Neuroophthalmology

Neuroophthalmology focuses its attention on diseases of the nervous system that affect vision, control of eye movement or pupil reflexes. Neuro-ophthalmologists often see patients with complex multisystem diseases and “exotic” are not uncommon. Neuro-ophthalmologists are often teachers in large university medical centers, usually in the department of ophthalmology, but may be from other departments or in private practice. Patients often have coexisting diseases in other areas ( rheumatology , endocrinology , oncology , cardiology , etc.), thus, a neuro-ophthalmologist is usually the link between the department of ophthalmology and other departments in the medical center. ^[3]

The neuro-ophthalmologist's office is filled with patients who have been incorrectly diagnosed or incorrectly diagnosed and have spent considerable money on diagnostic studies, who are often reiterated that neuroimaging is a normal method that may be incorrectly performed or misinterpreted for many neurophthalmic disorders. ^[4] Neuro-ophthalmologists are often active teachers in their school and the first four winners of the prestigious Academy of Ophthalmology educational awards were neuro-ophthalmologists. ^[5] Most neuro-ophthalmologists are passionate about their discipline and speak of high job satisfaction, stating that they think that this field of activity is still fascinating and difficult.

Neuro-ophthalmology is mostly non-procedural, however, neuro-ophthalmologists can be trained to perform eye muscle surgery, adult strabismus treatment, optical nerve fenestration for idiopathic intracranial hypertension, and botulinum injections for blepharospasm or hemifacial spasm .

Frank B. Walsh was one of the pioneers of neuro-ophthalmology, helping to popularize and develop it. Walsh was born in Oxbow, Saskatchewan (Canada) in 1895 and received a university degree from Manitoba in 1921. He joined the Wilmer Institute of Ophthalmology at Johns Hopkins University and began organizing Saturday morning neuro-ophthalmological conferences. Walsh compiled the first textbook on neuro-ophthalmology, which was published in 1947 and was updated over the years by his students. ^[6]

Ophthalmologists spend less time with patients due to economic difficulties, the use of mid-level practitioners, and the wider use of laboratory tests. Neuroophthalmology was more affected than other specialties due to the complexity of the patient’s problems and the time needed to make a neuro-ophthalmological history and physical testing. ^[5] In addition, the current payment for services rewards the number of services (implementation of the procedure pipeline), rather than the quality of service (correct diagnosis, patient education and counseling) and the visible patient complexes are not properly recognized.

Improving functional neuroimaging paves the way for better understanding, assessing and managing many neurological and neuro-ophthalmological factors. As understanding of neurobiology develops, neuroophthalmologists are more often used in treatment than in diagnosis, and new methods are emerging for the treatment of traditional diseases that destroy vision. ^[7] For example, clinical trials using gene therapy to treat Leber’s hereditary optic neuropathy began in February 2014, ^[8] which is one of the first uses for gene therapy of the central nervous system. Progress was made in understanding the regeneration of retinal ganglion cells and the restoration of the synaptic connections of the optic nerve and brain , ^[1] more than in other regions of the central nervous system. ^{[9] [10]} One of the objectives of the National Institute of Health is the use of the visual system as a window for understanding neuroplasticity and the use of regenerative medicine of the central nervous system, ^{[11] the} area of ​​neurology, which has a promising future and is closely intertwined with neuro-ophthalmology.

The weakening of the financial environment for academic neuro-ophthalmologists should be resolved so that a clinical infrastructure remains to treat patients, evaluate and implement new technologies and methods of treatment, and prepare a new generation of neuro-ophthalmologists. The data needed to identify the problem (income provided by other departments, the sum of previous costs of unnecessary tests, visits and procedures, to the neuroophthalmologist, the average time spent by the patient with the neuro-ophthalmologist, etc.) and taking into account the direction of ophthalmic and neurological research - is extremely important keep bright academic neuro-ophthalmology community in the future.