neuro-ophthalmology

A WINDOW TO YOUR BRAIN

What is Neuro-Ophthalmology?

Neuro-ophthalmology is a clinical discipline that represents the intersection between neurology and ophthalmology. Eye and pupil movements are sensitive biomarkers for brain disorders affecting the visual and the oculomotor pathways.

Extraocular muscle control and pupillary function is complex and involves multiple brain areas, including the cerebellum, brainstem, cerebral cortex, and the basal ganglia. Because of this, oculomotor function can be affected by many different inflammatory, neurodegenerative, and rare diseases including:

MEASURING BRAIN FUNCTION

Challenges in today's diagnostics

Today, assessments of eye movements and pupillary function are performed by a wide range of healthcare professionals including neuro-ophthalmologists, orthoptists, neurologists, ophthalmologists, and optometrists. Examinations can be time-consuming and results are largely qualitative.

Moreover, there is a scarcity of neuro-ophthalmologists around the world. The consequences are important and sometimes devastating for patients and the health system in general (e.g., undetected brain tumors, delayed start of therapy for multiple sclerosis etc.). In fact, studies have shown that there is a misdiagnosis rate of up to 70% before a patient sees a neuro-ophthalmolgist.

Imaging techniques such as OCT and MRI cannot compensate for these shortcomings. They are useful to identify structural damage, and are complementary to assessments of functional loss.

A NEW APPROACH

Improving neuro-ophthalmic assessments

We believe objective eye exams increase healthcare provider efficiency, reduce clinical error, and will support the early diagnosis and monitoring of neurological and ophthalmic diseases.

Automated, objective examinations enable neuro-ophthalmic assessments to be systematically performed and replicated, relieving the need for manual examinations, and even enabling telemedical practice.

Quantitative measurements of eye movements and pupillary function enable longitudinal monitoring of symptom onset and disease progression, and provide essential data to support further workup and referrals.

See the science behind it

Visual processing and oculomotor control involve large areas of the brain. Therefore, the majority of disorders of the central nervous system show visual signs or symptoms. The basic circuitry of visual- and oculomotor processing is well known - please find here some interesting studies and articles.

Virtual Reality Pupillography swings the flashlight on Glaucoma Management

RAPD measurements reliably detected asymmetries in optic nerve damage in glaucoma patients. SAP and RAPD combined led to an improved prediction of RNFL thickness, as measured by OCT.

Study shows great potential to automate quantitative pupillometric tests

Researchers at the University Hospital of Bern, Inselspital, present an accurate, easy to use, and fast method to measure an Relative Afferent Pupillary Defects / RAPD. In contrast to today's clinical practice, the measures are quantitative and objective.

Diagnosis and classification of optic neuritis -
The Lancet, Aug 2022

Accurate diagnosis of optic neuritis at presentation can facilitate the timely treatment of individuals with multiple sclerosis, neuromyelitis optica spectrum disorder, or myelin oligodendrocyte glycoprotein antibody-associated disease.

Ocular motor study in patients with Niemann Pick disease Type C

Eye movement abnormalities are sensitive markers in neurodegenerative disorders. One such rare autosomal recessive inborn error of metabolism is Niemann-Pick disease type C (NPC), caused by a mutation in the NPC1 (95%) or NPC2 genes.

Oculomotor and Vestibular Findings in Gaucher Disease Type 3

This study shows neuronal degeneration of the brainstem and cerebellum with combined involvement of both supranuclear and nuclear oculomotor structures and the vestibular system in GD3.

Diagnostic Error of Neuro-ophthalmologic Conditions: State of the Science

Diagnostic error is prevalent and costly, occurring in up to 15% of US medical encounters and affecting up to 5% of the US population. One-third of malpractice payments are related to diagnostic error. A complex and specialized diagnostic process makes neuro-ophthalmologic conditions particularly vulnerable to diagnostic error.

Patient Harm Due to Diagnostic Error of Neuro-Ophthalmologic Conditions

Misdiagnosis of neuro-ophthalmic conditions, mismanagement before referral, and preventable harm are common. Early appropriate referral to neuro-ophthalmology may prevent patient harm.

The human resource crisis in neuro-ophthalmology

Neuro-ophthalmology is facing a serious human resource issue. Few are entering the subspecialty, which is perceived as being poorly compensated compared with other subspecialties of ophthalmology.

The neuro-ophthalmological examination

The neuro-ophthalmological examination constitutes one of the most refined and exact components of the clinical examination, often allowing precise diagnosis and formulation of a treatment plan even within the compass of the first visit.

A window to your brain