What is a Neuro-Ophthalmologist?

A neuro-ophthalmologist is a physician who is trained in the diagnosis and treatment of disorders that involve the relationship between the eye and the brain.  This includes problems with the muscles of the eye, the optic nerve and its connection to the brain, and the areas of the brain that receive and process the visual information.  The physician  often is trained in ophthalmology (residency) and then does further training focusing on neuro-ophthalmology (fellowship). There are also some neuro-ophthalmologist that are trained in general neurology and then do a neuro-ophthalmology fellowship.

While there are many disorders that are handled by neuro-ophthalmologists, some of the more common include:

  • double vision
  • unexplained visual loss
  • optic nerve swelling
  • optic nerve damage
  • headaches
  • brain tumors or strokes affecting vision
  • blepharospasm
  • hemifacial spasm
  • orbital disease (thyroid eye disease)
  • orbital tumors

The treatment of these above conditions, and many others, are often handled by medications or specialized surgical procedures.  Usually these treatments can stop or reverse the visual problems.

Unlike some areas of ophthalmology where the diagnosis is often made by looking at the affected part of the eye, neuro-ophthalmology often requires extensive history taking of the current problem and background leading up to it, a very through exam of the eye, and other other specific test. Some of the tests used to help with the diagnoses include:

  1. MRI/MRA
  2. CT Scans
  3. Lab work
  4. OCT
  5. Fluorescein Angiography
  6. Visual Fields

By using this information the puzzle is put together and a diagnosis that is often not at first obvious starts to form.

Normally neuro-ophthalmologists are based out of large academic centers in larger cities, requiring patients to travel long distances for care.  Here at Sarasota Retina Institute we are fortunate to have Dr. Marc Levy, Dr. Jody Abrams and Dr. Thomas Spoor, all fellowship trained in the field of neuro-ophthalmology and orbital surgery.

 

Jody Abrams, MD

Neuro-ophthalmology/Oculoplastic Surgeon

Sarasota Retina Institute

Sarasota, Florida

Comments

  1. My mother just woke up a couple of days ago and was blind in her right eye. Has been in the hospital on steroids since. She still cannot see in her right eye. What are the chances of her regain vision or at least some vision in that eye? Also, the left eye is a bit blurry due to steroid IV’s and they’re hoping that she retains vision in that eye with all the current steroids and the treatment she’ll be on for the next 2 years. Apparently if she can still see out of her left eye in the next week, she’s close to being out of the woods on going blind in that eye. Is that true? Also, is it true that once you get this and it goes away that you never get it again? Finally, are there any procedures or drugs that can facilitate getting sight back in the right eye? I feel so bad for her it makes me sick!! She’s 74. Thanks!!! Steve.

    • Steve,

      I am sorry to hear about your mothers conditions. It sounds like your mother has a condition called giant cell arteritis or temporal arteritis. This is an inflammatory condition of the medium sized blood vessels in the body that can cause decrease in blood flow to the eye.

      The treatment is high dose steroids and it sounds like the doctors have taken the correct steps. The vision in her right eye has less then a 5% chance of any improvement even with the steroids. The chance of the left eye being affected is greatly decreased after she has been on the steroids for about 6 days (IV for the first few days then oral after that).

      She is not totally out the woods at that time but a greatly reduced risk of it affecting her good eye. She will need long term steroid therapy that can be from months to years and should be very cautious in the future of any change in vision or new headaches or temple pain as these could be a sign of reoccurrence and she would need a higher dose and slower taper.

      There is no other approved treatment or surgery for giant cell arteritis. Some doctors will use methotrexate to help with the long term steroids, but this is not a substitute.

      This is what I believe your mother has, but without examining her I can not make a firm diagnosis, but it does sound like her doctors are acting correctly. I hope that things go well for her and she maintains her vision.

