neuro ophthalmology thesis topics

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• Published: 26 June 2024

Neuro-ophthalmology: recent advances and paradigm shifts

• Susan P. Mollan   ORCID: orcid.org/0000-0002-6314-4437 1 , 2 ,
• Andrew G. Lee 3 , 4 , 5 , 6 , 7 , 8 , 9 &
• Clare L. Fraser   ORCID: orcid.org/0000-0002-0379-7743 10 , 11  

Eye ( 2024 ) Cite this article

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• Diseases of the nervous system
• Inflammation
• Neurological disorders
• Risk factors
• Visual system

The last decade has seen an unprecedented pace of translation and innovation in the field of neuro-ophthalmology, providing our previously diagnosable but untreatable patients with new management options that reduce morbidity and mortality. No longer are we the subspeciality that simply admires the disease, and now we have much more than steroids to offer patients.

We recognise that many general Ophthalmologists take care of neuro-ophthalmology diseases, and this was the focus for the “How to do it” opinion articles. The remit was to provide practical advice for targeted investigation, diagnosis and management starting with two common neuro-ophthalmic conditions, optic neuritis (ON) and idiopathic intracranial hypertension (IIH). There has been a dramatic shift in the way we should manage ON, as there a broad spectrum of ON pathology that needs urgent treatment to preserve vision [ 1 ]. Secondly, IIH is a condition that has become prevalent in the last decade and managing the spectrum of visual involvement can be challenging [ 2 ].

There can only be a few people who are not terrified examining a patient with nystagmus, let alone managing it. Madill and colleagues have distilled their experience and provided an aide to diagnosis to reduce unnecessary confusion and incorrect investigations [ 3 ]. With a rise in patient support groups and online forums, many patients with unusual visual phenomena are finding more information that lead them to self-diagnosis. The diagnostic criteria and biological basis for visual snow syndrome is being characterised, and while it is not vision threatening, having a good approach to people living with visual snow syndrome is helpful [ 4 ]. Another thought provoking opinion paper approaches functional visual loss from a perspective and understanding that many of us may not have had before [ 5 ].

It was important to build in authoritative reviews to keep pace with the advances in neuro-ophthalmic diagnosis, treatment, and monitoring. Conditions like non-arteritic anterior ischaemic optic neuropathy and pituitary pathology may seem relatively easy and with little change in management over many years, however there are increasing nuances to providing the best patient care [ 6 , 7 ]. The world of ON is no longer as simple as Multiple Sclerosis (MS) and non-MS related disease. Ramanathan and colleagues provide clear phenotyping for myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) [ 8 ]. With travel returning to pre-COVID-19 levels and an increasing number of ex-patriots living abroad, we will all see patients with diseases classically associated with somewhere else that we may be less familiar with. The infectious optic neuropathies case based article pulls together many conditions that may require bespoke management [ 9 ]. Following on there are two more papers looking at the infectious pathologies, herpes zoster ophthalmicus and syphilis. The two articles included here have allowed our colleagues to give their invaluable insights for both [ 10 , 11 ].

Keeping the issue topics global, traumatic optic neuropathy (TON) may be less frequently found in the editors’ countries. Meanwhile working in counties like Cambodia or Mongolia, Ophthalmologists might see between two to three TON cases per day. Blanch and colleagues outline the triangulated opinion that glucocorticoids should not be used for traumatic injury [ 12 ]. Corneal neuropathic pain is a debilitating condition that currently lacks translational programs to deliver therapies to meet patient’s needs: Watson and colleagues tackle this topic [ 13 ]. There is a thoughtful paper on dystrophic calcification and the relevance to optic disc drusen, while we still don’t have a treatment, understanding pathogenesis may pave the way for future therapies [ 14 ]. Chen and colleagues have laid the foundation of our knowledge to date on central retinal artery occlusion, while we await the results of three European trials evaluating intravenous thrombolysis within 4.5 h of onset of symptoms [ 15 ].

While neuro-ophthalmology is centred on history, more history and then examination, there is an increasing supportive role of diagnostic tests. These are highlighted through three clinicopathological articles. Optical coherence tomography (OCT) imaging has become a cornerstone of the neuro-ophthalmic examination [ 16 ]. Neuro-imaging has become an essential investigation; however pathology can be missed if the correct protocol is not requested and performed [ 17 ]. There are many patients the readers may have in clinic, where structural changes are just not providing the answer. The electrodiagnostic (EDTs) case review not only superbly translates the complex into simple but it will help you navigate how and when EDTs can be diagnostic and where they are helpful in follow-up [ 18 ].

In the age of “apps” to make our lives simpler, Bano et al. provided a clear review of those ophthalmology applications that are validated for clinical use [ 19 ]. Likewise purchasing a pupilometer for your clinical practice may be daunting, as not all devices sample the pupil movements in the same way [ 20 ]. With more accessible information than ever before, we have been observing the rise of big data research in neuro-ophthalmology. This holds great potential in a specialty that often deals in rare diseases [ 21 ].

Ophthalmologists interact with many other specialists as part of a multi-disciplinary team, including colleagues such as neurology, rheumatology, infectious diseases, to name a few! This interaction requires us to understand conditions that may lie, for the most part, outside our own specialty. Therefore we invited non-ophthalmologists to demystify investigation and treatment of myasthenia gravis and giant cell arteritis [ 22 , 23 ].

To completely shift the neuro-ophthalmic paradigm, one of the most exciting papers in this compendium is nerve fibre organisation in the human optic nerve and chiasm: what do we really know? [ 24 ] This article challenges our traditional thinking about the anatomy of the visual pathways. In particular, they support the idea that Wilbrand’s knee does not actually exist. The authors have carefully evidenced their thoughts and conclude that the assumed preservation of retinotopy in the human optic nerve and chiasm is probably not correct [ 24 ].

The special issue closes with a short summary of the challenges for the future in the neuro-ophthalmology workforce; in particular as demand has far outstripped the increasing number of people specialising in Neuro-ophthalmology [ 25 ]. We reflect on the wealth of advancing knowledge and the excitement of new treatments in this specialty: who would not be drawn to practice in Neuro-ophthalmology today?

Laviers H, Petzold A, Braithwaite T. How far should I manage acute optic neuritis as an Ophthalmologist? A United Kingdom perspective. Eye (Lond). 2024. https://doi.org/10.1038/s41433-024-03164-4 .

Bonelli L, Menon V, Arnold AC, Mollan SP. Managing idiopathic intracranial hypertension in the eye clinic. Eye. (Lond). 2024. https://doi.org/10.1038/s41433-024-03140-y .

Kamath A, Huang WC, Madill SA. How should I approach and manage adult-onset oscillopsia? Eye. (Lond). 2024. https://doi.org/10.1038/s41433-024-03130-0 .

Fraser CL. How do I recognise and manage visual snow syndrome? Eye. (Lond). 2024. https://doi.org/10.1038/s41433-024-03059-4 .

Ramsay N, McKee J, Al-Ani G, Stone J. How do I manage functional visual loss. Eye. (Lond). 2024. https://doi.org/10.1038/s41433-024-03126-w .

Parthasarathi P, Moss HE. Review of evidence for treatments of acute non arteritic anterior ischemic optic neuropathy. Eye. (Lond). 2024. https://doi.org/10.1038/s41433-024-03136-8 .

