Neuro-Ophthalmology

What is Neuro-Ophthalmology?

Neuro-ophthalmology is an ophthalmic subspecialty that addresses the relationship between the eye and the brain, specifically disorders of the optic nerve, orbit, and brain, associated with visual symptoms. Today, neuro-ophthalmologists provide comprehensive clinical care to a broad spectrum of patients with visual disturbance from optic nerve diseases, central nervous system disorders, ocular motility dysfunction, and pupillary abnormalities.

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What are the common symptoms of neuro-ophthalmic diseases?

Symptoms that are more common in neuro-ophthalmic disease include:

• visual loss
• visual disturbance
• diplopia
• unequal pupils
• eyelid and facial spasms

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What are the common types of neuro-ophthalmic diseases?

Numerous disorders are considered to be in the realm of neuro-ophthalmology and are evaluated by the neuro-ophthalmology service. A partial list of the most common neuro-ophthalmic conditions are listed below:

• optic neuritis
• ischemic optic neuropathy (including temporal arteritis)
• compressive optic neuropathy (including pituitary tumors)
• papilledema (including pseudotumor cerebri)
• inflammatory and infectious optic neuropathies
• cerebrovascular disorder involving vision
• tumors involving vision
• blephrospasm (including botulinum injections)
• hemifacial spasm (including botulinum injections)
• thyroid eye disease
• myasthenia gravis
• ocular motor disorders (including cranial nerve palsies)
• pupillary abnormalities
• paraneoplastic disorders (including paraneoplastic retinopathies and optic neuropathies)
• hereditary optic neuropathies

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What is involved in a neuro-ophthalmic evaluation at Bascom Palmer Eye Institute?

The neuro-ophthalmology service at Bascom Palmer treats nearly 4,000 patients with neuro-ophthalmic disorders. A thorough medical history is first taken followed by a comprehensive neuro-ophthalmic examination. Depending on the nature of the condition, necessary diagnostic procedures are performed followed by a discussion with the patient about the condition and treatment options.

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What are the diagnostic services available at Bascom Palmer Eye Institute?

Numerous diagnostic services are directly available including:

• visual fields, fundus photography
• MRI / MRA
• CT scan
• ultrasound - orbital and optic nerve
• electrophysiology tests (including ERG, EOG, VEP, multifocal ERG)
• cerebral angiography
• carotid doppler
• optical coherence tomography (OCT)
• hematological laboratory

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What neuro-ophthalmic treatments are available at Bascom Palmer Eye Institute?

Bascom Palmer Eye Institute offers comprehensive neuro-ophthalmic therapeutic procedures and services for the broad range of neuro-ophthalmic diseases and disorders. One of the more recent therapies is Vision Restoration Therapy (VRT). VRT is a non-invasive, computerized treatment that can help restore vision lost as a result of stroke or traumatic brain injury (TBI), a condition previously considered untreatable. NovaVision VRT—cleared by the U.S. Food and Drug Administration in 2003 is available to patients at Bascom Palmer Eye Institute.

“Until now, there has been no previous therapy to help improve visual impairment caused by stroke or traumatic brain injury,” said Bascom Palmer Eye Institute Neuro-Ophthalmologist Dr. Byron Lam. “Existing studies indicate that VRT may help stroke victims improve their field of vision by up to 20 degrees. For patients, this type of visual field improvement may give some patients the ability to read.”

VRT is conducted in the comfort of the patient’s home with the use of a computerized device. The patient performs a customized therapy which displays stimuli on the screen in the area identified during diagnostic that shows potential for recovery. The patient responds to each stimulus while focusing on the fixation point displayed. Repeated exposure to these stimuli over an initial treatment period of approximately six months activates neurons and helps improve vision, with some patients showing improvements within a couple months of beginning therapy.

While speech, physical and occupational therapy are the long-standing, mainstream treatment regimens for victims of stroke and brain trauma, VRT is the first clinical application of rehabilitation for vision loss. Like these traditional pillars of rehabilitation, VRT enables stroke and TBI patients to restore an area of function that can dramatically improve their quality of life.

Additional therapeutic procedures and services available include:

• inpatient medical treatment
• prism treatment with optical shop
• optic nerve sheath decompression
• orbital decompression (including for thyroid eye disease)
• botulinum injections for blepharospasm and hemifacial spasm
• temporal artery biopsy
• neurosurgical intervention
• interventional radiologic treatment of cerebrovascular lesions

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Frequently Asked Questions

What medical records and test results should I bring to my neuro-ophthalmic appointment?

Bringing medical records and actual MRI and CT scans to the appointment is extremely helpful in the evaluation of your condition. This will also reduce the likelihood of repeating previously performed tests.

How much time should I expect to be at Bascom Palmer during my neuro-ophthalmic evaluation?

Depending on the complexity of your condition, plan on spending at least half a day. In most cases, diagnostic services can be performed on the same day.

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Who are the neuro-ophthalmic specialists at Bascom Palmer Eye Institute?

Joel S. Glaser, M.D.
John R. Guy, M.D.
Byron Lam, M.D.
Joshua Pasol, M.D.
Norman Schatz, M.D.

What about neuro-ophthalmology research?

The neuro-ophthalmology service at Bascom Palmer Eye Institute participates in a number of research activities including clinical neuro-ophthalmology studies, electrophysiology studies, and pharmaceutical studies. The neuro-ophthalmology specialists also participate in several multicenter studies.

Other Neuro-Ophthalmology Resources

American Academy of Ophthalmology
Eye Resources on the Internet
National Eye Institute
North American Neuro-Ophthalmology Society

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