Neuro-ophthalmologists diagnose and treat conditions that are related to connections between the eye and brain (almost 50% of our brain is utilized for vision related tasks) as well as eye related symptoms due to neurologic conditions. At Maimonides, our neuro-ophthalmologists are members of a Neuroscience Team that includes neurosurgeons, neurovascular specialists and neurologists.
COMMON NEURO-OPHTHALMIC CONDITIONS:
Anisocoria (uneven pupils): A condition where one pupil is larger than the other. To a small extent a difference in pupil size is normal, and may vary from left to right over time. However, if there is a larger discrepancy in pupil size it may indicate or warn of a neurological issue.
Anterior Ischemic Optic Neuropathy: Anterior ischemic optic neuropathy (AION) is the loss of blood supply to the optic nerve tissue which causes damage to the nerve. Often without pain or other symptoms, patients may become aware of the condition due to decreased vision or difficulty seeing above or below the center of gaze. This is a leading cause of decreased vision in those over 50 years of age.
Blepharospasm: A condition in which uncontrolled blinking, squeezing, and eyelid closure occur in both eyes without an environmental cause. Affects an estimated 5 out of every 100,000 people.
Drusen: The condition is the accumulation of abnormal deposits of protein-like material in the front part of the optic nerve. It often is found on examination, is asymptomatic and rarely impedes vision. It affects 1% of the population and is more common in Caucasians.
Hemifacial Spasm: A chronic “spasms or contraction” affecting one side of the face. The spasm can be momentary or prolonged and impacts middle aged men and women equally.
Microvascular Cranial Nerve Palsy: A condition causing the interruption of the blood supply to one of the cranial nerves which ceases to function. This can cause acute double vision. The condition is most often experienced in patients with diabetes and high blood pressure.
Migraine: Classic migraine attacks start with visual symptoms (colored lights, flashes of light) followed by severe headache associated with nausea, vomiting, and light sensitivity. Migraine's affect 15-20% of the population and is even greater in women.
Myasthenia Gravis: Myasthenia Gravis (MG) is an autoimmune condition where the body's immune system damages its own muscle receptors leading to muscle weakness. It can result in lid droop (ptosis), and/or double vision.
Optic Neuritis: A condition where the body's immune system attacks its own optic nerve. The resulting inflammation can lead to pain around the eye often made worse by movement of the eye. It can also lead to a sudden decrease in vision (blurred, dark, dim or partial loss). Optic neuritis is a common cause of sudden visual loss in a young patient.
Pituitary Tumor: A benign condition found in almost 25% of the population. At times the tumors may grow large enough to compress the surrounding optic nerves, chiasm, and cranial nerves. If this occurs eye movement and facial sensation may be affected.
Pseudotumor Cerebri: A condition in which cranial pressure causes problems with vision and corresponding headaches. The patients experience optic disc inflammation but there is no evidence of a tumor.
Thyroid Eye: An autoimmune condition where your body stimulates the enlargement of eye muscles. This can result in bulging of the eyes, retraction of the lids, double vision, decreased vision, and ocular irritation. Often thought to coincide with thyroid gland malfunction, it may however be an independent condition that may not resolve when the thyroid is "controlled."
For in-depth patient information on the conditions above, visit:
North American Neuro-Ophthalmology Society (NANOS)
WHAT IS A NEURO-OPHTHALMOLOGIST?
Neuro-ophthalmologists specialize in visual problems deriving from issues related to the brain not the eyes. Neuro-ophthalmology is a subspecialty of both neurology and ophthalmology, requiring knowledge in problems of the eye, brain, nerves and muscles. Neuro-ophthalmologists must complete at least 5 years of clinical training after medical school and are typically board certified in Neurology, Ophthalmology, or both.
Some eye conditions treated by neuro-ophthalmologist are minor but others may lead to permanent visual loss, or even become life threatening. Neuro-ophthalmologists due to their multi-discipline training are well suited to treat a wide variety of problems.
Some common symptoms evaluated by neuro-ophthalmologists include: visual field loss, unexplained visual loss, transient visual loss, visual disturbances, double vision, abnormal eye movements, thyroid eye disease, myasthenia gravis, unequal pupil size, and eyelid abnormalities (see above list for details of conditions)
A NEURO-OPHTHALMOLOGY EVALUATION:
First you should request that all relevant information (notes, lab tests, CTs, MRIs, etc) be sent in advance of your appointment. Make sure you have a list of your medications. During the visit your pupils will be dilated with drops (typically last 4 hrs) causing brightness and blurry vision, so make sure someone drives you home and you may wish to bring sunglasses.
WHAT WILL OCCUR DURING AN EXAMINATION :
A neuro-ophthalmologic evaluation is a comprehensive exam in which you will be asked for detailed information regarding your current problem, medical history, and medication allergies. An eye exam will be conducted as well as a partial or complete neurologic exam. Records and scans from information sent in advance will be reviewed. After the examination, the neuro-ophthalmolgist will discuss the diagnosis, additional testing and treatment.
THE MAIMONIDES NEURO-OPHTHALMOLOGY TEAM:
Our experienced and respected neuro ophthalmology team, has expertise in both neurology and ophthalmology. The team is comprised of Robyn Wolintz, MD and Norman Saffra, MD, FACS
Robyn Wolintz, MD is a board certified Neurologist who completed a fellowship in neuro ophthalmology, specializing in neurologic manifestations of ophthalmic disorders. Norman Saffra, MD, FACS is a board certified Ophthalmologist who specializes in ophthalmic manifestations of neurologic disorders.