Wang MTM, Meyer JA, Danesh-Meyer HV. Neuro-ophthalmic evaluation and management of pituitary disease. Eye. (Lond). 2024. (In press).

Jeyakumar N, Lerch M, Dale RC, Ramanathan S. MOG antibody-associated optic neuritis. Eye. (Lond). 2024. https://doi.org/10.1038/s41433-024-03108-y .

Ambika S, Lakshmi P. Infectious optic neuropathy (ION), how to recognise it and manage it. Eye. (Lond). 2024. https://doi.org/10.1038/s41433-024-03152-8 .

Tao BKL, Soor D, Micieli JA. Herpes zoster in neuro-ophthalmology: a practical approach. Eye. (Lond). 2024. https://doi.org/10.1038/s41433-024-03030-3 .

Reid GA, Halmágyi GM, Whyte C, McCluskey PJ. Ocular vs Neurosyphilis. Are they the same? Investigation and Management. Eye. (Lond). 2024. (In press).

Blanch RJ, Joseph IJ, Cockerham K. Traumatic optic neuropathy management: a systematic review. Eye. (Lond). 2024. https://doi.org/10.1038/s41433-024-03129-7 .

Watson SL, Le DTM. Corneal neuropathic pain: a review to inform clinical practice. Eye. (Lond). 2024. https://doi.org/10.1038/s41433-024-03060-x .

Bentin JM, Heegaard S, Jørgensen NR, Grahnemo L, Hamann S. Optic disc drusen: Dystrophic calcification, a potential target for treatment. Eye. (Lond). 2024. https://doi.org/10.1038/s41433-024-03138-6 .

Chen C, Singh G, Madike R, Cugati S. Central retinal artery occlusion: a stroke of the eye. Eye. (Lond). 2024. https://doi.org/10.1038/s41433-024-03029-w .

Shin HJ, Costello F. Imaging the Optic Nerve with Optical Coherence Tomography. Eye. (Lond). 2024. https://doi.org/10.1038/s41433-024-03165-3 .

Cejvanovic S, Sheikh Z, Hamann S, Subramanian PS. Imaging the brain: diagnosis aided by structural features on neuroimaging studies. Eye. (Lond). 2024. https://doi.org/10.1038/s41433-024-03142-w .

Calcagni A, Neveu MM, Jurkute N, Robson AG. Electrodiagnostic tests of the visual pathway and applications in neuro-ophthalmology. Eye. (Lond). 2024. https://doi.org/10.1038/s41433-024-03154-6 .

Bano T, Wolffsohn JS, Sheppard AL. Assessment of visual function using mobile Apps. Eye. (Lond). 2024. https://doi.org/10.1038/s41433-024-03031-2 .

Philibert M, Milea D. Basics, benefits, and pitfalls of pupillometers assessing visual function. Eye. (Lond). 2024. https://doi.org/10.1038/s41433-024-03151-9 .

Colman BD, Zhu Z, Qi Z, van der Walt A. From real world data to real world evidence to improve outcomes in neuro-ophthalmology. Eye. (Lond). 2024. https://doi.org/10.1038/s41433-024-03160-8 .

Jacob S. Treating myasthenia gravis beyond the eye clinic. Eye. (Lond). 2024. https://doi.org/10.1038/s41433-024-03133-x .

Khalique MI, Arjunan M, Wood S, Mackie SL. The spectrum of giant cell arteritis through a rheumatology lens. Eye. (Lond). 2024. https://doi.org/10.1038/s41433-024-03153-7 .

Pawar PR, Booth J, Neely A, McIlwaine G, Lueck CJ. Nerve fibre organisation in the human optic nerve and chiasm: what do we really know? Eye. (Lond). 2024. https://doi.org/10.1038/s41433-024-03137-7 .

Mollan SP, Menon V, Cunningham A, Plant GT, Bennetto L, Wong SH, Dayan M. Neuro-ophthalmology in the United Kingdom: providing a sustainable, safe and high-quality service for the future. Eye. (Lond). 2024. https://doi.org/10.1038/s41433-024-03141-x .

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Acknowledgements

We are deeply in debt to all the reviewers who have dedicated their time to the critical analysis of each paper in this special issue. They met tight timelines and provided their expertise in assuring all the papers are balanced in their viewpoints.

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Susan P. Mollan

Translational Brain Science, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, B15 2TT, UK

Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA

Andrew G. Lee

Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA

The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA

Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA

Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA

University of Texas MD Anderson Cancer Center, Houston, TX, USA

Texas A&M College of Medicine, Houston, TX, USA

Save Sight Institute, The University of Sydney, Sydney, NSW, Australia

Clare L. Fraser

Department of Ophthalmology, Macquarie University, Sydney, NSW, Australia

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Contributions

Mollan S: First drafting of manuscript, collection of papers and critical review of the manuscripts in this special issue. Lee AG: Review of the manuscript, overview of the manuscripts. Fraser CL: First drafting of manuscript, collection of papers and critical review of the manuscripts in this special issue.

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Correspondence to Susan P. Mollan .

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Competing interests.

SPM has received payment for consultancy work from Invex Therapeutics. She has received payment for advisory boards from Gentech and Ocular Therapeutix. Grant funding has been paid to her institution from the National Institute of Health Research (NIHR131211), UK Space Agency and IIHUK. She is also a member of the Eye editorial board. AGL, MD, is on the speaker’s bureau for Amgen and Alexion and the Advisory boards for Viridian and is a consultant for Astrazeneca, Bristol Myers Squibb, and Stoke Therapeutics. AGL is also a consultant for the National Football League, NASA, and the United States Department of Justice. AGL is also a member of the Eye editorial board. CLF received payment for the Invex Therapeutics trial steering committee.

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Mollan, S.P., Lee, A.G. & Fraser, C.L. Neuro-ophthalmology: recent advances and paradigm shifts. Eye (2024). https://doi.org/10.1038/s41433-024-03188-w

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DOI : https://doi.org/10.1038/s41433-024-03188-w

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The Case–Control Study in Neuro-Ophthalmology

Ali g. hamedani.

Department of Neurology (AGH), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (AGH), University of Pennsylvania, Philadephia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics (AGH), University of Pennsylvania, Philadelphia, Pennsylvania

Stacy L. Pineles

Department of Ophthalmology (SLP), University of California, Los Angeles, California

Heather E. Moss

Department of Ophthalmology (HEM), Stanford University, Palo Alto, California; Department of Neurology and Neurological Sciences (HEM), Stanford University, Palo Alto, California

A case–control study is an observational epidemiologic study design that compares the prevalence of a risk factor or treatment exposure between 2 groups: those with a particular disease or condition of interest (cases), and a similar group that is at risk for this disease or condition but does not have it (controls). Because cases can be pooled across different centers and years of study, case–control studies are particularly well suited for studying rare diseases, which is frequently the case in neuro-ophthalmology. However, their inherently retrospective nature makes it challenging to establish temporality and to distinguish between association and causation. They are also susceptible to recall, selection, and confounding biases. It is therefore important for neuro-ophthalmologists to be familiar with the principles of case–control study design to critically appraise the neuro-ophthalmic epidemiologic literature. In this article, presented as a companion to Lin et al’s “Idiopathic Intracranial Hypertension and Anemia: A Matched Case–Control Study” ( 1 ) and Rueløkke et al’s “Optic Disc Drusen Associated Anterior Ischemic Optic Neuropathy: Prevalence of Comorbidities and Vascular Risk Factors” ( 2 ), we review the basics of case–control study design and highlight several common pitfalls in case–control studies for readers to consider when evaluating new studies.

