocular coherence tomography (OCT) and fundus photography
- Visual field testing
Frequently Asked Questions
What is papilledema?
Papilledema is a swollen optic nerve due to increased intracranial pressure. Optic
nerves can swell for several reasons, including increased pressure, inflammation,
infection, trauma and tumors/neoplasia. It is the responsibility of the neuro-ophthalmologist
to determine the cause of the swollen optic nerve.
Why does multiple sclerosis cause visual loss?
Multiple sclerosis is a poorly understood disease that causes inflammation of the
central nervous system. Since the eyes and visual pathways are part of the central
nervous system, they are at risk for problems associated with multiple sclerosis.
What is an optic neuropathy?
An optic neuropathy is damage to an optic nerve from a disease process. A variety
of processes can damage the optic nerves, such as genetic or congenital defects,
trauma, inflammation, infection and cancers. Depending on the process affecting
the optic nerve, treatment options may be available to save vision. If no treatment
options are available, it is still useful to understand the diagnosis or cause of
nerve damage so that a visual prognosis can be determined.