A window to your brain

A majority of disorders of the central nervous system show visual signs or symptoms. Today, roughly 25% of patients with multiple sclerosis and 50% of patients with brain tumors are diagnosed based on neuro-ophthalmic symptoms.

What is Neuro-Ophthalmology?

Neuro-ophthalmology is a clinical discipline that covers brain disorders affecting the visual system. Pathologies at many locations can be detected because the visual system involves large areas of the brain.

Neuro-ophthalmology contributes to the diagnosis and monitoring of diseases such as multiple sclerosis and brain tumors and also rare disorders that are difficult to diagnose, for example Progressive Supranuclear Palsy or Niemann Pick Type C disease. 

Today, roughly 25% of patients with multiple sclerosis and 50% of patients with brain tumors are diagnosed based on neuro-ophthalmic symptoms. This percentage is likely to increase as diagnostics become more reliable.

Neurophthalmoscope_Info (1)
Neurophthalmoscope_Info (1)

Challenges in today's diagnostics

Today, neuro-ophthalmic examinations are mostly performed manually by specialized physicians. Examinations are time-consuming and results are largely qualitative.

This frequently leads to false or late diagnoses and there is great untapped potential for early diagnosis of brain disorders. The consequences are important and sometimes devastating for patients and the health system in general (e.g., due to non-detected brain tumors, delayed start of therapy for multiple sclerosis etc.).

Imaging techniques such as MRI cannot compensate for these shortcomings. They are useful to find structural damage, while the physical examination shows a functional loss.

Neuro-ophthalmic diagnosis

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.

RAPD Study

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. 

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The lancet

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. 

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european journal of neurology

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. 

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Frontiers in Neurology

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.

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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. 

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american academy of ophthalmology

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. 

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journal of neuro-ophthalmology

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. 

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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.

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