STUDY DESIGN

Cohort and case–control studies both assess the association between an exposure (cause or risk factor, independent variable) and outcome (effect, dependent variable). In contrast to a prospective cohort study, where a large group of patients with heterogeneous exposures who have not yet experienced a particular outcome is followed over time to determine who develops the condition and who does not, case–control studies begin by identifying groups of patients with and without disease. In other words, cohort studies look forward in time, whereas case–control studies look backward in time. Identifying subjects based on outcome is ideal for studying rare diseases that have a low rate of incidence.

A case–control study begins by defining the outcome and exposure of interest. The outcome refers to the disease or condition of interest (or if one is only studying patients with a particular disease, then a prespecified event or result associated with that disease). Study subjects who have the outcome of interest are known as cases, and subjects who are at risk for the outcome (i.e., who were capable of developing it) but do not have it are known as controls. In Lin et al’s study of idiopathic intracranial hypertension (IIH) and anemia, the outcome was a diagnosis of IIH according to modified Dandy criteria: cases were IIH patients who were diagnosed at a single eye clinic over a 29-month period. Controls were patients seen at the same center and during the same period for conditions other than IIH. Note that controls are defined by the absence of an outcome rather than the presence of a different outcome: a study that compares the prevalence of risk factors between 2 different diseases (e.g., anemia in IIH vs anemia in NAION) would technically not be considered a case–control study.

Exposure refers broadly to a patient-level or environmental-level characteristic or comorbidity, which can be anything from a genetic risk allele to a predisposing medical condition (in Lin et al’s case, anemia), environmental exposure (e.g., smoking), or nonrandomized treatment. Case–control studies are classically retrospective in that assessment of the exposure occurs in hindsight, and the timing of the exposure is specified to occur before developing the outcome of interest. For example, in Rueløkke et al’s study of ischemic optic neuropathy, patients were queried about whether they were diagnosed with sleep apnea or vascular risk factors before their diagnosis of ischemic optic neuropathy. However, this does not always occur in case–control studies. For example, Lin et al allowed for the assessment of anemia to occur at the time of IIH diagnosis or up to a year afterward, allowing for more of a cross-sectional design. Case–control studies can also use data from existing cohort studies to create a truly prospective study (these are termed nested case–control studies or case cohort studies and are beyond the scope of this review).

Neuro-ophthalmologists are rare disease specialists. Even conditions such as IIH that are common in neuro-ophthalmic clinical practice are rare at the population level: the estimated incidence of IIH among overweight or obese women aged 20–44 years in the United States is less than 20 new cases per 100,000 individuals per year ( 3 ). Case–control designs are thus well suited to the study of neuro-ophthalmic disease. If Lin et al had wanted to use a prospective cohort study design to investigate the association between anemia and the risk of developing IIH in the future, they would have had to recruit over 200,000 new subjects, each with or without anemia, to identify 50 new IIH cases over a 2 year-period. A study of that magnitude would not be feasible because it would require hundreds of personnel and hundreds of millions of dollars. Instead, Lin et al were able to query their patient database and find 50 IIH patients and 50 patients without IIH, in whom they assessed for evidence of exposure to anemia. Because case–control studies are often used to study rare conditions, the availability of cases is typically the limiting factor in sample size determinations.

STATISTICAL CONSIDERATIONS

The standard measure of association between exposure and outcome in a case–control study is the odds ratio. An odds is a ratio of probabilities, specifically the probability of having the exposure and the probability of not having the exposure. An odds ratio, then, is a ratio of 2 odds (one for cases and one for controls). An odds ratio can best be illustrated using the classic two-by-two table—for example, using data from Table 1 in Lin et al’s study, a 2-by-2 table can be created ( Table 1 ).

Odds ratio example

For IIH, the odds of anemia diagnosis is (9/50)/(41/50) = 0.22, and for controls, the odds of anemia is (6/50)/(44/50) = 0.14; so, the odds ratio is 0.22/0.14 = 1.57. Note that in calculating the odds separately for each group, the individual sample size cancels out, and the equation for odds ratio can be simplified to (a × d)/(b × c) as denoted by superscripts. If the odds ratio is greater than one, it indicates that cases have a greater odds of having the exposure, and if the odds ratio is less than one, it indicates the opposite. In this case, an odds ratio of 1.57 means that IIH patients are 57% more likely to have anemia than controls, and hypothesis testing (e.g., chi square test, Fisher exact test, logistic regression) is used to determine whether this is statistically significant (in this case, it was not). Continuous variables such as hemoglobin can be analyzed continuously using t -tests or linear regression (as in Lin et al’s study) or categorically by defining categories for use in a 2-by-2 table. For example, the exposure of anemia could have been defined as hemoglobin <9 g/dL and compared to unexposed individuals with hemoglobin ≥9 g/dL. Selecting a cutpoint to define exposed and unexposed groups using a continuous variable depends on a number of factors including clinical definitions, sample size calculations, and underlying dose–response relationships.

Note that the odds ratio is technically different from the relative risk that is reported in cohort studies. Relative risk is calculated from a prospective cohort study as the incidence of the outcome in the exposed group divided by the incidence of the outcome in the unexposed group. In other words, relative risk compares the frequency of an outcome between groups according to exposure, and odds ratio compares the frequency of an exposure between groups according to outcome. Relative risk is interpreted as the extent to which a particular exposure increases the risk of developing a particular disease or outcome relative to the baseline population risk; for example, if Lin et al had conducted a prospective cohort study of anemia and IIH and found a relative risk of 1.57, it would mean that patients with anemia are 57% more likely to develop IIH than patients without anemia. In a case–control study, one cannot know the true baseline population risk (i.e., the risk of developing IIH in people without anemia) because the study is being conducted after patients have already developed or not developed the outcome. However, as long as the disease of interest is rare, the odds ratio from a case–control study will approximate the relative risk from a prospective cohort study.

SOURCES OF BIAS

In a case–control study, cases and controls are not randomized to having the exposure, and there is the potential for other differences between groups to confound the association between exposure and outcome, resulting in a significant association between the exposure and outcome that may in reality be due to other confounding variables associated with both the exposure and outcome. There are a number of statistical methods that can be used to adjust for potential confounding. One method that is highlighted in Lin et al’s study is matching, whereby the case and control groups are balanced according to a particular characteristic, thereby removing it as a potential confounder. In this case, Lin et al matched cases to controls by sex and age to account for the fact that young women are more likely to have anemia and are also the demographic at greatest risk for developing IIH. Paired statistical tests (e.g., paired t test, matched chi-square test, conditional logistic regression) must be used to account for the matched structure of the data.

Although confounding is a potential weakness in any observational epidemiologic study, there are several methodologic issues that are of particular concern in case–control studies. One important type of bias is recall bias, which refers to the fact that knowing whether a patient has a disease of interest affects their ability to recall whether they had a previous exposure or not. Recall bias can occur in any retrospective study where the exposure is ascertained after the outcome is already known, and it is most problematic when the exposure is self-reported. For example, Rueløkke et al compared patients with anterior ischemic optic neuropathy who had optic disc drusen (ODD) to those who did not (NA-AION). Patients with NA-AION are often counseled at the time of their diagnosis on the relationship between vascular risk factors such as diabetes, hypertension, hyperlipidemia, smoking, and obstructive sleep apnea and NA-AION, and the theoretical possibility that better control of these risk factors could reduce their risk of fellow eye involvement. If this experience makes it more likely for patients to recall their previous diagnoses of diabetes or other vascular risk factors, there could be greater recall among those patients, and any difference in the prevalence of vascular risk factors in the NA-AION group relative to the ODD group could be exaggerated. In Lin et al’s study of anemia and IIH, anemia was measured using a complete blood count (CBC) rather than self-report. Because patient recollection is not involved, recall bias is minimized.

