Neuro-ophthalmology is a medical field merging neurology and ophthalmology to address vision problems connected to the nervous system. Specialists diagnose and manage conditions where the visual disturbance originates from the brain, optic nerves, or eye muscles, rather than the eyes themselves. This discipline focuses on the complex nerve pathways that connect the eyes to the brain.
Conditions Treated by a Neuro-Ophthalmologist
A primary condition is optic neuritis, an inflammation of the optic nerve that causes sudden vision loss and is often linked to multiple sclerosis. Another is idiopathic intracranial hypertension (IIH), where high pressure around the brain causes swollen optic nerves, headaches, and vision changes.
Neuro-ophthalmologists also treat giant cell arteritis, an arterial inflammation that can cause abrupt vision loss if not treated immediately. Patients with unexplained vision loss, where a standard eye exam is normal, are often referred to find a potential neurological cause.
Visual field defects, or areas of lost vision, result from damage to the visual pathway from strokes or tumors. Double vision (diplopia) is also common and can be caused by eye misalignment from nerve problems or conditions like ocular myasthenia gravis.
Abnormal eye movements like nystagmus and pupillary abnormalities such as unequal pupil size are also evaluated. These can indicate a range of underlying neurological disorders.
The Patient Pathway in the UK
Accessing a neuro-ophthalmologist on the National Health Service (NHS) begins with a referral from a GP or optometrist. A general ophthalmologist may assess the patient first before making an internal referral to the sub-specialist. Neurologists also frequently refer patients with conditions like multiple sclerosis.
Direct self-referral on the NHS is not possible, as the system requires an initial assessment. For quicker access or a second opinion, the private healthcare sector is an alternative where patients can sometimes self-refer and may experience shorter waiting times.
What to Expect During a Consultation
A consultation is a detailed process, starting with an in-depth discussion of your medical history and the specific symptoms you have been experiencing. The specialist will ask about the onset and nature of your vision problems, as this history helps narrow down potential causes.
A thorough physical examination follows, including a test of visual acuity, an assessment of your pupils’ reactions to light, and an evaluation of eye movements. The specialist will also use an ophthalmoscope or slit lamp to look at the back of your eyes, paying close attention to the optic nerve and retina.
Diagnostic tests often include a visual field test (perimetry) to map your peripheral vision and detect any blind spots. Optical Coherence Tomography (OCT) is a non-invasive scan that provides detailed cross-sectional pictures of the retina and optic nerve.
Blood tests may be ordered to look for inflammation or other systemic issues. If a problem within the brain itself is suspected, the specialist will arrange for neuro-imaging, such as an MRI or CT scan, to get a detailed look at the brain and optic nerves.
Major UK Neuro-Ophthalmology Centres
Several UK hospitals are recognised as leading centres for neuro-ophthalmology. In London, Moorfields Eye Hospital and the National Hospital for Neurology and Neurosurgery at Queen Square are prominent institutions. These centres are known for managing complex cases and contributing to academic advancements.
Outside of the capital, The Walton Centre in Liverpool is a major hub for neurology and neurosurgery. Other university hospitals in major cities also have dedicated neuro-ophthalmologists, though these larger centres often handle the most complex referrals from a wide geographical area.
The concentration of expertise in these major hubs means they often lead research initiatives and clinical trials, helping to shape the future of neuro-ophthalmic care.