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Neuro-Ophthalmology Service at the University of Washington Neuro-ophthalmology is the subspecialty of ophthalmology that studies the connections of the eye with the brain. Over half the human brain substance is concerned in some way with the act of seeing, and many disorders of the nervous system affect the eyes or vision. It is convenient to divide topics in neuro-ophthalmology into three groups: 1.
Those that concern the afferent visual system from the retina of
the eye all the way to the parts of the brain that interpret the image.
This system deals with the visual input to the brain.2.
Those that concern the efferent visual system from the brain to the
eye, controlling such things as eye movement and pupil constriction.3. Those that
concern other systems, such as pain sensation, eyelid closure and
opening, migraine with visual symptoms, and so forth. The
University of Washington neuro-ophthalmology service is dedicated to providing
world-class consultation and treatment. Working in conjunction with the
departments of neurology, neurological surgery, and neuroradiology, our
faculty neuro-ophthalmologists are capable of caring for the most complex
neurological illnesses. Appointments for consultation may be scheduled by
calling (206) 598-4011.James C. Orcutt, MD, PhD, concentrates his area of interest to diseases of the orbit. His fellowship training, in London, U.K., was at the National Hospital for Neurologic Diseases, with Professor Michael Sanders; Moorfields Eye Hospital, with Professor John Wright, where he studied the orbit; and the Hospital for Sick Children, with Professor David Taylor, where the focus was pediatric neuro-ophthalmology. Raghu Mudumbai, MD recently joined the faculty of the Department of Ophthalmology. Dr. Mudumbai completed his residency training at the State University of New York-Health Science Center at Brooklyn. He later completed a fellowship in glaucoma at the New York Eye and Ear Infirmary, followed by a fellowship in neuro-ophthalmology, orbit, and oculoplastics at the University of Minnesota, Minneapolis. Craig H. Smith, MD, and his associate Steven Hamilton, MD, are in private practice of neuro-ophthalmology in Seattle, and serve as neuro-ophthalmology attending physicians at the University of Washington Eye Center on a biweekly, rotating basis. Dr. Smith was a neuro-ophthalmology fellow at Wills Eye Hospital in Philadelphia, with Professors Savino and Schatz, and Dr. Hamilton was a neuro-ophthalmology fellow at Harvard with Professor Simmons Lessell. The afferent visual system consists of the following parts: 1.
Retina, beginning with the rods and cones that translate light into
electrical signals. The nervous impulse is transferred to other nerve cells
that transmit and organize the information from the rods and cones, and
finally transmit the information to the ganglion cells, whose long axons
(nerve fibers) travel across the surface of the retina and are gathered
together in the optic nerve.Optic
nerve. There are about 1.2 million axons of the ganglion cells in each
optic nerve, which is smaller around than a pencil. The optic nerve and
retina can be seen by looking through the pupil with an instrument called
an ophthalmoscope.  The
optic nerve carries the axons from the back of the eye, across the back
part of the eye socket, through a small hole in the skull, where it meets
the optic nerve from the other eye in the optic chiasm.3.
Optic chiasm. The two optic nerves mix together in the chiasm to
sort out information from the two eyes in a specific way. Both eyes look
at the same thing, and the information about that image is travelling in
each optic nerve. The two images match up, so the right and left eye information
about a part of the image travel together as they leave the chiasm and make
their way into the brain. This sorting occurs regardless of which eye the
fibers came from, since each eye sees both to the right and to the left
(try this by covering one eye).4.
Optic tracts. These two bundles of nerve fibers leave the optic chiasm
and carry the visual information to the lateral geniculate body of the thalamus.
Right visual information goes to the left thalamus, and vice versa.5. Lateral
geniculate body. The axons from the ganglion cells of the retina finally
end here in a synapse, or electrical connection between cells. The next
cell sends its axon further back in the brain.6.
Visual radiations. The output from the lateral geniculate body travels
posteriorly, towards the back of the brain, in a fan-like structure of axons.7. Occipital
cortex. The final destination in the primary visual pathway from the
retina is here, where "seeing" is said to occur. It is very close to the
back of the skull, just above where it hooks onto the neck.8.
Higher visual cortex. Many areas of the brain help to interpret the
visual image and give it meaning. These "association" areas of the cortex
are not well understood because they are so complex.T he efferent visual system consists of the following parts: 1.
Eye movement system. Commands to move the eyes originate in the front
part of the brain, and these impulses travel via nerve fibers to the brain
stem, where the actual nerves that control the eye muscles originate. These
commands are modified by other cells, such as those in the cerebellum, to
be sure they are accurate and controlled.2.
Pupil movement system. Variations in light level produce changes
in the size of the pupils in the eyes. These involuntary movements originate
in the brain stem and travel to the eyes via two sets of nerve channels:
 the
sympathetic nerves and the parasympathetic nerves. Examination of the pupil
is an integral part of the neuro-ophthalmic examination.3.
Focusing system. As we look at things in our environment, we change
the focus of the eyes in a process known as accommodation. The nerves for
this function travel in the parasympathetic system. As we age, our ability
to change focus decreases, forcing the need for reading glasses or bifocals.Other systems important to neuro-ophthalmology include: 1.
Sensation around the eye and eyelids.2.
Movement of the eyelids, such as eye opening and closing. The eyelid
also tracks with eye movement as the eyes look up and down.3.
Integration with other neurologic functions, including hearing, speaking,
thinking, and feeling. Generalized disorders of nerve can often produce
neuro-ophthalmic abnormalities. Other general conditions, such as migraine,
can also produce prominent eye symptoms.For further information, click on the following links:
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