      Jody G. Abrams, MD

    • Dear Steve, SO sorry to hear about your mom. My mother has suffered the same affliction. It is , unfortunately, very uncommon and not diagnosed easily. By then, it is sometimes too late to save the eyesight of one or both eyes. What Dr. Abrams says is true for the most part. Please understand, once the optic nerve has been starved of blood supply for ONLY 10 MIN’S, it is over with. There is no going back. It does NOT regenerate. The nerve remains pale and flattened and when examined this is what the opthalmologist will see. Monthly blood work, ie: Sedimentation rate and CRP (c-reactive protein) levels. (these are the inflammatory markers that are most important). Her blood pressure may be unstable during times of decreasing the steroid dosages, all this is very important. Her pituitary gland may never recover because of prolonged use of these steroids, but that’s usually not a serious issue. The doctors you want to employ in her care are: Retinal Specialist, Neuro-opthalmologist, and a Rheumatologist (who is VERY familiar with Temporal Arteritis and isn’t going to try to “jump start” her pituitary by splitting up her steroid doses), AND, a VERY good Endocrinologist. Keep a good check on her bone density because of the steroids. My mom is 18mo. out from her first diagnosis, and is doing well with her one good eye. Good luck.

    • Steve, one more thing. This is a CHRONIC condition, and may flare up at any time. In other words, it will last the rest of her life. That is why you must have monthly checkups on her blood work and her remaining good eye. Even if she is able to get off the steroids completely, which may never happen just be prepared, she must be watchful for these flareups with following her blood work, perhaps she can stretch it out to every 2-3mo. if she’s doing well, but her eye health is utmost, and if she notes any changes AT ALL, grayness or haziness in her good eye, gray spots seen with her good eye, black spots, etc., return of any symptoms, ie: jaw stiffness (claudication), scalp pain, headaches, dizziness, any changes with any of that, she must see her doctor immediately. I’m not prescribing, but if it were my mother and she were experiencing these things, any of them, I would give her 20mg of Prednisone immediately and take her to the Retinal Specialist or the Neuro-opthalmologist, or the rheumatologist, whoever you can get her in to see immediately. This disease is VERY UNFORGIVING, and you don’t fool around with it. She could lose that other eye in a blink. Literally. My best good wishes and good health.

  2. Arthur Thomas says:

    Hi,
    I lost my right eye sight and I got tunnel vision on my left eye due to the brain tumor on 1997. Doctor said these all happened due to the damaged of optic nerve when I had tumor. I am 21 years of old. I am in Great Britain. Just I like to know are any chances to get my vision back? Specially on left eye where I got tunnel vision?
    I would be so much grateful if please and kindly send me your honest reply.
    With kind regards.
    Arthur.

    • Hi Arthur
      I assume the loss of vision in your eyes was from the tumor either directly pressing on the optic nerves or causing the spinal fluid pressure to be high causing loss of nerve tissue. Did this happen when you were 21 or when you were 6? If there is loss of the nerve tissue then at this time the medical world does not have a good proven therapy to help your loss. The problem is that you have lost a large number of the nerve fibers that connect the eye to the brain. I like to describe this as the HDMI cable that connects a video camera (your eye) to the TV (your brain). If you lose the small wires in the cord the picture becomes blurred or even lost no matter how good the camera works. To regain the picture the wire needs to be replaced. There is currently no surgery or medication that can do this, yet. I say yet because of the incredible results we are seeing out of the stem cell research arena. This is the future that can help some one with your problem. Stem cells will be able to replace the damaged tissue and reconnect to the brain. I feel that this is the best line of hope for people with your type of problem. And the good news is I think this is going to happen in the near future (possible 5-10 years). Another avenue that might help you would be implantable cameras that wire into the brain. This has been done on a few patients with certain causes for blindness (more retina the optic nerve ) but the picture is very blurry and only tolerated by people blind in both eyes.

      I hope this gives you some information that you find useful.