Information Bias

Information bias can result from limited availability of data. This is a consideration in Lin et al’s retrospective study, where measuring the exposure depends on the availability of data that have been collected for routine clinical purposes rather than research. Of an initial sample of 95 IIH patients, 45 (47.3%) were excluded due to a lack of available CBC. If these excluded subjects all had undiagnosed anemia, the prevalence of anemia in IIH would actually be 57% (54/95 × 100) instead of 18% (9/50 × 100), and a true association between anemia and IIH would be missed.

Selection Bias

Selection bias can occur as a result of how cases and controls are defined. For cases, rigorous diagnostic criteria (e.g., modified Dandy criteria for IIH in Lin et al’s study) are used to ensure that cases have an accurate clinical diagnosis. Inclusion criteria for controls are frequently less clearly defined but are equally important. Specifically, it is important for controls to be representative of the general population of interest, and the method in which controls are identified should not be associated with exposure because this would result in selection bias. A famous example of selection bias comes from a case–control study of coffee consumption and pancreatic cancer ( 4 ). In this study (published in the New England Journal of Medicine ), cases (pancreatic cancer patients) and controls (patients without pancreatic cancer) were asked about their coffee consumption, and cases were 2.7 times more likely to report drinking 3 or more cups of coffee daily. This led to widespread fear that coffee caused pancreatic cancer. However, one must ask an important question: from what population was the control group selected? In this case, controls were recruited from gastroenterology clinics, where the same providers were also seeing pancreatic cancer patients, and most control patients had gastroesophageal reflux disease, peptic ulcer disease, and other conditions that could potentially cause them to reduce their coffee consumption to reduce their symptoms. Thus, the prevalence of coffee consumption in the control group was lower than the population of patients with pancreatic cancer, resulting in a spurious association between coffee consumption and pancreatic cancer that subsequent studies have failed to confirm. In Lin et al’s study of IIH and anemia, control subjects were selected from patients who were seen at the same eye center for reasons other than IIH and had a CBC collected. If their reasons for seeking ophthalmic care (e.g., dry eye, uveitis) were associated with anemia, then the prevalence of anemia in the control group would not reflect the prevalence of anemia in the general population, and this could cause selection bias. Specifically, if both the IIH and control groups have a significantly increased prevalence of anemia relative to the general population, comparing IIH to controls would fail to demonstrate a significant difference (bias toward the null). Knowing that these conditions are not associated with anemia is reassuring, although the precise indications for checking a CBC in this group remain unclear.

The potential for bias limits the generalizability of case–control study results. Prospective cohort studies protect against information and recall biases, and randomized controlled trials provide ideal control for confounding, so the findings of a case–control study would ideally be confirmed in a prospective observational or interventional study before being implemented into clinical practice, but this is not always feasible.

In summary, case–control studies are a popular epidemiologic study design, and because they are ideal for studying rare diseases, they have widespread applications in neuro-ophthalmology. However, it is important for readers to understand how case–control studies are conducted and the potentials for confounding, information, recall, and selection biases to judge the extent to which a study’s findings affect true causal relationships that are relevant to the care of their patients.

Acknowledgments

A. G. Hamedani receives funding from the National Institutes of Health (NINDS T32 NS061779-10).

The authors report no conflicts of interest.

Contributor Information

Ali G. Hamedani, Department of Neurology (AGH), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research (AGH), University of Pennsylvania, Philadephia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics (AGH), University of Pennsylvania, Philadelphia, Pennsylvania.

Stacy L. Pineles, Department of Ophthalmology (SLP), University of California, Los Angeles, California.

Heather E. Moss, Department of Ophthalmology (HEM), Stanford University, Palo Alto, California; Department of Neurology and Neurological Sciences (HEM), Stanford University, Palo Alto, California.

The Neuro-ophthalmology Program in the Department of Neurology at Indiana University School of Medicine is dedicated to preserving vision and restoring vision problems from diseases affecting the brain and nerves.

The IU School of Medicine Neuro-ophthalmology Clinic is the largest in Indiana and welcomes children and adult patients from throughout Indiana and neighboring states. They specialize in the diagnosis and treatment of vision problems from diseases of the optic nerves, cranial nerves that control eye movements, and the pathways of vision in the brain.  Visits often include automated testing of a patient's visual field (peripheral vision) and a scan of the back of the eyes (optical coherence tomography—OCT) in addition to a thorough eye examination. Faculty members work closely with neuroradiologists, neurologists, ophthalmologists, optometrists, neurosurgeons, radiation oncologists, neuro-oncologists, neuro-immunologists, and other specialists to coordinate an individualized treatment plan.

In addition to patient care, faculty members participate in neuro-ophthalmology research, including neuro-ophthalmology telemedicine, neuro-ophthalmology education, and the search for vision biomarkers for Alzheimer disease.

Physicians play an active role in medical student and resident education in both neurology and ophthalmology in the clinic and the classroom.

Neuro-ophthalmology faculty members are also active in university, state, and national organizations, serving in leadership positions in the American Academy of Neurology, North American Neuro-Ophthalmology Society, Indiana Neurological Society, and the IU School of Medicine Neurology medical student clerkship. 

Melissa Ko, MD

Professor of Neurology

Devin D. Mackay, MD

Associate Professor of Neurology

Neuro-Ophthalmology

Case Based Practice

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Eye & ENT Hospital, Fudan University, Shanghai, China

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• Contains more than 80 carefully selected neuro-ophthalmic cases
• Uniform structure in each case
• Introduces the novel optical coherence tomography imaging technique

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About this book

This book provides a practical guide in neuro-ophthalmology. It contains more than 80 carefully selected neuro-ophthalmic cases. It covers visual afferent (Part 1) and efferent disorders (Part 2): the various optic neuropathies, diplopia from ocular and neurologic pathogen, pupil and lid abnormality. Each case presents with neuro-ophthalmology examination format, followed by ancillary test, finial diagnose, treatment and prognosis. A short review or comment highlights the important points of these disorders, up to date progress and literature are addressed in part of them. The novel optical coherence tomography imaging technique is also introduced to interpretation some visual pathway disorders and for follow-up. The massive photographs and neuro-imaging will help the reader for easy following. As a case-based practical manual, this book is a clinical reference for general ophthalmologist, neurologist, senior ophthalmology resident, specialist and fellow, and physician who are interested in neuro-ophthalmology field.

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Editors and Affiliations

Eye & ent hospital, fudan university, shanghai, china, about the editors, bibliographic information.

