The physicians of Delray Eye Associates, P.A. offer a full spectrum of eye care services, including neuro-ophthalmology diagnosis and treatment. For patients suffering from eye problems related to the central nervous system, heart and circulatory systems, endocrine or other systemic conditions, Delray Eye Associates can provide timely interventions to preserve vision and treat the underlying medical problem.
What Is Neuro-Ophthalmology?
Neuro-ophthalmology is the study and treatment of eye problems that stem from nervous system conditions or systemic disease rather than from the eye per se. It is a subspecialty of both ophthalmology and neurology. Due to their extensive training, neuro-ophthalmologists are uniquely qualified to diagnose patients from medical, neurological and ophthalmologic perspectives simultaneously. Delray Eye Associates, P.A. is fortunate to have Dr. Michael A. Schaffer, who has fellowship training in neuro-ophthalmology and is highly experienced at diagnosing and treating neuro-ophthalmologic conditions.
Conditions Treated by Neuro-Ophthalmologists
Neuro-ophthalmologists treat a wide range of eye disorders. Some diseases treated by neuro-ophthalmologists are limited to the eyes, while others are general medical conditions. Disorders treated by neuro-ophthalmologists include:
Anterior ischemic optic neuropathy (AION) – Damage to all or part of the optic nerve due to an inadequate supply of oxygen resulting from reduced blood flow, or a “stroke” in the optic nerve. It can cause a sudden decrease in vision and is most common in patients over the age of 50.
Optic neuritis – An autoimmune disease in which the body’s immune system becomes overactive and attacks the myelin, a substance that coats the optic nerve. It can cause discomfort and sudden vision loss and can occur in young patients. Episodes of optic neuritis typically resolve on their own; however, severe cases may be treated with intravenous steroids, which also may help prevent progression to multiple sclerosis in selected patients at risk.
Anisocoria – Different-sized pupils; sometimes a sign of serious underlying medical conditions. Prompt evaluation is sometimes necessary.
Homonymous hemianopia – Loss of vision on one side of the visual field in each eye. It is caused by damage to the part of the brain that receives information from either the right or left side of the visual world, often from a stroke. Patients with this disorder may have difficulty completing daily tasks, such as driving, due to a lack of complete visual information. Treatment is directed toward helping patients cope with their limited vision and treating the underlying cause.
Thyroid eye disease – Also known as thyroid orbitopathy or Graves’ disease; an autoimmune condition affecting the muscles that move the eye. It can cause bulging eyes, double vision, decreased vision and retraction of the eyelids. Depending on the severity of the condition, treatment can range from eye drops and lubricating ointments to surgery.
Myasthenia gravis – An autoimmune condition that leads to muscle weakness and can result in droopy eyelids, also known as ptosis, as well as double vision. It can be treated with medications that affect neurotransmitters and enzymes responsible for muscle strength, as well as steroids and, in some cases, surgery.
Benign essential blepharospasm (BEB) – Involuntary blinking, squeezing and closing of the eyelids. It is believed to be caused by improper functioning in the basal ganglia brain region. BEB may interfere with some activities, such as driving. It can be treated with Botox injections to paralyze the spastic muscles.
Hemifacial spasms – Involuntary muscles spasms that affect one side of the face, forcing the eye to close. They can be treated with Botox injections to paralyze the muscles and prevent spasms.
Pseudotumor cerebri – Vision loss and headaches caused by high pressure in the head. It can be treated by reducing the cerebrospinal fluid pressure in the brain and spinal cord by means of weight loss, medication or drainage.
Cranial nerve palsies – Eye and eyelid movements are coordinated by a series of nerves located at the base of the brain, known as cranial nerves. These may be affected by numerous conditions, including atherosclerosis (hardening of the arteries), tumors or aneurysms. Cranial nerve dysfunction frequently results in double vision. The diagnosis may often be made by a complete neuro-ophthalmic exam. Prompt and appropriate evaluation is critical to obtain appropriate studies and avoid unnecessary testing. Treatment depends on the underlying cause.
Double vision – Double vision, or diplopia, may have a variety of etiologies, some benign and some vision- or even life-threatening. These may include thyroid disease, myasthenia gravis, stroke, aneurysm, tumors of the brain or eye socket (metastatic or primary), decompensated congenital weakness or insufficiencies acquired with the aging process. A complete neuro-ophthalmic exam may be all that is necessary to make the proper diagnosis. Treatment may be in the form of medication, prism glasses or surgery.
Your Neuro-Ophthalmology Exam at Delray Eye Associates, P.A.
A neuro-ophthalmology exam is a comprehensive assessment that may take several hours. Your neuro-ophthalmologist will review your medical history and discuss your current symptoms with you. The doctor will then provide a complete eye exam. Depending on your situation, a variety of tests may be performed, including a scan of your optic nerve or retina, a visual field test to measure your peripheral vision, muscle balance testing to assess the alignment of the eyes, and/or a neurological exam to assess your sensation, coordination and strength.
Here is a link to the North American Neuro-ophthalmology Society webpage, with a section devoted to patient education: www.nanosweb.org For patients spending time in other locations there is an option to search for a local neuro-ophthalmologist.