      Jody Abrams, MD
      Oculoplastics/ Neuro-ophtahlmology
      Sarasota Retina Institute
      Sarasota Florida

  3. I am hoping someone can help me help my 11 month old son who has Down Syndrome. At two months he developed bilateral Nystagmus. I took him to the pediatric ophthalmologist who was recommended highly as he sees many of the children affected with disabilities in our area. He did an exam, which required two applications of drops to dialate his eyes. At this time, he was almost 5 months old. I was told he had small optic nerves and that this is called Optical Nerve Hypoplasia. This doctor told me that we wouldn’t know how this would affect his sight but he did say he could see and that he didn’t think it would have a huge effect but we just wouldn’t know until later. He recommended he have an MRI. We took our little man for the MRI which showed nothing of concern. The chiasm and optic nerve looked to be normal. We were then told he needed to have blood tests done for a panel on his hormones. They did this and the results showed low IGR 1 factor (growth horomone), low cortisol and high TSH (Thyroid Stimulating Horomone). So, we then took him to the Endocrinologist who said that he did not think that Nicholas had Optical Nerve Hypoplasia. He said he wasn’t worried about the high TSH because this is normal of children with Down Syndrome. He did give my son a shot in the leg to induce his adrenal glands to make cortisol and had his blood drawn an hour later. That blood test was apparently acceptable. About 2 months later, I got a letter from the State that my son was eligable for Children’s Special Health Care services (for children with special needs) under the doctor’s diagnosis of hypothyroidism (this was the first time we had heard that he actually had a diagnosis related to his horomones). So here is the deal…. from what I read on Optical Nerve Hypoplasia, my son fits. He has feeding issues, sleep issues and tends to not focus well on objects unless they are a very short distance from him. I just took him to this same specialist for his 6 month follow up and the specialist tells me that he now thinks he will retract the diagnosis of optical nerve hypoplasia. He said his optic nerve is small, but not so small that he would use this as his diagnosis. Now don’t get me wrong, this is great news…… but I do not want to get myself set up one way (again) and be told something different the next time we go in. Does anyone know how small is too small regarding the optic nerve? He is 11 months old and I really do not know what to think. I’d love to think this is a miraculous thing, but I am very guarded.

    • JAbramsMD says:

      Danielle,
      The pediatric ophthalmologist sounds like he did the correct workup. If there is a question of optic nerve hypoplasia then an MRI to look for an absent corpus callosum (part of the brain that connect the two sides) and lab work for hormone levels are very important. If he has since changed the diagnosis then it could be that he got a better look at the nerves. It is often very hard to see nerves in infants especially if there is nystagmus. The diagnosis of optic nerve hypoplasia is made by judging the nerve size (in microns, with 1500 microns being normal). At this time you should continue with the ophthalmologist to have your son watch for a lazy eye or need for glasses. Some children with Downs will need glasses and it is important to get these put on as soon as needed since it will maximize their visual potential. Unfortunately there is no treatment for optic nerve hypoplaia at this time. So wether the diagnosis is there or not you have done the right thing and sounds like giving your son every chance to get the best vision. If the nystagmus continues there are prisms that can sometimes be used to limit the nystagmus, and even some new reports of using Azopt (a glaucoma drop) to dampen the movement. Once again the idea is to maximize the vision.
      I hope this helps some. Good luck with everything.

      Jody Abrams, MD
      Oculoplastics and Neuro-ophthalmology
      Sarasota, Florida

    • Kelly Martini says:

      Danielle,
      I happened to stumble on this post while doing a Science in the News homework assignment with my 11 year old son who was diagnosed with ONH and bilateral Nystagmus at 5 months. He has normal hormone levels and no endocrine issues. His MRI revealed normal brain function. I felt compelled to reply to your post because it sounds so similar to what our sons early life consisted of. We had OT, PT, Speech, orientation and mobility, cognitive therapists and a food specialist because he could not eat anything other than a stage 2 baby food until the age of 3. We were told that his brain function was normal and all we would need to worry about was his vision. That was a major relief after hearing about all the other scary conditions that can come along with ONH. It has been a very long road and I am happy to report that our son is a compassionate, independent, large print reading, honor roll student at the Florida School for the Deaf and Blind. However, there were lots of bumps along the way and sleepless nights wondering how I could reach him. Our son was completely echolalic until the end of 1st grade and now he speaks perfectly with high school vocabulary. If all I had to worry about was his vision, as I was first told, I would be on easy street. I would suggest a third opinion based off of the symptoms you described.
      Best of luck,

