A neuro-ophthalmologist is an eye doctor who deals with vision or eye problems associated with conditions of the brain and nervous system. So, for example, a neuro-ophthalmologist would be called to examine an individual who is experiencing vision loss following a brain injury or a patient who has difficulty controlling their eye movements.

In order to become a neuro-ophthalmologist, one must be certified in ophthalmology and neurology. The certification ensures that the doctor has significant knowledge and expertise in problems affecting both the eyes and the nervous system. 

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Conditions a neuro-ophthalmologist treats

While neuro-ophthalmologists can diagnose and treat many conditions, the most common issues they deal with include:

Outside of these conditions, there are certain symptoms that may lead an eye doctor to refer a patient to a neuro-ophthalmologist, including:

• Sudden, unexplained loss of vision 

• Reduced or blurred vision

• Double vision (diplopia)

• Blind spots

• Other persistent vision disturbances

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What happens during a neuro-ophthalmology exam?

The nervous system, according to the National Institute of Health, is made up of two parts: 

• The central nervous system, which includes the brain and spinal cord

• The peripheral nervous system, which includes all the nerves that branch off of the spinal cord and extend throughout the body

With that in mind, the Review of Optometry explains that a neurologic exam can be broken up into five steps:

Mental status exam 

At the beginning of the exam, the eye doctor will typically ask you a series of simple, casual questions. While this generally seems like natural conversation to the patient, eye doctors do this to assess whether the patient is alert and oriented. 

If a patient is giving strange answers to questions, not giving answers at all, or acting confused, the eye doctor may choose to give them a mini mental status exam (MMSE). A MMSE is a quick questionnaire that assesses different facets of cognitive function like language, orientation and recall.

Cranial nerve testing

The brain has twelve pairs of cranial nerves that make different functions possible. Examples of these functions include vision (cranial nerve #2), pupil restriction and eyelid elevation (cranial nerve #3), and ocular mobility (cranial nerve #4).

During a routine eye exam, cranial nerves 2, 3, 4 and 6 are evaluated. Neuro-ophthalmological exams will test other cranial nerves to determine if an issue is present in the brain and, if so, where it’s located. Cranial nerves are located in different regions of the brain, so if the function of one or more cranial nerves is affected, it can help neuro-ophthalmologists map where the problem may be.

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Motor reflex evaluation

A neuro-ophthalmologist may check for tremors, tics or muscle weakness that could indicate a neurological issue that could affect eye movements and position.  

Coordination 

Tests of coordination — such as quickly touching your nose, then the doctor’s fingertip, then your nose again — also may be included during a neuro-ophthalmology exam to see if there may be neurological problems that could cause eye movement problems like nystagmus. 

General sensory exam 

A neuro-ophthalmologist may also check your ability to sense pressure, touch and other sensations to help evaluate your overall neurological health.

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