Neuro-Ophthalmology

A neuro-ophthalmologist is a doctor who specializes in visual problems that relate to the nervous system. This includes loss of sight due to injury to the brain or the optic nerves which transmits visual signals from the eyes to the brain. Such injury can be caused by trauma, inflammation, strokes, tumors, toxicities and infections.

The neuro-ophthalmologist also sees patients who have problems controlling eye movement, which may result in difficulty looking in certain directions, or double vision due to misalignment. This misalignment, which is also called strabismus, can sometimes be treated with prism lenses or in some cases with surgical procedures.

Weill Cornell Eye Associates offers comprehensive neuro-ophthalmology services by physicians who have neurological as well as ophthalmological expertise and have completed a neuro-ophthalmology fellowship. Up to date diagnostic equipment and state of the art facilities complement our caring staff, who recognize that patients with neuro-ophthalmological problems require communication and counseling along with comprehensive clinical services.

Typical disorders we treat:

  • Optic Nerve Disease
  • Vision Loss
  • Visual Field Loss due to Tumor or Stroke
  • Double Vision or Ocular Motility Dysfunction in association with Diseases of the Nervous System
  • Papilledema
  • Intracranial Hypertension
  • Nystagmus
  • Disorders of the Lids and Pupils

For more information on any of the above conditions and disorders, please visit geteyesmart.org, the official eye health information website from the American Academy of Ophthalmology

Which patients should be seen by a neuro-ophthalmologist?

Patients who have any loss of visual acuity, visual field or color vision due to a problem with the brain or optic nerves.

Patients who have or are suspected to have high intracranial pressure (pressure in the head) should see the neuro-ophthalmologist because this increased pressure can cause optic nerve swelling and loss of vision.

Patients who have problems moving their eyes or double vision due to misalignment should be seen by a neuro-ophthalmologist. Such a problem may result from injury to the brain centers, nerves or muscles that control eye movements or from a nerve transmission problem called myasthenia gravis.

Patients who have tumors of the pituitary gland or other tumors that may compress the vision pathways may be referred to a neuro-ophthalmologist to make sure there is no loss of visual fields, even when they are not aware of any vision problems. This is particularly important prior to and after operations to remove these tumors.

Patients who have unequal pupils are evaluated by neuro-ophthalmology. A sudden change in pupil size may reflect a serious underlying condition and should be seen emergently.

Patients with involuntary shaking of the eyes (nystagmus).

Botulinum toxin therapy (Botox®) is available for patients diagnosed with blepharospasm or hemifacial spasm.

What takes place during a neuro-ophthalmology examination?

The neuro-ophthalmology exam begins with a careful history of the patient's problem and a review of any neurological or medical problems that could be relevant. This is followed by an evaluation of the patient's vision and eye movements and typically includes testing of the visual acuity, color vision and visual fields. The eye will be examined under the microscope (slit lamp) with special attention paid to the optic nerve and retina in the back of the eye. In most cases, dilating drops will be administered to allow easy viewing of these important structures. The pressure and size of each eye may be checked as well. Eye movements will be evaluated, which may include the use of prism lenses and special charts. In cases of unequal pupils, certain drops may be administered which help identify the cause of the problem. Visual field testing is conducted at a machine which displays lights in various parts of the visual world while the patient presses a button to acknowledge each light. In this way, patterns of visual field loss may emerge that can help lead to a diagnosis.

Finally, the neuro-ophthalmologist will sit down with the patient and discuss their condition and any treatments or management strategies that may be offered.

What should you bring to your neuro-ophthalmological examination?

    You should bring:
  • Your glasses and a copy of your prescription if you have it.
  • A referral from your referring physician with the specific reason for the visit.
  • Any relevant prior medical records including radiology reports.
  • A CD or films of any MRI or CT of the brain or eyes that was done previously so that we can personally review the images.

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