      Kelly

  4. I have a five year old son, who has a condition with his optic nerve. At 6 months of age we were told his optic nerve was too small. We tried patching his “good” eye for several months with no noticeable difference. We were told by his eye specialist the only chance he ever had of gaining/improving sight in this eye was through stem cell research.

    Recently his left eye, which is the eye that has the small optic nerve, has started to affect how he functions. He has started covering his right eye in order to see properly. We went back to see a specialist and they said there is nothing we can do. I am hoping for a different answer. I am not worried about the cosmetics of his eye alignment as much as anything we can do to help his sight.

    He has almost perfect sight in his right eye, and in his left eye he can see light and shadows. Any information you can give would be tremendously appreciated.

    Thank you, Chasity

    • JAbramsMD says:

      Chasity,
      I am a little confused about which eye he is covering to see correctly. Is he covering his right (which would mean he sees nothing essentially) or his left and only letting the right one work. Is the left one moving or turning in or out? This could cause him some distortion and is a reason he could cover the left eye. If the left eye is causing him some distortion then you can look at putting a contact lens over the left eye to block the vision, but I would be careful with this. Since he is less then 7 blocking the vision in that eye can cause him to loose the little vision he has left in the eye. While it is not much if anything ever happened to the right eye any vision in left eye is better then none.
      unfortunately there is currently no approved treatment for the small optic nerve (optic nerve hypoplasia). The doctor is correct in that stem cells are most likely the future treatment for your son. The great news is looking at the studies currently underway at some major universities I think that this will be available treatment in about 10 years or so. This is great for his future.
      I am sorry I can not offer a lot of different information. But unlike the outlook 10 years ago the future looks good for your son

      Jody Abrams, MD
      Oculoplastics/Neuro-ophthalmology

  5. donato zeccola says:

    I AM WRITING ON BEHALF OF MY UNCLE. HE IS GOING BLIND IN BOTH EYES…HE SURGERY DONE AND BELEIVE THE DOCTOR MAY HAVE AFFECTED THE NERVE. THERE IS A PENDING CASE. HE CAN NOT SEE TO WRITE THIS BUT I HAVE READ THE ARTICLE…HE CAN NOT TRAVEL. IS THERE ANYONE YOU CAN RECOMMEND IN THE NEW YORK AREA? I AM PRAYING HIS VISION CAN BE RESTORED.

    • JAbramsMD says:

      Donato,
      I am sorry to hear about the problems your uncle is having. Can you tell me what part of New York you are in ? If in the city Dr. Marc Dinkin and Dr. Mark Kupersmith are both excellent neuro-ophthalmologist. The most important thing now is to try and get your uncle stable and if possible restore his sight. I wish you both luck.

      Jody Abrams, MD
      Oculoplastics/Neuro-ophthalmology
      Sarasota Retina Institute
      Sarasota, Florida

  6. Hi, my son was diagnosed with optic nerve hypoplasia and I’ve been told there is no cure. However, I met someone that had the same thing and she had some type of surgery at 6 months old and she can see just fine, she was also completely blind from it. Do you know what this surgery is called and who can preform it?

