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Neuro-ophthalmology

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Neuro-ophthalmology

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 or ophthalmology, then do a fellowship in the complementary field. Since diagnostic studies can be normal in patients with significant neuro-ophthalmic disease,[1] 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. university-based medical centers. Patients often have co-existing disease 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.[3]

Contents

  • Description 1
  • Notable neuro-ophthalmologists 2
  • The future of neuro-ophthalmology 3
  • References 4
  • External links 5

Description

Neuro-ophthalmology focuses on diseases of the nervous system that affect vision, control of eye movements, or pupillary reflexes. Neuro-ophthalmologists often see patients with complex multi-system disease and “zebras” are not uncommon. Neuro-ophthalmologists are often active teachers in their academic institution, and the first four winners of the prestigious Straatsma American Academy of Ophthalmology teaching awards were neuro-ophthalmologists.[4] Most neuro-ophthalmologists are passionate about their discipline and report high job satisfaction, stating that they think the field continues to be both fascinating and challenging. Neuro-ophthalmology is mostly non-procedural, however, neuro-ophthalmologists may be trained to perform eye muscle surgery to treat adult strabismus, optic nerve fenestration for idiopathic intracranial hypertension, and botulinum injections for blepharospasm or hemifacial spasm.

Two neuro-ophthalmology fellows of Andrew G. Lee published reasons why they chose to pursue the discipline:[5]

Notable neuro-ophthalmologists

Frank B. Walsh was one a pioneer of neuro-ophthalmology, helping to popularize and develop the field. Walsh was born in

  • The Neuro-Ophthalmology Virtual Education Library (NOVEL)

External links

  1. ^ a b Lessell, S (Apr 2000). "What can we expect in neuro-ophthalmology in the next century?". Archives of ophthalmology 118 (4): 553–4.  
  2. ^ "North American Neuro-Ophthalmology Society". North American Neuro-Ophthalmology Society Home Page. Retrieved 28 September 2014. 
  3. ^ McDonnell, Peter (11/1/2004). "Is neuro-ophthalmology in jeopardy?". Ophthalmology Times 29 (21): 4. 
  4. ^ a b Frohman, LP (Sep 2008). "The human resource crisis in neuro-ophthalmology.". Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society 28 (3): 231–4.  
  5. ^ Spitze, A; Al-Zubidi, N; Lam, P; Yalamanchili, S; Lee, AG (October 2014). "Neuro-ophthalmology as a career.". Indian journal of ophthalmology 62 (10): 1013–4.  
  6. ^ Angelucci, Diane. "Groundbreaking neuro-ophthalmologist honored". EyeWorld. Retrieved 28 September 2014. 
  7. ^ Newman, SA (Jun 2012). "Interventional neuro-ophthalmology: not an oxymoron.". Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society 32 (2): 177–84.  
  8. ^ Lam, BL; Feuer, WJ; Schiffman, JC; Porciatti, V; Vandenbroucke, R; Rosa, PR; Gregori, G; Guy, J (Apr 1, 2014). "Trial end points and natural history in patients with G11778A Leber hereditary optic neuropathy : preparation for gene therapy clinical trial.". JAMA ophthalmology 132 (4): 428–36.  
  9. ^ Watanabe, M; Fukuda, Y (Nov 2002). "Survival and axonal regeneration of retinal ganglion cells in adult cats.". Progress in retinal and eye research 21 (6): 529–53.  
  10. ^ Xia, Y; Nawy, S; Carroll, RC (Nov 7, 2007). "Activity-dependent synaptic plasticity in retinal ganglion cells.". The Journal of neuroscience : the official journal of the Society for Neuroscience 27 (45): 12221–9.  
  11. ^ "NEI Audacious Goal Initiative". National Eye Institute. Retrieved 28 September 2014. 

References

The financial environment for academic neuro-ophthalmologists must be addressed so that there is the clinical infrastructure to treat patients, assess and implement emerging technologies and treatments, and train the next generation of neuro-ophthalmologists. Given the direction of ophthalmic and neurologic research, it is imperative to continue to have a vibrant academic neuro-ophthalmologic community for the future.

Improved functional neuroimaging is paving the way for better understanding, assessment, and management of many neurologic and neuro-ophthalmologic conditions. As our understanding of neuroscience evolves, neuro-ophthalmologists are becoming increasingly better at treatment, rather than only diagnosis, and novel therapies are emerging to treat traditionally vision-devastating disease.[7] For example, clinical trials began in February 2014 to use gene therapy to treat Leber hereditary optic neuropathy,[8] which is one of the first uses of gene therapy in the central nervous system. Progress has also been made in understanding retinal ganglion cell regeneration and in re-establishing synaptic connections from the optic nerve to the brain,[1] more than in other regions of the central nervous system.[9][10] One of the goals of the National Institutes of Health is to use the visual system as a window to understand neural plasticity and regenerative medicine in the central nervous system,[11] an area of neuroscience that has a promising future and is intimately intertwined with neuro-ophthalmology.

Doctors have been decreasing the time spent with a patient due to economic pressures, the use of nonphysicians, and increasing reliance on laboratory tests. 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.[4] 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.

The future of neuro-ophthalmology

[6]

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