Book Title : Neuro-Ophthalmology

Book Subtitle : Case Based Practice

Editors : Guohong Tian, Xinghuai Sun

DOI : https://doi.org/10.1007/978-981-19-4668-4

Publisher : Springer Singapore

eBook Packages : Medicine , Medicine (R0)

Copyright Information : People's Medical Publishing House, PR of China 2022

Hardcover ISBN : 978-981-19-4667-7 Published: 22 November 2022

Softcover ISBN : 978-981-19-4670-7 Published: 22 November 2023

eBook ISBN : 978-981-19-4668-4 Published: 21 November 2022

Edition Number : 1

Number of Pages : VIII, 507

Number of Illustrations : 141 b/w illustrations, 379 illustrations in colour

Topics : Ophthalmology , Neurology

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Neuro-Ophthalmology in India

Editor(s): Digre, Kathleen B. MD

Department of Ophthalmology, Jaypee Hospital, Noida, India

Almost all neuro-ophthalmologists in India come from an ophthalmology background, after completing 8–9 years in the medical field, which includes five and a half years of Bachelor of Medicine and Bachelor of Surgery (MBBS) and 3 years of postgraduation in ophthalmology. A significant number of neuro-ophthalmologists combine this training with pediatric ophthalmology. Neuro-ophthalmology services are usually concentrated in larger ophthalmology departments based in major cities. The story of neuro-ophthalmology in India mirrors the growth of the major eye institutes in the country.

India became an independent country in 1947. A growing interest arose in the field of neuro-ophthalmology in the mid-1950s. A neuro-ophthalmology unit was established at the Government Ophthalmic Hospital (Regional Institute of Ophthalmology), Chennai, in 1954, which functioned in conjunction with the Department of Neurosurgery at Madras Medical College. The first neuro-ophthalmic clinic in India was started at Madurai Medical College in 1965. It was initially led by Dr. G. Venkataswamy, followed by Dr. Krishnamoorthy and then by Dr. G. Natchiar ( Fig. 1 ).

In 1967, Dr. L.P. Agarwal founded the RP Center, All India Institute of Medical Sciences (AIIMS), Delhi, and Dr. D.K. Gehlot was the pioneering faculty who provided neuro-ophthalmology services. Residents had a 3-month posting in neurology and neurosurgery to understand the neurological aspects of the specialty. Dr. Gehlot was frequently quoted, “Ophthalmology may be sight saving but neuro-ophthalmology is lifesaving.” Every year approximately 8–10 senior residents are trained in the subspecialty, often combined with expertise in strabismus surgery.

The neuro-ophthalmology unit at Aravind Eye Hospital, Madurai, was established in 1977, and it was headed by Dr. G. Natchiar for the next 30 years. Neuro-ophthalmic courses and workshops were conducted periodically from the year 1980. The department at Madurai is currently headed by Dr. Mahesh Kumar, who trained with Dr. Natchiar. Aravind Eye Hospital conducts regular short-term observerships (3 months) in neuro-ophthalmology, and approximately 15 students have completed the course.

In 1978, Dr. Vimla Menon ( Fig. 2 ) took over as head of the Department of Neuro-Ophthalmology and Strabismus at RP Center, Delhi. It has grown to 5 faculty, including Dr. Pradeep Sharma and Dr. Rohit Saxena. Dr. Menon was one of the earliest neuro-ophthalmologists of the country, with a particular interest in optic neuritis and has several research publications on the topic. In 2019–2020, 3,367 new patients and 3,542 return patients were seen at RP Center.

The credit for starting neuro-ophthalmology at Sankara Nethralaya, Chennai, South India, goes to Dr. B. Sridhar Rao, a glaucoma specialist, in the year 1981. Dr. Lingam Gopal, an outstanding vitreoretinal surgeon, also developed interest in neuro-ophthalmology. He was mostly self-trained but had observerships with Drs. Lawton Smith and Joel Glaser in Miami, Florida, in 1987. In 1992, Dr. Navin Jayakumar became the first full-time neuro-ophthalmologist at Sankara Nethralaya (SN) having trained with Drs. Neil Miller, Steven Seldon, Alfredo Sadun, Barrett Katz, Joel Glaser, and Lawton Smith. Dr. Jayakumar established valuable relationships with Drs. G. Arjundas and B. Ramamurthy, renowned in neurology and neurosurgery, respectively.

In the northern part of the country, a neuro-ophthalmology unit at Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGI), Lucknow, was started in the Department of Neurosurgery in 1988. It was the vision of late Dr. D.K. Chabbra. Dr. Kumudini Sharma joined the unit from its inception. She completed a neuro-ophthalmology fellowship at the Texas Tech Health Sciences Center at Lubbock, USA, in 1990. In 2013, an ophthalmology department was formed and neuro-ophthalmology was shifted under this department. Since 2014, SGPGI has a 1-year postdoctoral certificate course in neuro-ophthalmology, which includes rotations in neurology, neurosurgery, and neuroradiology.

In 1997, L V Prasad Eye Institute (LVPEI), Hyderabad, established a dedicated pediatric ophthalmology, strabismus, and neuro-ophthalmology unit. Dr. B. Venkateshwara Rao headed the unit for a decade. Teams led by Dr. Subhash Kaul, Head, Neurology Department, NIMS Hospital; Dr. Manas Panigrahi, Neurosurgeon, NIMS Hospital; and leading neuroradiologists in Hyderabad provided additional comprehensive patient care.

Currently, all 4 tertiary eye care centers of LVPEI, Hyderabad, Visakhapatnam, Bhubaneshwar, and Vijayawada, have dedicated pediatric ophthalmology, strabismus, and neuro-ophthalmology units. Dr. Ramesh Kekunnaya heads the unit at Hyderabad. Dr. Virender Sachdeva (LVPEI, Visakhapatnam) did 1-year clinical research fellowship with Drs. Nancy Newman and Valerie Biousse. Dr. Pratik Chougule (LVPEI) did a research fellowship with Dr. Dan Milea.

In 1998, Dr. J.L. Goyal started a neuro-ophthalmology clinic at Guru Nanak Eye Center, Delhi, which has trained a large number of postgraduates.

Dr. Satya Karna joined the Department of Neuro-Ophthalmology at SN, Chennai, in 1999, followed by Dr. S. Ambika, who is the current head of the department. She did her neuro-ophthalmology training with Drs. Andrew Lee, James Goodwin, Avertano Noronha, Joel Glaser, and Bryon Lam. Dr. Rashmin Gandhi joined the department in 2008. The subsequent growth of the department has been meteoric with as many as 6 consultants now practicing full-time neuro-ophthalmology. Since 2008, 8 ophthalmologists have undergone an 18-month neuro-ophthalmology fellowship at SN.

The Department of Neuro-Ophthalmology in Narayana Nethralaya (NN), Bangalore, was established by Dr. Rohit Shetty, in 2007. He did an observership in neuro-ophthalmology at UC Irvine, USA, and leads the team of experienced and dedicated neuro-ophthalmologists. Dr. Abdul Rawoof works with visiting neurologist Dr. Sujith Kumar at Narayana Nethralaya 1,, and Dr. Jyoti Matalia, a neuro-ophthalmologist at NN2, works in collaboration with the neurology and neurosurgery department of the Mazumdar Shaw multispecialty hospital. She is known for her expertise in performing optic nerve sheath fenestration.

Dr. Amod Gupta, an astute retina specialist, provided neuro-ophthalmology services during his tenure at Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, during his long tenure. A dedicated neuro-ophthalmology clinic was run from 2011 to 2014 by Dr. Swati Phuljhele Aalok (currently faculty at Rajendra Prasad [RP] Center, AIIMS). A dedicated neuro-ophthalmology clinic was restarted in January 2019 by Dr. Jaspreet Sukhija, after training with Dr. Gordon Plant in the United Kingdom. Dr. Vivek Lal, a neurologist at the institute, has been a keen contributor to the specialty and also an active participant in the joint conferences.

