Neuro-ophthalmology is a branch of ophthalmology that entails neurologic disorders affecting the visual system. Neuro-ophthalmology is within the scope of training and experience of a board certified ophthalmologist. A clinical history and ophthalmic examination are important factors that enable an ophthalmologist to arrive at opinions that are based on scientific principles.
The clinical history is based on the chief complaint of the injured party. Usually, the chief complaint consists of a visual disturbance of the sharpness of vision (acuity) or visual field, double vision (diplopia), and some form of sensory disturbance such as headache, numbness, or tingling sensation. Specific questions may be used to elaborate on the claimant’s chief complaint.
Historical facts are considered when an expert provides pertinent testimony. The date of onset of symptoms is usually an important consideration as well as whether the symptoms are stable, progressing, or resolving. The past work-up of the injured party by other physicians may contribute to an understanding of the injured party’s problem and prognosis.
Disturbances of the visual system are explored in neuro-ophthalmology expert testimony. For example, it is important to ascertain if the visual disturbance is in one or both eyes since this information helps the ophthalmologist localize the problem along the neuro-ophthalmic pathway.
The speed of progression is another important variable. Gradual or sudden visual disturbance will usually help distinguish a slowly progressive disorder such as a tumor from a sudden onset disorder from a problem arising in the circulation. A visual disturbance that presents as an intermittent problem can be due to an inflammatory disease such as temporal arteritis or carotid artery disease. The visual field exam can be useful in further defining the area affected in the disease process.
Neuro-ophthalmology expert testimony may consider findings from an eye examination to support testimony. Depending on circumstances, considerations for testing include measurement of visual acuity and external examination of the skull, face, and area around the eyes. Testing of color vision, Amsler grid, pupils, and ocular motility are also considered. Slit lamp examination of the eye and fundus examination are within the scope of an ophthalmic evaluation. Finally, visual field examination, also known as perimetry, can be an important factor when determining neuro-ophthalmic diagnosis since many neurologic disorders may affect the peripheral vision in specific patterns.
The prognosis of an injury depends on an accurate diagnosis. For example, a pituitary tumor that has started to affect the optic nerve and cause visual field loss may be successfully treated with appropriate surgery. Conversely, an embolic stroke involving the occipital cortex of the brain may result in permanent vision impairment. Trauma to the neuro-ophthalmic pathway needs to be considered on a case by case basis for an ophthalmology expert to proffer opinions based on medical fact.
Neuro-ophthalmology expert testimony by a board certified ophthalmologist is often helpful when evaluating the diagnosis and prognosis of neurologic injuries that affect the vision system. A comprehensive understanding of neurologic and ophthalmologic issues can be essential when presenting credible medical opinions.
The prognosis of an injury depends on an accurate diagnosis. For example, a pituitary tumor that has started to affect the optic nerve and cause visual field loss may be successfully treated with appropriate surgery. Conversely, an embolic stroke involving the occipital cortex of the brain may result in permanent vision impairment. Trauma to the neuro-ophthalmic pathway needs to be considered on a case by case basis for an ophthalmology expert to proffer opinions based on medical fact.
Neuro-ophthalmology expert testimony by a board certified ophthalmologist is often helpful when evaluating the diagnosis and prognosis of neurologic injuries that affect the vision system. A comprehensive understanding of neurologic and ophthalmologic issues can be essential when presenting credible medical opinions.
The prognosis of an injury depends on an accurate diagnosis. For example, a pituitary tumor that has started to affect the optic nerve and cause visual field loss may be successfully treated with appropriate surgery. Conversely, an embolic stroke involving the occipital cortex of the brain may result in permanent vision impairment. Trauma to the neuro-ophthalmic pathway needs to be considered on a case by case basis for an ophthalmology expert to proffer opinions based on medical fact.
Neuro-ophthalmology expert testimony by a board certified ophthalmologist is often helpful when evaluating the diagnosis and prognosis of neurologic injuries that affect the vision system. A comprehensive understanding of neurologic and ophthalmologic issues can be essential when presenting credible medical opinions.
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