What is a Neuro-Ophthalomologist?

Neuro-ophthalmologists take care of visual problems that are related to the nervous system; that is, visual problems that do not come from the eyes themselves. We use almost half of the brain for vision-related activities, including sight and moving the eyes. Neuro-ophthalmology, a subspecialty of both neurology and ophthalmology, requires specialized training and expertise in problems of the eye, brain, nerves, and muscles. Neuro-ophthalmologists complete at least 5 years of clinical training after medical school and are usually board certified in Neurology, Ophthalmology, or both.

Although some problems seen by neuro-ophthalmologists are not worrisome, other conditions can worsen and cause permanent visual loss, or become life threatening. Sometimes the problem is confined to the optic nerve or the nervous system and other times it is related to a general medical condition. Neuro-ophthalmologists have unique abilities to evaluate patients from the neurologic, ophthalmologic, and medical standpoints to diagnose and treat a wide variety of problems. Costly medical testing is often avoided by seeing a neuro-ophthalmologist.

Some of the common problems evaluated by neuro-ophthalmologists include: optic nerve problems (such as optic neuritis and ischemic optic neuropathy), visual field disturbances, double vision, abnormal eye movements, thyroid eye disease, myasthenia gravis, unequal pupil size, and eyelid abnormalities.

Preparing for the Neuro-Ophthalmology Evaluation

  • Request that your treating physicians send all relevant information to the neuro-ophthalmologist prior to your appointment, including office notes, results of lab tests and reports of CT and MRI scans.
  • If you have had a CT or MRI scan performed, arrange to pick up the actual films and bring them with you, or have the facility mail them to the neuro-ophthalmologist in advance of your appointment.
  • You may have your pupils dialated during the visit. The eye drops last about 4 hours and will make things look bright and blurry up close. You may also wish to bring your sunglasses. Please also bring any current glasses you wear for distance or reading.
  • Ladies, in order for the physician to get a good look at your eyelids, and to avoid ruining your appearance when the eye drops are administered, do not wear eye makeup.
  • Bring a complete list of medications with you, including the name and dosage of prescription and over-the-counter medications.

How does the procedure work?

  • The neuro-ophthalmologic evaluation is one of the most comprehensive examinations you will experience. It may take a few hours to complete. You will be asked to give an account of your current problem and relate your entire medical history, including previous hospitalizations, operations, serious illnesses, medical problems in your family members, and medication allergies.
  • You may have a partial or complete eye examination. This may include testing of your peripheral vision (visual field test).
  • You may have a partial or complete neurologic exam to test your strength, sensation, and coordination.
  • The neuro-ophthalmologist will review the records and scans from previous evaluations, if applicable.
  • After the examination, the neuro-ophthalmologist will discuss the diagnosis (or possible diagnoses), the need for any additional testing and possible treatment.