Conferences and Meetings

In India, the annual conferences of the neurology and ophthalmology societies include instruction courses, symposia, free papers, and posters in neuro-ophthalmology.

Sankara Nethralaya, Chennai, organized the First International Update in Neuro-Ophthalmology in India in 2002 with speakers who included Drs. Andrew Lee, Avertano Noronha, Sharon Tow, Robert Daroff, and Barry Cullen. In 2009, the Second International Update in Neuro-Ophthalmology was graced by the presence of Drs. Neil Miller, Andrew Lee, Peter Savino, and Prem Subramanian.

In 2016, the LVPEI organized Impulse, a focused meeting on pediatric neuro-ophthalmology, at LVPEI, Hyderabad. Since 2018, LVPEI organizes a common pediatric neuro-ophthalmology session for its faculty and fellows, which is also attended by neuroradiology faculty from Citi Neuro Center, Hyderabad, and pediatric neurology team at Rainbow Hospital.

In 2017, SN organized Synapse (Symposium in Neuro-Ophthalmology: Afferents and Efferents)—with Drs. Andrew Lee, Prem Subramanian, Dan Milea, and Clement Tan. National speakers included Dr. Vivek Lal, Head of Neurology at PGIMER, Chandigarh, who has a special interest in neuro-ophthalmology. Synapse-2 was held in 2019 with Drs. Satoshi Kashi, Nancy Newman, Valerie Biousse, Carmen Chan, Dan Milea, and Richard Kho.

The Indian Neuro-Ophthalmology Society (INOS) was established in 2018, with the diligent efforts of Dr. Vimla Menon and Dr. Rohit Saxena, who currently serve as president and secretary of the society, respectively. INOS has 130 registered members from all over the country ( https://www.inosindia.com ). It has conducted 2 annual conferences at New Delhi in 2018 and 2019 and 3 international webinars in 2020.

In 2019, Looking Beyond the Eye, an annual meeting of eye and systemic diseases at LVPEI, Visakhapatnam, focused on the theme of “Neuroimaging in common neuro-ophthalmological conditions.” The meeting brought together neuro-ophthalmologists, neurologists, neurosurgeons, and neuroradiologists under one roof and was very well appreciated by the delegates.

COVER (Congress on Optic Nerve Vasculature and Emerging treatment), a Continuing Medical Education on optic nerve, is conducted by NN, Bangalore, every 4 years with national and international faculty in neuro-ophthalmology and glaucoma giving their best inputs and sharing the latest treatment protocols.

Neuro-ophthalmology is included in ophthalmology course curricula and in the programs of all major ophthalmology conferences, such as the annual meetings held by the All India Ophthalmological Society and Delhi Ophthalmological Society.

India took the lead by organizing the first ever Global Neuro-Ophthalmology Case Festival webinar on September 26–27, 2020, with Drs. Neil Miller, Gordon Plant, Mark Kupersmith, Valerie Purvin, and Andrew Lee among several eminent neuro-ophthalmologists discussing a variety of interesting and challenging cases. It was attended live by more than 1,000 participants each day.

Research and Publications

India's scientific contributions to the field of neuro-ophthalmology include more than 238 articles and 11 textbooks published between 1970 and 2020, most of these in the past 2 decades (see Supplemental Digital Content , Table 1, https://links.lww.com/WNO/A465 ).

A text book of neuro-ophthalmology was written by Dr. Natchiar in 1985 ( Fig. 3 ), which was the first of its kind for postgraduates, and it was widely read throughout the country.

Dr. Vimla Menon's pioneering research includes determining the role of dexamethasone as a replacement for methylprednisolone in treatment of optic neuritis. One of the first research publications in neuro-ophthalmology from the RP Center, New Delhi, was on the role of visual-evoked potentials (VEP) in optic atrophy published in Indian Journal of Ophthalmology in 1982. Since then, the RP Center has contributed 60 publications in various peer-reviewed journals. The RP Center has pioneered research in the field of optic neuritis including description of distinct features of optic neuritis in Indian population, role of VEP, optical coherence tomography (OCT), functional MRI, and microperimetry. Research on the role of dexamethasone as a substitute for methylprednisolone in the management of optic neuritis, the role of steroids in NAION, ethambutol-related toxic optic neuropathy, and profile of LHON has been completed.

The RP Center has multiple publications on the profile and management of cranial nerve palsy, particularly various innovations in the management of third nerve palsy. Various studies have been conducted in collaboration with departments of neurology, neuroradiology, and pediatric neurology at AIIMS, Delhi, in fields of optic neuritis, multiple sclerosis, parkinsonism, Alzheimer disease, idiopathic intracranial hypertension (IIH), and neurodevelopmental disorders in children.

The neuro-ophthalmology team at SN, Chennai, published the Sankara Nethralaya Atlas of Neuro-Ophthalmology in 2003 and its second edition in 2007 ( Fig. 4 ). In 2015, SN released the Atlas of Neuroimaging in Ophthalmology authored by Drs. Ambika, Veena Noronha, and Padmaja.

Some of the faculty at LVPEI are doing research on important conditions including atypical optic neuritis, atypical presentations of IIH, and cerebral venous sinus thrombosis.

The Department of Ophthalmology at Guru Nanak Eye Center, Delhi, has conducted many thesis projects, such as electrophysiological changes in glaucoma, central serous retinopathy, diabetic retinopathy, amblyopia, optic neuritis, anterior ischemic optic neuropathy, central retinal vein occlusion, ethambutol toxicity in adults and children, and traumatic optic neuropathy. They also did 4 thesis projects for Master of Chirurgiae (neurosurgery) on visual functions, field changes, OCT changes, and electrophysiological changes before and after surgical removal of anterior visual pathway compressive lesions and lesions of occipital cortex.

As the understanding of disease mechanisms continues to improve in this high-technology era and new treatment modalities for neuro-ophthalmic conditions become available, several new fellowship programs will arise and the number of practicing neuro-ophthalmologists in India will undoubtedly increase.

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Neuro-Ophthalmology Cases for the Neurologist

Affiliations.

• 1 Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, 6560 Fannin Street, Scurlock 450, Houston, TX 77030, USA.
• 2 Department of Ophthalmology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA.
• 3 Department of Neurobiology and Anatomy, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 7.420, Houston, TX 77030, USA.
• 4 Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, 6560 Fannin Street, Scurlock 450, Houston, TX 77030, USA; Department of Ophthalmology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA; Department of Ophthalmology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Ophthalmology, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA; Department of Neurology, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA; Department of Neurosurgery, Weill Cornell Medicine, 1300 York Avenue, New York, NY 10065, USA; Section of Ophthalmology, UT MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Electronic address: [email protected].
• PMID: 27445244
• DOI: 10.1016/j.ncl.2016.04.005

Neurologists should be aware of specific urgent and emergent neuro-ophthalmic conditions, including giant cell arteritis, arterial dissection, intracranial aneurysm, pituitary apoplexy, and invasive sino-orbital fungal infection (eg, mucormycosis). Early recognition and treatment can greatly impact patient morbidity and mortality, including the preservation of vision and life. Neurologists should be cognizant of the key and differentiating clinical and radiographic features for these presentations.

Keywords: Arterial dissection; Giant cell arteritis; Intracranial aneurysm; Mucormycosis; Pituitary adenoma and apoplexy.