    • JAbramsMD says:

      Amanda,
      I am not sure what surgery the person you meet had. Optic nerve hypoplasia is a small optic nerve due to a decreased amount of nerve fibers. These fibers are what carry the information from the eye to the brain. If they are decreased in number the signal strength to the brain is weak. There is no current surgery to help resolve this issue that is accepted. There are some places in the world preforming stem cell transplants for this. Outside the US I am very leery of the centers since their reputation in the medical community is not the best and they will not share their clinical results, only tales of success. In the US there are some study centers working on stem cell transplant but this is in the very early stages of clinical research still. The good news is that this research is progressing very quickly and your son has a good chance that he will be helped early in his life.
      The thing I always warn patients and the parents of patients is to be careful with things that sound to good to be true. The last thing you want is for your son to end up in a worse situation.
      I hope this gives you some guidance.

      Jody Abrams, MD
      Oculoplastics/ Neuro-ophthalmology
      Sarasota Retina Institute
      Sarasota, Florida

  7. My step-son has partial vision loss bilaterally. When he was diagnosed with Type 2 Diabetes 2 years ago he was initially treated with high insulin dosage to get the diabetes under control, which it is. About a year ago he began having blurry vision which has worsened and also lost color vision. He has see local Opthamologists and been worked up at Bascom Palmer here in Miami who have all concluded that there is pressure on the optic nerve but there is no tumor. They described it to him as a “fake tumor” but offered no treatment of any kind other than a diuretic. Do you think there’s anything that can be done to help him? Would you ( Dr. Abrams or associate) be willing to see him and evaluate his problem. This problem is affecting every area of his life especially his ability to make a living. I would appreciate any informa-toon or suggestion!! Thank you

  8. My fiance is legally blind (ONH). She started seeing a spot in her left eye , top left corner (1.5 years ago). We went to her optometrist who was not able to see anything wrong. He believed it was something wrong with her optic nerve, but he had no way of knowing. There has been noticeable loss in the VF where the spot is.

    This spot has gotten a little worse since she first saw it. It is more noticeable in bright light, and has what I would call flare ups. She can always see it, but at times it is much darker than others – random times in the day, no correlation.

    We are trying to get in to see a neuro-ophthalmologist. She doesn’t have constant headaches, balance issues, noticeable weight loss, or any other worrisome symptoms. Researching her condition online doesn’t really lead anywhere, mostly just “floaters”, but I can’t imagine that is what this is. I worry for the worst, tumors always seem to pop up while “googling” similar symptoms.

    What kind of condition does this seem like to you?

    Thank you,
    Gabriel

    • Jody Abrams, M.D. says:

      Gabriel,
      I think you are making a wise choice getting her to see a neuro-ophthalmologist. Did she have a visual field or an OCT? These can help show were the problem might be. I am not able to give you an answer of what this might be, it could be a tumor, but it also could be infection, inflammation, nutritional problem, or even some genetic issues. Where do you live and I can give you some help finding a neuro-ophthalmologist.

      Jody Abrams, MD
      Oculoplastics/Neuro-ophthalmology

      • Thank you for your reply Jody.

        I know she had a visual field test, I am not sure about an OCT. She has had two visual field test since the spot first started happening. The second one showed vision loss where the spot is seen.

        We live in eastern Kentucky.

      • Jody,

        We got in to see a neuro-ophthalmologist (Karl Golnik, M.D) in Ohio, we were told he was world renowned. He checked my fiance’s eye several times, but did not see / hear anything from us that troubled him. We told him about her primary eye physician visits, and that she had seemed to lose vision in her VF per the visual field tests, which he reviewed. He asked if her spot moved, which she said no.

        He ended up telling us that he believed this spot was a floater. This of course confused us, as we did not understand why her optometrist would not have suggested this (her optometrist seemed to think something else was going on). I mentioned to him that I thought floaters “floated”, but he said not always, and that he had a floater that is static.

        At the end of the day, we know this doctor deals with unusual eye issues every day, and we should be able to trust that diagnosis. The spot in her eye is still there, never moves, some days it is darker than others.

        Does the diagnosis of a floater make sense to you from what I have described?

        Thank you for your time, I am very thankful to be able to have a dialogue with someone that has similar knowledge / experience.

