We provide professional support in NEURO OPHTHALMOLOGY.
As old as the history of humanity, headache is the most common medical complaint and affects more than 80% of the population. One of the causes of headaches is eye-related problems. Patients complaining of headaches are often referred to an ophthalmologist by another doctor. Neuro-ophthalmology is the field of science which treats headaches associated with ocular diseases and deals with common disorders of the ocular and nervous system.
In order for an object to be seen, its image must first be perceived in the eye and then in the visual cortex located in the back of the brain. When there is a problem with the visual tracts, sudden or progressive losses of vision may occur. In diseases related to ocular movements, double vision is the main symptom and the problem can be about eye muscles, nerves or the brain’s control centers. Patients with such complaints as temporary vision loss or double vision, hallucination, drooping eyelids and difference in pupil size are also handled by neuro-ophthalmology. The patient’s history is crucial for accurate diagnosis of head-eye aches. Success of this treatment is possible through doctor-patient collaboration and continuous follow up.
Inflammation of the optic nerve (optic neuritis) is an ocular disease which most frequently occurs between 18-45 years, is more common in women and characterized by unilateral, painful loss of vision. It manifests itself in the form of an attack as a result of a compromised immune system. Color perception and brightness is also reduced in the painful eye. In nearly 1/3 of patients, edema forms in front of the optic nerve; in most cases there is retention in the (posterior) parts of the nerve that are close to the brain.
At diagnosis stage, VEP (visually evoked potential) and OCT (Optical Coherence Tomography Scanner) are used at our clinic to examine appearance of the nerve fiber layer and vision area is examined via computer. Brain lesions are investigated through MR imaging of the brain. The number and shape of these lesions (spots) is important in identifying MS risk. MS is a chronic brain disease progressing with attacks.
Optic neuritis may be the first finding of the onset of MS. A disorder of the optic nerve resolves to a large extent in 3-5 weeks. However, optic neuritis attacks may recur. The rate of recurrence within 10 years is 35%. Optic neuritis has a 50% likelihood of occurring at any stage of MS disease and is the first finding of MS in 20% of patients.
The risk of developing MS after optic neuritis is 30% in the first 5-7 years and around 75% in 15-20 years in women.
MS attacks may occur in the form of optic neuritis, double vision and numbness and weakness in the limbs.
Current approaches in the treatment of optic neuritis include IV administration of high-dose cortisone and the use of interferon when the risk of MS is high.
The course of the disease after optic neuritis can be identified through periodic OCT nerve fiber layer analyses. If the OCT nerve fiber layer is becoming thinner, this means that the number of plaques in the brain is increasing. Follow up with OCT and VEP tests is very important and instructive in this disease.
Other Diseases of the Optic Nerve
• Infarction (intraocular injections are possible)
• Toxicity (ethambutol and methyl alcohol toxicities are the most common; treatment is possible if the patient presents without delay)
• Hereditary (a new drug has been developed for Leber optic neuropathy)
• Traumatic (early presentation of the patient is important)
Today, Alzheimer’s disease and Parkinson’s disease, which are diseases of the brain, and glaucoma and macular degeneration (yellow spot disease), which are ocular diseases, are described as progressive (neuro-degenerative) disorders of the nerve tissues. Studies have been undertaken to investigate their shared characteristics and important information has been discovered. The OCT examination used for the diagnosis and treatment of glaucoma and yellow spot disease is now used for Alzheimer’s and Parkinson’s disease as well. OCT provides diagnostic results in detailed eye examinations (for glaucoma, yellow spot disease etc.) and reveals very specific findings in conditions like Alzheimer’s-Parkinson’s disease and mildly impaired consciousness. Such specific findings are characterized by damaging and thinning in specific regions of either the retina or optic nerve fibers. Losses in nerve fibers are significant in the early diagnosis of Alzheimer’s and Parkinson’s disease. Nerve fiber thinning can be identified by OCT before the brain’s regions for memory, movement etc. are damaged, allowing early diagnosis and treatment. Scanning of the retina and optic nerve fibers by OCT, a short and easy imaging method, in people with certain complaints or familial history of Alzheimer’s and Parkinson’s disease plays a major role in early diagnosis of the disease.
Diagnosis and close follow up of treatment with a retinal examination (FAF and OCT) is important for success. Retinal examination allows early diagnosis. Treatments have been started to prevent progression in patients diagnosed at an early stage. Because of genetic factors, people with a familial history of Alzheimer’s and Parkinson’s disease should have regular eye examinations after the age of 50.
Optic Neuritis (Inflammation of the optic nerve)
Inflammation of the optic nerve (optic neuritis) is an ocular disease which most frequently occurs between 18-45 years, is more common in women and characterized by unilateral, painful loss of vision. It manifests itself in the form of an attack as a result of a compromised immune system. Color perception and brightness is also reduced in the painful eye. In nearly 1/3 of patients, edema forms in front of the optic nerve. In most cases, there is retention in the (posterior) parts of the nerve that are close to the brain.
At diagnosis stage, VEP (visually evoked potential) and OCT (Optical Coherence Tomography Scanner) are used at our clinic to examine appearance of the nerve fiber layer and computer vision area.
Ischemic Optic Neuropathy
It occurs due to accumulation of edema and blood in the optic nerve after occlusion of the capillaries supplying the nerve. It is seen frequently in patients with hypertension and diabetes. Intraocular injections can be made for treatment.
Optic Nerve Toxicity
Ethambutol (the drug used for tuberculosis treatment) and methyl alcohol toxicities (cologne, counterfeit alcoholic drinks etc.) are the most common forms. Treatment is possible if the patient presents without delay.
Hereditary Optic Neuropathy
Leber optic neuropathy is a maternally-inherited, bilateral vision loss. A drug has been launched abroad to treat this disease or improve vision.
Traumatic Optic Neuropathy
It develops following direct impact to the eye or head trauma. Early diagnosis is important in treatment.
• FFA (Angiography of the eye)
• OCT (Optic Nerve Scanning)
• VEP (Visual tracts between the brain and the eyes)