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Neuro-Ophthalmology

Washington University Physicians offers world-class care for complex eye disorders. The University is home to the largest neuro-ophthalmic practice between Chicago, Ill., and Columbia, Mo., and one of only a few neuro-ophthalmology practices in St. Louis.

Patients are usually referred by specialists, ophthalmologists, neurologists, neurosurgeons, primary care physicians or internists.

Clinical services are supplemented by comprehensive ophthalmologic diagnostic laboratories, and optometry in vision centers. Physicians can call the following appointment line for their patients between 8 a.m. to 4:30 p.m. (CST) Monday - Friday.

CALL 314-362-3937 FOR APPOINTMENTS

Treatment Specialist :

Collin M. McClelland, MD

J. Banks Shepherd III, MD

Gregory Van Stavern, MD

What is neuro-ophthalmology?

A neuro-ophthalmologist specializes in the diagnosis and treatment of neurological disorders as they affect the visual system.

Vision extends well beyond the eyes themselves. A very large portion of the brain is devoted to the visual system, including one section oriented to the interpretation of images coming from the eyes and another section that controls the movement and positions of the eyes.

Who benefits from neuro-ophthalmology?

Typically, patients are those with conditions such as stroke, brain tumor, inflammatory diseases of the eye socket (the orbit, conditions affecting the optic chiasm and diseases of the optic nerve (the nerve that connects the eye to the brain). Damage to the nerve can result from drug overdoses, exposure to toxins in the environment, damage to the nerve itself, diabetes and bacterial and viral infections.

Conditions and disorders include : diplopia, visual migraine, strabismus, hemi-anopia, optic atrophy, optic neuritis, papilledema, papillitis, pituitory ademona, ischemic optic neuropathy, and other neuropathy that affects the optic system.

How are neuro-ophthalmologic disorders diagnosed?

Techniques used to diagnose neuro-ophthalmic disorders include very careful determination of the visual function of each eye independently, including its acuity, and ability to distinguish color, fine detail in an image, and to see depth perception in space. And perhaps most importantly, to see things indirectly, or out of the corner of the eye (peripheral vision).

One of the tests referred to as perimetry, conducts visual field testing by projecting spots of light onto a flat, uniformly illuminated surface. The patient is required to give divided attention when they're asked to fix their gaze on one spot, but respond when they detect the presence of another. This is a relatively complex procedure that gives a neuro- ophthalmologist information about the nature and location of disease within the optic nerve or brain.

Other centers may be able to conduct the range of diagnostic tests offered at Washington University, but performing them in the appropriate order is critically important and requires extensive clinical experience.

How are neuro-ophthalmic disorders treated?

Treatment depends on the underlying nature of the problem. The eye specialists spend a great deal of time dealing with people who have problems with eye movement or double vision as a consequence of disease within the eye socket or disease within the nerves that control the muscles of the eye.

Whenever possible, we employ conservative techniques such as the use of optical devices or prisms to eliminate double vision, but treatment options extend to and include surgical treatment of the eye muscle that adjusts or changes the movement or position of the eyes. Surgery is reserved for those for whom prism therapy in inadequate.

Our specialists have extensive experience in injecting botulinum toxin for control of eyelid and eye movements. They also treat a large number of patients with blepharospasm, neurologically classified as a focal dystonia, a condition in which involuntary closure of both eyes results in effective functional blindness when not treated.

What can a patient expect during the first visit?

Records patients should bring to their first visit include a list of medications, any prior lab work, ophthalmology records (including notes from previous surgeries), and MRI, CT scans or other X-rays. Patients also are asked to bring their glasses, a pair of sunglasses and pictures of themselves from the past.

During an initial neuro-ophthalmology evaluation, you should expect to spend from three to six hours for thorough testing and medical advice.

After the initial appointment is made,patients will be contacted by our Patient Registration Service, to help them complete necessary forms prior to the appointment. This eliminates some of the paperwork from the first visit. The staff in Patient Registration Services will also verify with the patient's insurance carrier or health plan that the visit will be covered.

If the appointment is more than 48 hours away, patients can register online, if they wish.

 
   
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Copyright 2014 Washington University School of Medicine
Copyright 2014 Washington University School of Medicine