What Does a Neuro-Ophthalmologist Do?
Neuro-ophthalmologists specialize in diagnosing and treating visual problems related to the nervous system, including loss of central or peripheral vision, pupil changes, eye movement disorders, and optic nerve disorders. These problems aren’t caused by issues with the eyes themselves, but instead by issues with the brain, nerves, and muscles.
What Neuro-Ophthalmology Conditions Do We Treat?
We treat a full range of neuro-ophthalmology conditions, including:
- Anisocoria — Pupils of different sizes caused by various brain and eye conditions.
- Cranial nerve palsy — Paralysis of one of the cranial nerves that controls facial and eye movement or your ability to hear, see, smell, and taste.
- Diplopia (double vision) — A condition that occurs when the eyes are out of alignment and coordination relative to one another and resolves when one eye is covered. Monocular diplopia, or double vision in one eye, is usually not neurologic.
- Homonymous hemianopia — Causes visual field loss on the same side in both eyes.
- Ischemic optic neuropathy — Causes vision loss due to low blood flow to the optic nerve.
- Myasthenia gravis — An autoimmune condition often affecting the eyelids and eye muscles, causing drooping of eyelids and/or double vision.
- Nystagmus — Causes involuntary, repetitive movements of the eyeballs that often accompany other brain problems.
- Optic disc drusen — Benign clumps of proteins that collect and harden inside the optic disc, the front portion of your optic nerve, which connects each eye to your brain.
- Optic nerve or chiasmal glioma — Tumors that grow on or near the optic nerve.
- Optic neuritis — A condition involving loss of central vision due to an inflamed optic nerve, often related to multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), or myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).
- Orbital or brain tumor — An abnormal growth that develops in the cavity around your eye or in your brain.
- Pituitary tumor — An abnormal growth on your pituitary gland that can cause hormonal imbalances and other symptoms, including serious vision loss and peripheral visual field loss, if left untreated.
- Pseudotumor cerebri — Also called idiopathic intracranial hypertension (IIH), this condition occurs when there is elevated spinal fluid pressure in the head, causing headaches and vision loss.
- Stroke — Causes problems with brain function that may result in loss of peripheral vision, nystagmus, eye, facial, or limb muscle weakness, or eye misalignment.
- Temporal arteritis — A condition that causes inflammation in the arteries, leading to blindness in both eyes if not promptly diagnosed and treated.
Who’s Eligible for Neuro-Ophthalmology Care?
You may be eligible for neuro-ophthalmology care if you have a neurological disorder that affects your vision.
What Neuro-Ophthalmology Services Do We Offer?
Our neuro-ophthalmology services include:
Diagnostic services and ocular imaging
Our diagnostic and ocular imaging services include:
- Anterior segment and external photography — Creates images of the front of the eye.
- Electrooculography (EOG) — Measures and compares electrical activity in the front and back of the eye in response to eye movements or changes in light exposure.
- Electroretinography (ERG) — Measures electrical activity in your retina.
- Fluorescein angiography (FA) — Highlights structures in the back of your eye using fluorescent dye and a special camera.
- Fundus autofluorescence — Highlights structures in the back of your eye using natural pigments in the cells of your eye.
- Fundus photography — Creates images of the back of the eye, including the retina and optic nerve.
- Ocular ultrasound — Uses sound waves to create images of structures inside your eye.
- Optical coherence tomography (OCT) — A noninvasive imaging test that uses reflected light to create images of structures in the back of your eye, like the optic nerve.
- Ultrasound biomicroscopy — Uses sound waves to create detailed images of the front of your eye.
- Visual evoked potential or response (VEP or VER) — Measures electrical activity in the brain in response to visual stimuli to check how well your eyes, optic nerve, and visual pathways are working.
- Visual field examination — A noninvasive test that measures your peripheral vision.
Neuro-ophthalmology treatments
Medication
Your care team may recommend medications including:
- Anti-inflammatory medications, such as ibuprofen or corticosteroids, used to treat swelling and inflammation.
- Biologic medications given through an IV or an injection to control inflammation, reduce your need for corticosteroid medications, and lower your risk of side effects.
- Blood pressure medications to reduce blood pressure.
- Diabetes medications to control blood sugar levels.
- Eye drops to moisturize the eyes, control eye pressure, or change the eyelid or pupil.
- Oral medications to treat muscle weakness.
- Oral medications to lower intracranial spinal fluid pressure.
Vision care and rehabilitation
Your doctor may recommend treatments to improve vision and quality of life, such as wearing a patch over one eye or wearing prism glasses.
Eye patches help stimulate eye muscles in the uncovered eye or block images to reduce double vision. Prisms in or on glasses may expand your field of vision by changing how objects appear. They can be part of your lenses or come as lens attachments.
Referral to low-vision services or vision rehabilitation therapy may also help restore normal vision and eye movement over time, depending on your condition. It can also teach you how to cope with your symptoms by using strategies for reading and performing everyday tasks.
Surgical care
Depending on your condition, your doctor may recommend surgical treatments, including:
- Strabismus (eye muscle) surgery — If your eye muscles do not recover a normal range of motion on their own, your doctor may recommend and refer you for eye muscle surgery. During the procedure, your surgeon will weaken, strengthen, or reposition your eye muscles to correct misalignment of your eyes and improve double vision.
- Oculoplastic surgery — Reconstructive eye surgery with an oculoplastic surgeon to treat problems with eye muscles and other abnormalities.
- Optic nerve decompression — Relieves pressure on your optic nerve, performed by an oculoplastic surgeon.
- Optic nerve sheath fenestration — An eye surgery that involves making incisions around your optic nerve to reduce pressure, promote CSF drainage, and lower the risk of permanent vision loss. This procedure is performed by an oculoplastic surgeon.
- Shunt — Involves placing a tube in your brain to drain cerebrospinal fluid (CSF) and reduce pressure, performed by a neurosurgeon.
- Stent — Involves using a small tube to prop open a vein in your brain called the venous sinus, performed by a neurosurgeon. The stent reduces pressure in your brain by allowing blood and CSF to drain more effectively.
What Can I Expect?
You will need a physician referral to schedule your appointment. Information from your referring doctor, including imaging tests and visual field tests, provides crucial information and prevents unnecessary repetition of testing.
You should check with your health insurance company to see if you need an insurance referral.
During your visit
On the day of your visit:
- Bring images (on disk or film) of all recent brain MRI or CT scans for review.
- Your pupils will be dilated to allow comprehensive examination.
- You may be in the office for four to six hours so that doctors can review your case and scans and obtain diagnostic testing.
- You may be sent for more blood work/neuroimaging to aid the diagnosis.
To get your scan results, call the office the day after the scan is obtained or completed, or use MyUPMC to contact your doctor.
Why Choose UPMC for Neuro-Ophthalmology Care?
When you choose UPMC for neuro-ophthalmology care, you will receive:
- Access to world-class expertise — Our world-renowned experts care for people with a full range of neuro-ophthalmologic disorders.
- A full range of treatment options — We offer treatment and follow-up care to reduce the risk of vision loss and other complications.
- Multidisciplinary care — We partner with ophthalmologists, neurosurgeons, neurologists, vision rehabilitation specialists, and other medical experts to provide complete care that optimizes your quality of life.