        -Gabriel

        • Jody Abrams, M.D. says:

          I have seen large floaters causing VF defects. You are right that most do move but occasionally they can seem fixated. My recommendation would be if nothing appears wrong on the rest of the exam is to just watch the visual field defect closely. She should have the test repeated in a few months to see if there is any change. If there is, sometimes that helps guide us for more workup. This is why close followup is important.

          Jody Abrams, MD

  9. Roger Lewellyn says:

    Hi, I’m hoping someone can help me.I am being treated for vastibular ballance disorder. I had a flare up in Sept. About the same time I started seeing floaters in both eyes. I also have migranes,then around the last week in November I started experiencing poor coordination, difficulty walking and mantaining balance bumping in to things and lost of depth perseption. I am also experiencing numbness around my left eye area and ending around my left cheek area and constant dizziness. But I havent had any injuries. I really hope you can help me or point me in the right direction. Thank- you. Roger Lewellyn.

    • Jody Abrams, M.D. says:

      Roger,
      I would make sure if you have not had a complete workup that you pursue this as soon as possible. Based on your symptoms there are multiple problems that need to be investigated. You at minimum should get an MRI, and probably some blood work, and most likely a lumbar puncture. I would suggest a neuro-ophthalmologist or a neuro-otologist.

      I hope this helps
      Dr. Jody Abrams

  10. Roger Lewellyn says:

    I have had an MRI done and blood work done for posible M.S. All test results came out clear. Thank-you Roger Lewellyn.

  11. Roger Lewellyn says:

    Sorry I forgot to put down thatt I also have spasms in my left eye. Thnks

  12. Hoping to find answers on Leber’s, can anyone help me?

    • Jody Abrams, M.D. says:

      Lisa,
      I think you might of talked to Peggy in our office today. For Lebers there are a few studies at centers like Standford, Emory and I think Bascom Palmer looking at some treatments. They are still early in the study stages. You could possible contact them to find out if your loved one could qualify for any of them.

      Jody Abrams, MD

  13. Ery Burgess says:

    Hi,
    My father in law had an accident over a year ago, where he hit his head and had 10 stitches, his blood pressure dropped drastically and he lost his vision. We have seen Duke and Chapel Hill specialists but no one can give us a reason of why he lost his sight; he has been diagnosed with serious optic nerve damage and the possible reason was when his blood pressure dropped. They have done several MRIs, CTscans, and others.
    We are trying to find any possible options, we live in North Carolina and we are willing to travel and do whatever it takes.

    • Jody Abrams, M.D. says:

      Do you know how low the blood pressure went? If there was a significant drop in the pressure he could of had a stroke of the optic nerve. This damage to the nerve is unfortunately often permanent. What happens is that the optic nerve needs a lot of blood just like the brain. When the blood flow is decreased, which happens with a drop in blood pressure, the nerve cells dye off and that causes the loss of vision. Did he lose vision on one eye or both? Some nerves are more susceptible to this then others, just a variation of genetics.
      There is currently no good treatment for optic nerve damage. I believe that the future of treatment is going to be stem cells. There is a lot of research going into this but nothing is available clinically yet.

      I hope this helps clear some stuff up.

      Jody Abrams, MD

  14. Jody, i have a friend who has been blind his whole life and was diagnosed with optic nerve hypoplasia. His dream is to be able to see one day. Is there anything that can be done For ONH?

    • Jody Abrams, M.D. says:

      Heather,
      There is currently nothing that can be done, but that is probably going to change sooner then later. Stem cells are advancing very quickly and could be the best hope to get vision back by growing the nerves. There are some retinal implants that are now approved and could possible in the near future be used to help your friend. Dr Joe Rizzo in Boston is one of the leaders in this field and I would keep an tab on his research for your friend.

