NEURO OPHTHALMOLOGY
Neuro ophthalmology, a highly specialized field in opthalmology which specialises in neurological problems related to the eye, This branch of medicine is dedicated to the diagnosis and management of disorders that affect both the eye and the brain, offering a unique perspective on conditions that often require a multidisciplinary approach which include Ophthalmologists, Neurologists, physicians, Radilogists, Rheumatologists and Oncologists.
In Neuro Ophthalmology Early recognition of symptoms is crucial because Neuro Ophthalmic issues if not treated on time, it could result in Optic Nerve atrophy (death of the optic nerve).
The primary goal of neuro ophthalmology treatment is to enhance one’s quality of life by preserving and restoring visual function, while also addressing any root causes affecting the visual system
Treatment options include addressing the underlying cause, symptom management, and rehabilitative therapy to enhance visual function.
When to approach your doctor
Sudden loss of vision or reduced vision
A sudden eye stroke or black out (loss of vision called transient ischemic attack) • Visual hallucinations, where patients see things, shapes where there are none
Intractable headaches without any seeming cause or plausible reason
Double vision and headaches
Difficulty in colour vision (especially inability to identify red & green colours)
Difficulty in seeing light (Photophobia)
Visual Field Defects (visibility coverage)
A specialist, a neuro-ophthalmologist can only effectively identify the above symptoms and initiate subsequent treatment of their causes.
Common Neuro Ophthalmological Conditions
Optic Neuritis:
This is a condition that involves inflammation of the optic nervedue to various reasons – starting from an infection to an autoimmune disorder.
Optic Neuritis:
This is a condition that involves inflammation of the optic nervedue to various reasons – starting from an infection to an autoimmune disorder.
Papilloedema:
Disc swelling secondary to increased intracranial pressure (ICP)
It must be distinguished from optic disc swelling from other causes which is simply termed “optic disc edema”.
Nutritional Optic Neuropathy:
Damage to the optic nerve caused by toxicity due to substances found in tobacco & alcohol. This could also occur due to lack of nutrients and deficiency of vitamin B-complex and folic acid.
Nutritional Optic Neuropathy
Damage to the optic nerve caused by toxicity due to substances found in tobacco & alcohol. This could also occur due to lack of nutrients and deficiency of vitamin B-complex and folic acid.
Diabetic Neuropathy
People with diabetes are typically not aware that they are also at risk for developing retinal diabetic neuropathy, which is the loss of nerve cells in the retina.it occurs due to Optic nerve damage due to uncontrolled diabetes. the blood supply to the retina gets cut-off, leading to vision loss.
The nerve damage actually does come first, before the vessel damage. Even people with diabetes who never get retinopathy can still develop this damage.
Patients, often perform tests called (OCT) HFA and FFAthat allow to examine the retinal nerve fiber health in detail.
Ischemic neuropathy
Ischemic optic neuropathy (ION) refers to several conditions that all cause vision loss because of a lack of blood flow to part of your optic nerve. Without blood flow, the affected areas stop working correctly and start to die. If the disruption in blood flow is severe or lasts too long, it can damage the optic nerve permanently
Factors responsible for Ischemia of Optic Nerve
Ischemic neuropathy
Ischemic optic neuropathy (ION) refers to several conditions that all cause vision loss because of a lack of blood flow to part of your optic nerve. Without blood flow, the affected areas stop working correctly and start to die. If the disruption in blood flow is severe or lasts too long, it can damage the optic nerve permanently
Factors responsible for Ischemia of Optic Nerve
Anatomic differences (smaller or crowded optic disk, also known as “disk at risk”)
High blood pressure (hypertension)
Type 2 diabetes
Atherosclerosis (plaque buildup inside your arteries)
Sleep apnea
Low blood pressure while sleeping (nocturnal hypotension)
Anemia (low red blood cell count or hemoglobin).
Smoking (including vaping)
Migraines
Medications. Phosphodiesterase inhibitor medications (such as those that treat erectile dysfunction) may contribute to ION. But experts don’t think these drugs can cause ION on their own
Giant Cell Arteritis
What tests will be done to diagnose ischemic optic neuropathy?
Several tests can help diagnose ION or a condition causing/contributing to it. Some of these are simple and minimally invasive or noninvasive. Examples of these include:
Vision check to see if you have any visual field defects (blind spots).
Blood pressure check.
Blood tests (looking for conditions like Type 2 diabetes, high cholesterol, vitamin deficiencies, etc.).
Eye pressure (intraocular pressure) check
Fluorescein angiography
Optical coherence tomography (OCT)
Your eye specialist will ideally be able to pick up an optic nerve issue during an eye examination through thorough clinical examination and various investigations. A brain CT scan or an MRI is then typically done to assess whether there is associated damage in the brain as well
TREATMENT
Ischemic Optic Neuropathy need quick treatment with high dose anti-inflammatory corticosteroid medications like prednisone oral and injections.
The corticosteroid doses start high and gradually decrease over days or weeks. Some people may need to take low doses of thesemedications for an extended period to prevent ION from causing permanent vision problems.