Copyright © 2016 Elsevier Inc. All rights reserved.

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Doheny Eye Institute Announces Upcoming Presentations at ARVO 2024 Annual Meeting

Doheny eye institute announced that more than 25 of its scientists and clinician-scientists will present their latest research during the upcoming association for research in vision and ophthalmology (arvo) annual meeting, the premiere gathering for eye and vision scientists from across the globe..

PASADENA, Calif., April 24, 2024 (GLOBE NEWSWIRE) -- Doheny Eye Institute , one of the nation’s leading vision research institutions, announced that more than 25 of its scientists and clinician-scientists will present their latest research during the upcoming Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting, the premiere gathering for eye and vision scientists from across the globe. The meeting will take place May 5-9, 2024 in Seattle at the Seattle Convention Center. Doheny Eye Institute and UCLA Stein Eye Institute will also be exhibiting together onsite at Booth #4515.

Doheny and UCLA Stein Eye Institute will kick-off their joint presence at ARVO by hosting a breakfast forum on the topic of Fresh Perspectives on Retinopathy on Sunday, May 5, from 6:30 a.m. to 8:00 a.m. PDT. Kaustabh Ghosh, PhD, will moderate the session. The breakfast will take place in the Menzies Suite of the Grand Hyatt Seattle located at 721 Pine Street. ARVO attendees who are interested in attending the breakfast can learn more and RSVP at this link .

“Doheny Eye Institute is eager to share our latest findings and exchange insights with other leaders in vision research during the ARVO Annual Meeting,” said Deborah A. Ferrington, PhD, Chief Scientific Officer at Doheny Eye Institute. “This is an important opportunity to further discussions, knowledge and ideas as we all work together towards the common goal of eyesight for all.”

Dr. Ferrington was selected to present a mini-symposium session at ARVO:

Mini-Symposium Session Topic: Genotype-Specific Differences in Mitochondrial Function Specific to the CFH Y402H Risk Allele Associated with AMD Who: Deborah A. Ferrington, PhD Location: 606 - Seattle Convention Center - Arch Building Session: 538 Abstract Number: 6468 When: May 9 from 2:45 p.m. until 3:00 p.m. PDT

In addition to the highly selective mini-symposium session, Doheny scientists will participate in 28 paper and poster presentations during the ARVO annual meeting. The body of Doheny research to be shared at the conference spans from breakthrough findings for diseases, such as age-related macular degeneration and diabetic retinopathy, to advanced discoveries in neuro-ophthalmology, retinal cell biology and visual neuroscience.

At the conclusion of ARVO 2024, SriniVas R. Sadda, MD, the Director of Artificial Intelligence & Imaging Research at Doheny, will officially step into his role as President of ARVO. His term will run through the ARVO Annual Meeting in 2025. Dr. Sadda has served as ARVO President-Elect over the past year.

A complete list and schedule for all of the Doheny Eye Institute and UCLA Stein Eye Institute research presentations is available by clicking this link .

About Doheny Eye Institute Doheny Eye Institute is one of the nation’s leading vision research institutions with a history dating back over 75 years. Doheny scientists and clinician-scientists remain at the forefront of vision science investigating how retinal neurons function in health and in diseases, such as diabetic retinopathy, optic neuropathies, uveitis, age-related macular degeneration, and the use of artificial intelligence for improved diagnosis of ocular diseases.

Since 2013, the Doheny and UCLA Stein Eye Institute affiliation combines the strength, reputation, and distinction of two of the nation’s top eye institutions to advance vision research, education, and patient care in Southern California. Together, Doheny Eye Institute and UCLA Stein Eye Institute are ranked in the Top 5 vision centers in the country by U.S. News & World Report.

For more information visit www.Doheny.org .

Contact: Molly Ann Woods Doheny Eye Institute 310-717-0955 [email protected]

Debbie Ehrman FINN Partners [email protected]

Locum Consultant Neuro-ophthalmologist

Job posting for locum consultant neuro-ophthalmologist at university hospitals birmingham, job summary.

Applications are invited for the post of Consultant Neuro-Ophthalmologist at the University Hospitals Birmingham NHS Foundation Trust (UHB). The post will be based on a full time 10 PA permanent contract. This is an additional post to manage emergency work from the region, including the Birmingham Midland Eye Centre.

Ophthalmology is located at four hospital sites as part of UHB which are: Queen Elizabeth Hospital Birmingham (QEHB), Heartlands Hospital Birmingham (HHB), Solihull Hospital (SH) and Good Hope Hospital (GHH).

There are more than 30 substantive consultants who provide an outpatient and surgical service. The entire range of Ophthalmology sub-speciality clinics are provided and there is a close communication with consultants in other specialities.

As well as consultant ophthalmologists the eye service is supported by ophthalmic specialist trainees, staff-grades, fellows, orthoptists, optometrists, ophthalmic nurses and ophthalmic technicians. There is a programme of training for extended roles, with Clinical Nurse Specialists in a number of specialities.

Imaging facilities vary across the hospital sites depending on the service needs, however, it currently includes OCT, OCTA, Bluepeak AF, Multicolour, HRA-OCT for FFA/ICG, California UWF Optos, Ultrasound, UBM, AS-OCT, Corneal topography and research access to FLEX mobile Spectralis and Anterion SS AS-OCT. In addition, UHBFT has a substantial neuro-radiology department with access to the full range of neuro-imaging facilities.

Main duties, tasks & skills required

This is an additional post to support UHB Ophthalmology services in Neuro-ophthalmology and the successful applicant will be expected to establish a service to help meet the clinical requirements of the emergency workload from across the region. It is anticipated that the post holder will have post-CCT subspecialty training in Neuro-ophthalmology. The post holder will be expected to contribute to the research portfolio of the department. Whilst the majority of sessions are likely to take place at QEHB, there may be a clinical need for sessions to also be at any of the other hospital sites also.

Flexibility with regard to the timetabling of fixed sessions will be expected. We are working towards a three session day so some of the timetabled fixed sessions may be evening sessions and/or weekend sessions. We are also increasing our provision of community ophthalmology and thus clinics may include review of remotely acquired investigations. Flexible/annualised sessions may be included for some theatre sessions to support the department maximising theatre capacity for our patients.

On-Call Duties

At present there are no regular on-call or out of hours duties. The trust is a Stage one Trauma Centre and out of hours provision at UHB may be necessary in the future. It is expected that the clinical team participate in supporting the review of ward referrals in clinic.

We are recognised as one of the leading NHS Foundation Trusts in the UK. Our vision is to Build Healthier Lives, and we recognise that we need incredible staff to do this.

Our commitment to our staff is to create the best place for them to work, and we are dedicated to:

Investing in the health and wellbeing of our staff, including a commitment of offering flexible working where we can; Offer our staff a wide variety of training and development opportunities, to support their personal and career development objectives.

UHB is committed to ensuring that our staff are treated fairly and feel that they belong, by creating a kind and inclusive environment. This is about equity of opportunity; removing all barriers, including discrimination and ensuring each individual member of staff reach their true potential, achieve their ambitions and thrive in their work. This is more than words. We are taking action. Our commitment to an inclusive culture is embedded at all levels of the organisation where every voice is heard, driven by our diverse and active staff networks, and at Board level by the Fairness Taskforce led by our CEO. We nurture a culture which empowers staff to challenge discriminatory behaviours and to enable people to bring their 'whole self' to a kinder, more connected and bold place to work.