      Jody Abrams, MD

  15. Christina Dunn says:

    Hello my name is Christina. My son Anthony is 7 years old. When he was 6 he had gotten a number of unexplained headaches. He began throwing up for a week. I brought him into several times to doctors and Emergency room visits. They all told me they didnt see anything and that he was just doing it for attention. He had woken up one morning with his whole left side of his body paralyzed. I brought him in again and they told us it was Bells palsy. They gave medicine and it got better but the headaches were still severe. A few days later I brought him back in and they gave him IV fluids from being dehydrated. A doctor that knows his normal behaviors seen him and admitted him into the hospital. At this time his eyes deviated and he said he could no longer see. When he tried to look at anything it was close up to his face. They began a number of tests and later diagnosed him with pseudo tumor cerebre. He had surgery to place a VP shunt in his head and tube in his stomach. His eyes were no longer deviated but his sight was still gone. He ended up getting a blood clot in his brain few days after surgery. They put him on blood thinners that he was on for 6 months. His ophthalmologist said his nerves are completely damaged and his sight will not return. His left eye is completely blind, where his right eye is 20/200. Lately he has been saying he can see a little better and even was able to see some slight vision out of his left eye. We were told that it wasn’t improving. Is there anything that can be done? Thank you for your time.

    • Jody Abrams, M.D. says:

      Christina,
      I am sorry to hear about the troubles your son has had. That is a very rare diagnosis for such a young person. It sounds like the increased pressure around his brain caused damage to his optic nerve. This can cause swelling of the nerve and after a while death of the nerve tissue. Unfortunately there is not a lot that can be done to help recover the nerve at this point except keep the pressure normal in his brain. He needs to be very careful to protect that eye from injury. While there is no current therapy for optic nerve damage there is hope for him. I believe as do many other doctors that in the not so far future we will have stem cells to help treat problems like this. We should be able to regrow the nerve tissue to allow him to see again. This might sound like science fiction, but a lot of research is going on right now for this and it looks promising.
      I hope this gives you some answers. I would encourage you to use all local resources for low vision training for your son. He can have a full and productive life even with decreased vision.

      Jody Abrams, MD

  16. Marichu Calloway says:

    Hi My only son he is 11 yrs old has a eye tumor we called Opticnerve glioma , he been checked by 3 eye surgeons here in northern California ,until now we still cant find the specialist who specialize and willing to do operation. Please I really need help for my son. Thank you so much ! God Bless !

    Sincerely
    Marichu Calloway

    • Jody Abrams, M.D. says:

      Marichu,
      I would look at a academic institute like UC San Francisco. I would also touch base with Dr Kim Cockerham she is a great surgeon and if she can not help you at least she can point you in the right direction. If you still are having trouble I would go see Dr Jerry or Carol Shields on the east coast.
      Good Luck
      Jody Abrams, MD

  17. Hey, I have neurofibromatosis I became completely blind in right eye and legally blind in left eye from it when I was 4 I’m now 27. My son who is 4 vision is getting worse he went from having 20/20 a year ago this past December he had 20/30 last month he had 20/40. What’s his chances of becoming blind? I’m worried sick he will have to go through life like I did.

    • Jody Abrams, M.D. says:

      What was the cause of your blindness exactly? Does he have neurofibromatosis? I would definetly get him to see a pediatric ophthalmologist as soon as possible. Depending on the cause of the decreased vision there could be some treatment for him. Where are you located and possible I can help recommend someone.

      Jody Abrams, MD

  18. my husband was diagnosed with temporal arteritis (giant cell disease) in 2013. he was on steroids for a year and his vision seemed to improve. but now that the dr. took him off his eye sight has gotten worse. he still has a black spot in his right eye and still blurry in both eyes. he has had cataract surgery on both eyes and still no improvement. he keeps telling me he is going blind. could this happen and if so how long would it take? is there any thing else that could help him? please let me know.

    • Jody Abrams, M.D. says:

      Susan
      He can still lose vision from the giant cell arteritis (GCA). This disease can flare up at any time, even when it was quite for years. It could happen in a short time or be slow. This is why it is important to make sure he is followed up on a regular basis by doctors familiar with treating GCA. If he starts to have any of the symptoms of GCA (vision loss, headaches, jaw pain, weight loss, fever, temple tenderness) then he needs to contact his doctor ASAP.

