Neuroophthalmology - Diseases of the Optic Nerve and the Visual Pathways

Lecture for General Medicine and Stomatology students

Neuro-ophthalmology is an academically-oriented subspecialty that merges the fields of neurology and ophthalmology, often dealing with complex systemic diseases that have manifestations in the visual system.                                                                               

 Neuro-ophthalmologists initially complete a residency in either neurology, neurosurgery, or ophthalmology, then do a fellowship in the complementary field. Since diagnostic studies can be normal in patients with significant neuro-ophthalmic disease, a detailed medical history and physical exam is essential, and neuro-ophthalmologists often spend a significant amount of time with their patients.
Common pathology referred to a neuro-ophthalmologist includes afferent visual system disorders (e.g. optic neuritis, optic neuropathy, papilledema, brain tumors or strokes) and efferent visual system disorders (e.g. anisocoria, diplopia, ophthalmoplegia, ptosis, nystagmus, blepharospasm, seizures of the eye or eye muscles, and hemifacial spasm). The largest international society of neuro-ophthalmologists is the North American Neuro-Ophthalmological Society (NANOS), which organizes an annual meeting and publishes the Journal of Neuro-Ophthalmology. Neuro-ophthalmologists are often faculty at large university-based medical centers. Patients often have co-existing diseases in other fields (rheumatology, endocrinology, oncology, cardiology, etc.), thus the neuro-ophthalmologist is often a liaison between the ophthalmology department and other departments in the medical center.
Neuro-ophthalmology has been affected more so than other specialties due to the complexity of the patients and the time required to do a neuro-ophthalmic history and physical exam. Additionally, the current medical reimbursement system rewards quantity of service (performing assembly line procedures) rather than quality of service (making a correct diagnosis, patient education, and counseling), and seeing complex patients is not adequately recognized.

Lecture deals with basic anatomy of the eye, orbit and optic nerve and pathways and continues to specific problems like optic neuritis, papilloedema etc. and gives students the basic knowledge important for pregradual students.


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