A neuro-ophthalmologist is a physician who has completed residency training in ophthalmology or neurology as well as  fellowship training in neuro-ophthalmology. This takes at least four or five years after graduation from medical school. It qualifies such a physician to treat visual problems related to the nervous system. He or she can evaluate you from the perspectives of neurology, ophthalmology, or general medicine, and can therefore treat a wide variety of conditions.

Patients are referred to a neuro-ophthalmologist from many different types of doctors including ophthalmologists, neurologists, neuro-surgeons, or endocrinologists. At Horizon Eye Care, we have two neuro-ophthalmologists on our staff and ready to serve you (see below).

Problems Evaluated by Neuro-Ophthalmologists

• Unequal pupil size
  

• Double vision
  

• Visual field loss

• Unexplained vision loss

• Thyroid eye disease
  

• Eyelid abnormalities

• Myasthenia gravis
  

• Optic nerve problems

• Visual disturbances

• Please request that the referring physician send all information relevant to your visit, including office notes, lab results and reports of any imaging studies such as CT or MRI.
  

• If you have had an MRI or CT of your head please bring copies of the scan with you, either on CD or film.
  

• Avoid wearing any eye makeup, as it can get into your eyes and may cause irritation.
  

• Bring a list of all your medications, with each drug’s name and dosage. Include any over-the-counter medications too, such as vitamins or supplements, painkillers, etc.
  

How the Visit Will Proceed

The exam is very comprehensive and may take several hours. Our neuro-ophthalmologist will ask you to discuss your symptoms and review your past medical history, allergies, and family history. You will have a complete eye examination and perhaps a visual field test to assess any loss of peripheral vision. Other tests may also be performed as the need arises.

There may be a neurological examination, partial or complete, to test your coordination, strength, and sensation. If there are any records or scans from previous evaluations, they will be reviewed.

At the end of the visit the neuro-ophthalmologist will discuss his or her findings and any diagnosis made. There is a possibility that more than one diagnosis will be considered and these will be discussed as well. They might recommend additional tests and possible treatment options will be explained. The neuro-ophthalmologist will send a letter to the referring doctor explaining the findings.

The neuro-ophthalmologist may need to refer you to another type of specialist depending on the exam findings. One of the eye conditions which is sometimes hard to diagnose, and may require an evaluation of a neuro-ophthalmologist is glaucoma. Glaucoma is a leading cause of blindness worldwide, and usually gives no early symptoms. Please see our Glaucoma page for more information.

Optic nerve sheath surgery

The optic nerve runs from the back of the eye (retina) to the brain’s vision center. It carries image information, converted by the retinal cells to electrical energy. The brain then interprets this energy and finds words to name or describe it. The optic nerve is covered by a non-flexible sheath of connective tissue.

There is fluid inside the spinal column which extends into the cranium. If something increases the pressure of this fluid, it can put stress on the optic nerve because the sheath is unable to stretch to accommodate the extra pressure. This can harm vision, unless the pressure is somehow reduced. A procedure we offer to achieve this reduction is called an optic nerve sheath fenestration.

A small opening, or window, is made in the sheath covering the optic nerve. This allows excess fluid to drain out and it becomes absorbed by the surrounding tissues. High pressure on the optic nerve is immediately relieved, which may restore lost vision or prevent future vision loss. This surgery can be performed on both adults and children.

Strabismus surgery

Strabismus is the condition where one eye is focused in a different direction from the other. The eyes are misaligned and while one is looking straight ahead, the other is turned outward, inward, up or down. This is a problem related to the eye’s muscles.

Each eye has six muscles outside it which move it side to side and up and down. If their relative strengths are not equal, strabismus occurs. Strabismus surgery is designed to weaken or strengthen specific muscles so as to equalize the strength on each side of the turned eye. A muscle that is too strong can be disconnected and reattached further back on the eye to weaken their effect. Alternatively, a weak muscle can be strengthened by either shortening it, or changing it's position on the eye.

In some cases an adjustable suture is used. This means your surgeon will tie a temporary knot in the operating room. When you are seen in the office the muscle position can then be changed to strengthen or weaken its function.

The final results of surgery will be evident after four to six weeks, although you can resume normal activities in a few days. Eye redness will subside in a couple of weeks.

Temporal artery biopsy

The temporal artery is a blood vessel which brings fresh blood upwards, in front of the ear, and branches across the head and face. Because it is near the skin, it is relatively easy to access it.

Sometimes blood vessels develop an inflammation (vasculitis), and when this affects the temporal artery, it is known as Temporal Arteritis or Giant Cell Arteritis. It can suddenly rob a person of their vision in one or both eyes. The inflammation can block the artery that supplies the optic nerve, reducing or stopping blood flow, which would starve the tissue normally nourished by the artery.

To diagnose the problem, a biopsy is done. In other words, a piece of the artery is taken out and studied in a laboratory. The incision is made near the hairline above the ear or in the forehead so the resulting scar will not be very visible. The forehead has very good collateral blood flow so removing this artery is not a problem. This artery does not supply blood to the eye so this procedure cannot cause vision loss. The procedure is generally very well tolerated and may be done in the office.

This biopsy should be done very promptly if Temporal Arteritis is suspected. Symptoms include scalp tenderness, pain in the jaw while chewing, sudden vision loss, double vision, fevers, weight loss and muscle aches.

Mark M. Malton, MD

Elizabeth R. Waller, MD

Adult Strabismus:

Stephen A. Daugherty, MD

Elizabeth R. Waller, MD

 
To learn more about your vision and eye health, please contact our office. We will be glad to give you a personal consultation and answer your questions clearly. We serve all of Charlotte, North Carolina.