      Jody Abrams, MD

  19. Gabriel Hill says:

    Dr Adams,

    I have posted questions here before, and truly appreciate your replies. While I know it is hard to give anything other than generic answers for such complicated cases, I am going to ask a few more questions.

    My wife was diagnosed with ONH as a teenager. Her vision has seemed to get worse as she has gotten older. I believe at one time, her vision was recorded at 20/100 in one eye. That eye now is 20/200. This caused her optometrist to refer her to a neuro-ophthalmologist, as ONH isn’t a progressive condition.

    It always seems like we hit a dead end. The neuro-ophthalmologist did not seem interested in what was wrong, other than he knew it could not be fixed. While that may be very true, knowing what to expect for the future is very valuable. If she will eventually lose her vision, we want to prepare.

    From a professional standpoint, why is it so hard to get a diagnosis? From what I remember, we need to have a multifocal ERG, and a VEP do determine if her vision problem is due to her retina or optic nerve. But will those test actually provide us with answers? Getting those tests are very hard (at least from my experience going to appointments with my wife).

    How would you go about this situation?

    • Gabriel Hill says:

      Also, sorry for the mistype of your name. I meant : Dr. Abrams

    • Jody Abrams, M.D. says:

      Where are you located at? I might be able to help direct you somewhere else that would give you a better response. I think she needs a complete workup to make sure nothing else is going on that would hurt her vision and cause it to progress. Does she have Lebers? If so one of the top people in this is Nancy Newman on the east coast and Alfredo Sadon on the west coast. If she has not seen either one of these experts I would look at making the trip at least once to hear their opinions.

      Hope this gives guidance

      Jody Abrams, MD

Trackbacks

  1. [...] Giant cell artertis (GCA), also known as temporal arteritis, is an autoimmune disorder that causes inflammation of the medium and large arteries of the body.  Loss of vision due to temporal arteritis is commonly managed by a neuro-ophthalmologist. [...]

  2. [...] them together double vision (called diplopia) occurs. Testing of the visual field is often used by neuro-ophthalmologist and glaucoma specialist to help diagnosis disease of the eye or [...]

  3. [...]  If there is no improvement with prisms or exercises the orthoptist works in conjunction with the neuro-ophthalmologist to determine further treatment. This can be surgical, botulinum injections, or medication depending [...]

  4. [...] As neuro-ophthalmologists we are often asked to see patients for double vision aka diplopia. The patient can complain of constant or intermittent double vision.  It is important to be seen as soon as the diplopia is noticed since this can be a sign of a medical emergency. It is also important to make sure a trained eye care professional (often a neuro-ophthalmologist) evaluate the eyes and to determine the needed workup. [...]

  5. [...] a neuro-ophthalmologist I am often often asked to see patients who have had a stroke. These patients can be seen at the [...]

  6. [...] a neuro-ophthalmologis  and oculoplastic surgeon, I get to see people with a variety of  multiple complaints. As [...]

  7. [...] Another type “light flashes” are those associated with ocular migraine.  These “light flashes” are called “scintillating scotomas”, and are persistent, lasting 20 -40 minutes.  Classically they are jagged, in a ring-like figure, begin centrally and expand outwardly.  They are not associated with a headache, but can be visually troublesome until they resolve. Often these ocular migraines are not associated with any systemic problem, but if they start to get worse it is a good idea to see a neuro-ophthalmologist. [...]

  8. [...] The doctors at Sarasota Retina institute have been using Botox for many years to help migraine suffers. Even before the FDA approved it, we saw great results from the medication. [...]

  9. […] new emerging area for neuro-ophthalmology is damage to the optic nerve caused by sleep apnea.  I see many patients referred for problems of […]

Speak Your Mind

*