Neuro Ophthalmologist
All vision problems need not necessarily stem from the eye. Some vision problems involve the brain. Neuro ophthalmology is the sub specialty of both neurology and ophthalmology. A neuro ophthalmologist is a phycian who specializes in the diseases affecting vision that originates from the nervous system. Conditions such as optic nerve disorders, loss of vision from central nervous system disease, double vision diplopia and involuntary movement of the eyes nystagmus are some of the disorders under the purview of a neuro ophthalmologist. An ophthalmologsit attends to patients with disease or injury in the eye ball, cornea and the lens or into the eyeball at the retina inside the eye. If any problem occurs behind the eye in the optic nerve or in some distinct visual pathways connecting the brain, it requires the special skills of a neuro ophthalmologist.
A neuro ophthalmologist could be an ophthalmologist or a neurologist with additional special training. After completing a residency program in any one of the two specialty areas, they take a fellowship in neuro ophthalmology for a year or two before starting to practice as a neuro ophthalmologist. A neuro ophthalmologist attends to a full spectrum of neuro opthalmic conditions including evaluation, diagnostic and referral services of rare and complex disorders. A neuro ophthalmologist caters to:
Patients who suddenly lose part of their side vision.
Patients suffering from double vision.
Patients with unequal pupils.
A patient suffering form a stroke.
A patient with brain tumor
Patients who suddenly have their vision out of focus
Any and every patient with unusual vision problems.
In addition to the above, a neuro ophthalmologist provides emergency evaluation of a wide variety of disease that can cause visual loss. Unexplained visual loss can arise out of uncommon disease conditions like myasthenia gravis, multiple sclerosis, mitochondrial disease and other muscular diseases that affect the eye. The neuro ophthalmologist uses special testing techniques including visual fields, visual evoked response, imaging studies such as CT, MRI and angiography and ultrasound to diagnose the disease patterns. It becomes necessary for the neuro ophthalmologist to work closely with other medical specialists to offer multidisciplinary care and solution for complex cases.
Optic Neuritis
Optic neuritis is a condition where the optic nerve gets inflamed. Due to the inflammation, light and visual images are not clearly transmitted to the brain. Optic neuritis can be caused by autoimmune diseases such as multiple sclerosis or viral infections such as chicken pox or measles. Optic neuritis is usually the first sign of multiple sclerosis. This condition tends to affect more women than men.
Patients suffering from optic neuritis notice reduced vision. This is more so when the body temperature is elevated. The eyes are sore and painful when moved. There is reduced color perception and diminished peripheral vision. Persons suffering from optic neuritis may have headache and fever. The vision diminishes for about a week and then gradual improvement is noticed. Typically most patients suffering from optic neuritis tend to recover most of their vision within about 6 months.
The opthalmologist will test the patient's color vision and visual field. Eye presure and pupillary function will be examined. The optic disc is viewed with indirect ophthalmoscopy. Brain MRI may be taken for testing for multiple sclerosis. Intravenous steroid medication has shown results on those suffering from initial occurence of optic neuritis.
Tonometry
Tonometry test is a diagnostic test to measure the intraoccular pressure (IOP). When the tonometry test measures the pressure inside the eye, it can help in detecting glaucoma. Ensure that you take off your contact lenses. Do not wear tight clothing around the neck as it can lead to increased pressure inside the eye. Do not smoke a few hours prior to the tonometry test. The tonometry test is also conducted in cases of head or eye surgery and hyphema.
When the pressure builds up within the eye due to improper drainage, it can cause permanent damage to the ooptic nerve. Tonometry is done as part of routine eye examination to check for glaucoma. Anesthetic eyedrops are used to numb the eye before using the tonometer. In the applanation method of testing intraoccular pressure, a paper stained with fluorescein is placed to the side of the eye thereby staining the front of the eye. The tonometer is then brought close to the cornea for testing. Here the intraoccular pressure is measured by the amount of weight that is needed to flatten the cornea. This type of tonometry test can also be conducted with a pencil-like instrument, which will give instant digital measurement. The air puff method of conducting tonometry is a non-contact one where a puff of air is blown at your eye and change in the light reflected from the cornea is measured to arrive at the intraoccular pressure. This method is preferred for children and persons who have undergone LASIK surgery.
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