Overcoming clinical challenges in Neuro-ophthalmology

Abstract

Neuro-ophthalmology is a subspecialty which requires expertise in both ophthalmological and neurological diseases, in particular an understanding of neurological diseases that can impact the function of the eye, or visa-versa. The efferent neurological pathways control eye movement, whereas the afferent visual system covers the visual information being received by the brain. The body of work submitted in this thesis represents the integration of my expertise in ophthalmic diagnosis and neuro-ophthalmic clinical practice. In particular the application of the principles of clinical electrophysiology of vision and retinal imaging, to further the understanding of pathophysiology, diagnosis and management of neuro-ophthalmically important conditions. The research is grouped into four areas linked by the application of diagnostic techniques in neuro-ophthalmic and systemic disease. The first chapter covers neuro-ophthalmic disease with significant systemic comorbidity, including optic neuritis, giant cell arteritis and migraine. This chapter also includes key papers on the pathophysiology of visual snow syndrome. In the second chapter the use of ophthalmic diagnostic methods to reveal of systemic conditions is reviewed. In particular the use of fundus imaging in the diagnosis of cases presenting to the emergency department. Also discussed are imaging techniques to reveal systemic issues in patients with obstructive sleep apnea and concussion. The third chapter reveals insights into rare and orphan neuro-ophthalmic disease, including intracranial hypertension and genetic optic neuropathies. The final chapter looks at the application of new diagnostic approaches of optical coherence tomography and the electrophysiology of vision in the field. A combination of structural and functional assessment in the neurological pathways of vision is critical to improve diagnosis, management, and prognostic understanding of disease processes.