University Hospitals Birmingham is a Smoke-Free premises hospital.

Job description

Clinical Governance

The appointee will be expected to participate in all aspects of clinical governance as developed by the Trust to monitor, maintain and develop the quality and effectiveness of care.

The Trust is committed to the development and maintenance of the highest clinical standards through individual appraisal. This will include the audit of personal and clinical practice as well as involvement in departmental and speciality reviews. It will also involve attention to continuing professional development and to meeting requirements for continuing medical education as expected by the Royal College of Ophthalmologists. It will also involve the awareness of professional standards and the responsibility to undertake safe and ethical clinical practice and the importance of responding promptly to any circumstances, which may result in increased clinical risk or adverse outcome.

• Extensive experience of general ophthalmology and medical management of patients with Neuro-ophthalmic complaints. Interpretation of neuro-imaging.
• Established portfolio of teaching experience.
• Ability to establish good working relationships with staff and be able to communicate well with patients.
• Flexibility.
• Good organisational skills and time management.

Person specification

Qualifications.

• Full GMC Registration. On the Specialist Register or within 6 months of completion of training.
• CCST or CCT.
• FRCOphth or equivalent.

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

Certificate of Sponsorship

Applications from job seekers who require current Skilled worker sponsorship to work in the UK are welcome and will be considered alongside all other applications. For further information visit the UK Visas and Immigration website.

From 6 April 2017, skilled worker applicants, applying for entry clearance into the UK, have had to present a criminal record certificate from each country they have resided continuously or cumulatively for 12 months or more in the past 10 years. Adult dependants (over 18 years old) are also subject to this requirement. Guidance can be found here Criminal records checks for overseas applicants.

UK Professional Registration

Applicants must have current UK professional registration. For further information please see NHS Careers website.

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August is Children’s Eye Health and Safety Month

The nonprofit Prevent Blindness recognised the awareness month with a slate of resources

Prevent Blindness will offer free resources including fact sheets, social media graphics and toolkits throughout the month. Image credit: ©AntonioDiaz – stock.adobe.com

August is Children’s Eye Health and Safety Month. Prevent Blindness, a US-based nonprofit, has launched a dedicated website to educate parents, caregivers, professionals and policy makers on the important role vision and eye health plays in a child’s development, learning ability and social engagement.

According to a news release, Prevent Blindness will offer free materials on children’s vision issues, such as myopia and amblyopia, provide information on access to eye care, and encourage US-based participants to advocate for federal funding for state and community children’s eye health programs. 1

“Back in 1908, Prevent Blindness began as an organisation dedicated to eradicating blindness in newborns. More than a century later, we continue to promote children’s vision and eye health through public education and by advocating for support of programs that provide access to eyecare,” said Jeff Todd, president and CEO of Prevent Blindness. “We encourage everyone to join us in this mission, and find out how to help us put our kids on the path to a lifetime of healthy vision.”

Volunteer researchers with the National Center for Children’s Vision and Eye Health at Prevent Blindness has authored a report, titled Association of Sociodemographic Characteristics with Pediatric Vision Screening and Eye Care: An Analysis of the 2021 National Survey of Children’s Health . 2 The researchers found that only 53 % of children in the US received a vision screening in 2021. This disparity is more pronounced among children from disadvantaged backgrounds. 

The organisation stressed that early detection and treatment is key. Without it, uncorrected vision disorders can impair healthy development, interfere with learning, and even lead to permanent vision loss. However, vision screening and regular eye care can help detect and treat potentially irreversible vision impairment. Visual functioning is a strong predictor of academic performance in school-age children.

Prevent Blindness will offer free resources including fact sheets, social media graphics, toolkits, videos and webpages on a variety of topics on children’s vision from infancy through adolescence. The NCCVEH, now celebrating its 15th anniversary, offers on getting children ready for school, taking a child to an eye doctor, preparing a child for wearing glasses or contact lenses, tips for preventing eye injuries, and much more. 3

The non-profit recognises ocular health awareness months throughout the year. In late February, Prevent Blindness kicked off its “Retinopathy of Prematurity (ROP) Education and Support Programme” as part of the inaugural ROP Awareness Week. It offers fact sheets and social media graphics in both English and Spanish as well as a dedicated web page and video series that includes patients with ROP, parents of children with ROP, a paediatric ophthalmologist, psychologist, ROP nurse and family support organisations.

The Prevent Blindness Focus on Eye Health Expert Series has free episodes dedicated to a wide range of children’s vision and eye health topics including: 5

• “ Children’s Vision and Eye Health ,” with R.V. Paul Chan, MD, MSC, MBA, FACS, Head, Department of Ophthalmology and Visual Sciences, The John H. Panton Professor of Ophthalmology, University of Illinois at Chicago College of Medicine, and Director, Pediatric Retina and Retinopathy of Prematurity Service, Illinois Eye and Ear, UI Health. Dr. Chan is also a volunteer member of the  Prevent Blindness Board of Directors .
• Through a partnership with Delta Gamma, “ Children's Vision and Parent Advocacy ,” featuring Lauren C. Ditta, MD, Pediatric Neuro-Ophthalmologist at Le Bonheur Children's Hospital and Associate Professor of Ophthalmology and Paediatrics at Hamilton Eye Institute, University of Tennessee Health Science Center, and Delta Gamma alumna.
• “ Partnering with School Nurses for Children's Vision and Eye Health ,” with Donna Mazyck, MS, RN, NCSN, CAE, FNASN, former Executive Director of the National Association of School Nurses (NASN).

The Office of Head Start’s National Center for Health, Behavioural Health and Safety is offering “Emerging Eye Health Issues in Young Children.” 6 Expert speakers include Donna Fishman, director of the NCCVEH; Elise B. Ciner, OD, FAAO, Pennsylvania College of Optometry at Salus University; and Fuensanta A. Vera-Diaz, PhD, OD, Associate Professor of Optometry, New England College of Optometry, and volunteer on the Prevent Blindness Scientific Committee, who provided information on myopia prevention.

Additional general information on children’s eye health and safety , and more on the NCCVEH and its variety of programs , is available online.

References:

Prevent blindness declares august as children’s eye health and safety month to educate parents, professionals, and government leaders on the importance of healthy vision for kids - prevent blindness. published july 30, 2024. accessed july 30, 2024. https://preventblindness.org/2024-childrens-vision-month/, antonio-aguirre b, block ss, asare ao, baldanado k, ciner eb, coulter ra, decarlo dk, drews-botsch c, fishman d, hartmann ee, killeen oj, yuen j, collins me. association of sociodemographic characteristics with pediatric vision screening and eye care: an analysis of the 2021 national survey of children's health. ophthalmology. 2024 may;131(5):611-621. doi: 10.1016/j.ophtha.2023.12.005. epub 2023 dec 10. pmid: 38086435., your child’s sight - national center. accessed july 30, 2024. https://nationalcenter.preventblindness.org/your-childs-sight/, focus on eye health expert series - prevent blindness. published april 9, 2018. accessed july 30, 2024. https://preventblindness.org/focus-on-eye-health-expert-series/, emerging eye health issues in young children | eclkc. eclkc.ohs.acf.hhs.gov. published july 9, 2024. accessed july 30, 2024. https://eclkc.ohs.acf.hhs.gov/video/emerging-eye-health-issues-young-children.

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