What is it?

Neuro-ophthalmology is a subspecialty of ophthalmology that is responsible for studying diseases of the nervous system that affect vision.

To be able to see, it is not only necessary that there be some ocular structures in perfect condition (cornea, crystalline lens, retina), capable of collecting visual information from our environment, but also a neural circuit that is capable of transporting these visual stimuli to the brain ( occipital cortex), where they will be interpreted. In other words, it is not enough to have healthy eye structures, but we must have visual pathways (optic nerve) and a brain in perfect condition.

What pathology does neuro-ophthalmology treat?

Neuro-ophthalmology treats diseases that mainly affect the optic pathway.

Possibly the pathology most commonly associated with neuro-ophthalmology is optic neuritis. Neuro-ophthalmological pathology shows great variability with age:

·         Young patients: In young patients, the most frequent pathologies are probably multiple sclerosis and migraines.

·         Adult patients: The most prevalent pathology is tumors, mainly of the pituitary.

·         Elderly patients: In these patients, the pathology differs according to sex, thus, in women the most prevalent pathology would be some slow-growing tumors, such as Meningiomas (tumors of the meninges). While, in men, the most prevalent pathology would be cerebrovascular accidents.

Possibly the most common pathology associated with neuro-ophthalmology is optic neuritis and optic neuropathies. Optic neuritis is an inflammatory disease. On the contrary, neuropathies can have different causes, such as, for example, traumatic, compression (mainly tumors), hereditary (Leber’s disease), toxic (alcoholic neuropathy), due to nutritional deficiency, secondary to radiotherapy, or associated with intracranial hypertension. In addition, neuritis / optic neuropathies can be unilateral (affecting only one eye) or bilateral (affecting both eyes).

Diagnosis

The first approach is a complete ophthalmological consultation, which includes, in addition to visual acuity, a study of contrast sensitivity and a color vision test. However, unlike other subspecialties, in neuro-ophthalmology it is necessary to perform different examinations to determine the location and degree of the lesion. Among the different diagnostic tools used in neuro-ophthalmology, the following stand out:

·         Study of pupillary reflexes (pupil contraction).

·         Fundus.

·         Visual field.

·         Ocular motility.

·         Electronystagmography.

·         Imaging studies: CT and cranial nuclear magnetic resonance imaging.

Treatment

Neuro-ophthalmology is a multidisciplinary subspecialty. The function of the ophthalmologist is, in many cases, to diagnose, since the treatment of many of the pathologies that cause damage to the optic pathway is addressed by other specialties, such as neurosurgery or otorhinolaryngology.

The ophthalmologist, really, indicates and performs few treatments. However, the observations and diagnoses made by the ophthalmologist are crucial for the diagnosis of very serious pathologies, such as tumors.