Neuro-ophthalmology

Treating problems with the eye-brain connection.

Your care starts with experience and extensive training

Neuro-ophthalmology is a relatively new subspecialty that deals with complex systemic diseases affecting the nervous system, resulting in vision loss or other visual problems that are not due to the eyes themselves. This also includes loss of sight due to injury to the brain or the optic nerves that transmit visual signals from the eyes to the brain.

Our neuro-ophthalmologists have first completed a residency in either neurology or ophthalmology, and then have completed a fellowship in the other field. They are board-certified in neurology, ophthalmology or both. Because many neuro-ophthalmic problems may have started with symptoms in places other than the eyes, we’ll get your detailed medical history and conduct a complete physical exam if we see clues of a systemic problem.

Not all vision problems originate from your eyes themselves. In some cases, vision loss or eye problems arise due to disease or damage that affects the brain or the optic nerve, the bundle of nerves that connect the eye to the brain. When this is the case, neuro-ophthalmology can help.

Neuro-ophthalmology is a subspecialty of both neurology – the study of the nervous system – and ophthalmology – the study of the eyes. Neuro-ophthalmologists are specialized doctors with expertise in both fields. Their dual expertise makes them uniquely qualified to evaluate, diagnose, and treat issues with your visual system that are related to the nervous system.

Neuro-ophthalmic conditions can be caused by several diseases and disorders that impact that nervous system, such as stroke, inflammation, brain tumors, trauma, infection, multiple sclerosis, and more. Anyone experiencing visual deficits because of these conditions may benefit from neuro-ophthalmology. Additionally, patients should also see a neuro-ophthalmologist if they have or are suspected of having:

  • elevated intracranial pressure (pressure inside the head)
  • abnormal eye movements or double vision
  • tumor on their pituitary gland or other areas which may put pressure on the optic nerve
  • unequal pupil sizes

These and other factors can impact the nervous system and cause vision loss. Our team of neuro-ophthalmologists can help diagnose and treat vision problems related to these conditions.

Your treatment will be determined by the cause(s) behind your symptoms, which can include:

  • Loss of vision from optic nerve disorders:
    • Optic neuritis, wherein swelling damages the optic nerve. This swelling may be related to multiple sclerosis or infections
    • Ischemic optic neuropathy,optic nerve damage that results from a blockage of the blood supply
    • Compressive optic neuropathy (e.g., from tumors).
    • Inherited disease.
  • Visual effects of cognitive and neurodegenerative diseases like Parkinson’s, Alzheimer’s and posterior cortical atrophy.
  • Vision problems from other neurological diseases, including myasthenia gravis, stroke and multiple sclerosis.
  • Thyroid eye disease (TED), an autoimmune condition wherein your immune system attacks your thyroid gland and your eye muscles. This causes the tissue of your eye to become inflamed. We can treat TED both medically and surgically.
  • Idiopathic intracranial hypertension (pseudotumor cerebri), a condition where the pressure around your brain increases. This can cause papilledema, swelling of the optic nerve. It can be treated with medication, surgery or cutting-edge nonsurgical procedures.
  • Tumors of the eye socket and brain that affect vision. We can perform all orbital surgery ourselves, plus more if needed with the skull-based surgery team at UCHealth

Double vision, also known as diplopia, is another common vision disorder that can be treated by neuro-ophthalmology. Many of the neurological disorders that cause double vision can be treated surgically by our team of specialists. Neurological disorders that can cause double vision include:

  • Cranial nerve palsies: a condition where your cranial nerves, which connect your brain to other parts of your body including your eye, lose functionality. This causes the affected eye to turn downwards even when you are staring straight ahead, leading to double vision
  • Trauma
  • Thyroid eye disease (TED): the inflammation caused by TED can stiffen your eye muscles, making it so that they cannot move in line with each other and leading to double vision
  • Tumors of the orbit (the structure surrounding the eye) or brain.
  • Adult strabismus (crossed eyes), which occurs when the eyes’ muscles are unable to move in sync. This can happen because of trauma, head injury, stroke, or diseases like diabetes and myasthenia gravis. It could also be residual from childhood strabismus. It is a relatively common occurrence

Neuro_Ophthalmology-X-Ray

Your treatment will be determined by the cause(s) behind your symptoms, which can include:

  • Loss of vision from optic nerve disorders:
    • Optic neuritis.
    • Ischemic optic neuropathy.
    • Compressive optic neuropathy (e.g., from tumors).
    • Trauma.
    • Inherited disease.
  • Visual effects of cognitive and neurodegenerative disease like Parkinson’s, Alzheimer’s and posterior cortical atrophy.
  • Vision problems from other neurological diseases, including myasthenia gravis, stroke and multiple sclerosis.
  • Thyroid eye disease (TED), which we can treat both medically and surgically.
  • Idiopathic intracranial hypertension (pseudotumor cerebri), a condition that may be treated with medication, surgery or cutting-edge nonsurgical procedures.
  • Tumors of the eye socket and brain that affect vision. We can perform all orbital surgery ourselves, plus more if needed with the skull-based surgery team at UCHealth.

Many neuro-ophthalmic disorders start with symptoms in places other than the eye, or they are caused by other medical conditions. For this reason, our specialists will begin your neuro-ophthalmology evaluation by getting your detailed medical history. You may be asked questions about your family history, current lifestyle, past hospitalizations, and any symptoms you have. We will also complete a physical exam to understand your current vision problems and look for clues of a systematic problem. This exam will involve evaluating your visual acuity, eye movement, color vision, and visual field tests. Additionally, we will closely examine your retina and optic nerve, and take measurements of your eye size, shape, and internal pressure.

Given the range of diseases and disorders neuro-ophthalmology covers, your treatment will depend on what condition is causing your vision problems. Getting the right diagnosis is critical to making sure you get your sight back, so your neuro-ophthalmologist will likely spend a significant amount of time with you during the first evaluation. Once you have been diagnosed with a specific condition, your neuro-ophthalmologist can begin assessing what additional testing is needed and what treatment is right for you.

You’ll love our unique approach

Your care starts with experience and extensive training. Our neuro-ophthalmologists have first completed a residency in either neurology or ophthalmology, and then have completed a fellowship in the other field. They are board-certified in neurology, ophthalmology or both and have years of experience treating a range of conditions. All of this means they are uniquely qualified to help you with your specific vision needs.

Because we offer the only dedicated neuro-ophthalmology department in the Rocky Mountain region, our doctors see a broader range of patients than other neuro-ophthalmologists in the country. When a patient is referred to us by another provider, we give them quick access to a diagnosis and treatment, usually within two weeks instead of the months required with other doctors. We also offer clinical trials that keep our treatments at the forefront.

Neuro_Ophthalmology-Consult

Your case is unlike any other to us. We will evaluate it from the neurologic, ophthalmologic and medical standpoints to best diagnose and treat you with a personalized plan. Our team will work with your other doctors to provide a coordinated plan to speed your recovery. Make an appointment today so we can work together on getting you back to doing the things you love in life.

Neuro-ophthalmology

Dr. Prem Subramanian MD, PhD, Neuro-ophthalmologist | UCHealth

Your eyes are in good hands

111 invention disclosures

40 active clinical trials

14 issued patents

4 “Inventors of the Year”

Meet your team

Dr-Prem-Subramanian

Dr. Prem Subramanian

“Taking care of patients with neuro-ophthalmologic problems is a challenge because it is so complex, and rewarding because we provide answers where others cannot.”

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Dr. Victoria Pelak

“Caring for patients within the field of neuro-ophthalmology for the past 20 years has been an enormous privilege, with so many stories of patients’ courage that will always inspire me.”

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Dr-Victoria-Pelak