A Profile of Neuro-Ophthalmic Practice Around the World

To compare contrast neuro-ophthalmic practice in various countries, an 18-question survey was sent to the international North American Neuro-Ophthalmology Society (NANOS) members in the spring of 2016.; At least 1 NANOS member was contacted for each non-US nation in the NANOS membership roster. If there were multiple NANOS members from 1 country, multiple were contacted. If responses were received from more than 1 person from a single country, the first response received was used as the source data. The survey (in English) was emailed to 47 NANOS members from 31 countries. Twenty responses were received representing members from 15 nations.; In all 15 nations, at least half of the neuro-ophthalmologists were trained as ophthalmologists. In 60% of nations, at least half of the neuro-ophthalmologists were trained internally, whereas in 33% of countries, at least half were trained in the United States. The number of physicians who practiced a significant amount of neuro-ophthalmology ranged from low (0.08/million, India) to high (3.10/million, Israel). Countries having the highest percentage of neuro-ophthalmologists exclusively practicing neuro-ophthalmology also were those with better patient access to neuro-ophthalmic care. Requirement of approval to see a neuro-ophthalmologist or for imaging studies requested by neuro-ophthalmologists was not typical. In most nations, academic neuro-ophthalmologists were paid a straight salary. In no nation were neuro-ophthalmologists paid more than another ophthalmic subspecialty.; Individual national health care system designs and compensation models have had a profound influence on the rewards and challenges that face neuro-ophthalmologists. There seems to have been a connection between recognition of the discipline, financial rewards of neuro-ophthalmic practice, conditions that permit full-time neuro-ophthalmic practice, and patient access to care. A higher percentage of gross national product for health care did not seem to insure an adequate supply of neuro-ophthalmologists

The CAR with Poor ERG-onomics: Is It an Optic Neuropathy or Retinopathy?

A 69 year-old woman had 2 months of bilateral visual loss. One year before, she had cataract extraction OD with post-operative acuities of 20/25 OD and 20/50 OS. She had undergone a radical mastectomy in 1960, with no further therapy, as she had no metastasis. Five months before presentation, she was found to have a lung mass, fe~ to be a second primary. Pathology revealed metastatic breast carcinoma, with no other metastases. Her initial exam revealed acuities of 20/400 OD and 20/300 OS, with Ishihara plates 0/6 OD and 1/6 OS. The pupils were 2/2.5mm, RRL, with no RAPD

Pseudotumor Cerebri in a Child

Lethargy; Vomiting; Anorexia; FeverA 9-year old female with a 6-week history of lethargy, a month of anorexia, post-prandial vomiting, persistent headache and two weeks of fevers of 102-103 degrees Fahrenheit. Previous history significant for frequent nosebleeds.CTSystematic necrotizing vasculitisIV glucocorticoids; Anticonvulsants1. Leavitt, Randi Y, and Fauci, Anthony S. Polyangiitis overlap syndrome: Classification and Prospective clinical experience. Amer. J. of Med. 81:79-85, 1986. 2. Fauci, AS, Haynes, BF, and Katz P. The spectrum of vasculitis: Clinical, pathologic, immunologic, and therapeutic considerations. Ann. Int. Med. 1978;89:660-676. 3. Fauci, AS. Vasculitis. J. Allergy Clin. Immunol. 1983;72:211-223. 4. Johnston, I and Paterson, A. Benign intracranial hypertension-I: Diagnosis and prognosis. Brain 97:289-300,1974. 5. Silberberg, Donald H, and Laties, Alan M. Increased intracranial pressure in disseminated lupus erythematosus. Arch. Neurol. 29:88-90,1973. 6. Maiuri, F, De Chiara A, Benvenuti, D, and Stella, A. Benign intracranial hypertension and Guillain-Barre syndrome in systemic lupus erythematosus. Acta Neurol. (Napoli) 5:475-478,1983. 7. Bettman, Jerome W, Jr, Daroff, Robert B, Sanders, Michael D, and Hoyt, William F. Papilledema and asymptomatic intracranial hypertension in systemic lupus erythematosus. Arch Ophthal 80:189-193,1968. 8. Carlow, Thomas J, and Glaser, Joel S. Pseudotumor cerebri syndrome in systemic lupus erythematosus. JAMA 228:197-200, 1974. 9. Devanney, JW, and Shea, JH. Allergic encephalopathy with papilledema. Report of a case. AMA Arch. Neurol. Psychiatr. 68:791-793,1952. 10. Feig, Peter U, Soter, Nicholas A, Yager, Henry M, Caplan, Louise, and Rosen, Seymour. Vasculitis with urticaria, hypocomplementemia, and multiple system involvement. JAMA 236:2065-2068,1976. 11. Masheter, HC. Behcet's syndrome complicated by intracranial thrombophlebitis. Proc. Royal Soc. Med. 52:1039-1040,1959. 12. Kalbian, V, and Challis, M. Behcet's disease: Report of twelve cases with three manifesting as papilledema. Am. J. Med. 49:823-829,1970. 13. Graham, EM, Al-Ashkar, AF, Sanders, MD, and Hilton, P. Benign intracranial hypertension in Behcet's syndrome. Neur¬ophthalmology 1:73-76,1980. 14. Pamir, NM, Kansu, T, Erbengi, A, and Zileli, T. Papilledema in Behcet's syndrome. Arch Neurol. 38:643-645,1981. 15. Bielory, L, Gascon, P, Lawley, TJ, Young, NS, and Frank MM. Human serum sickness: A prospective clinical, immunological, and immunopathological analysis of 35 patients treated with equine antithymocyte globulin for bone marrow failure. Medicine, in press. 16. Cury, D, Breakey, AS, and Payne, BF. Allergic granulomatous angiitis associated with uveoschleritis and papilledema. A.M.A. Archives of Ophthalmology 55:261-266,1956

Sarcoid Optic Neuropathy and Chiasmopathy: Diagnostic Evaluation

Sarcoidosis is a multi-system disease effecting the eye in about 22% of cases and the nervous system in about 5%. The most common neurologic involvement is facial nerve palsy, typically a compressive phenomenon from lacrimal gland involvement, and not a primary neurologic event. Optic nerve sarcoidosis is not a common manifestation of sarcoid as reported in the literature

Neuro-Ophthalmic Manifestations of Vasculitis

The vasculitides are a miscellaneous group of diseases with a common feature of inflammation in blood vessels leading to secondary Ischemic changes in the 11ffected organ or tissue. The diagnosis requires the demonstration of inflammation within the walls of blood vessels and should include damage to the endothelium, muscle and{ or elastica, a cellular infiltrate and fibrin deposition. The demonstration of immunoreactant deposition (e.g., complement, immunoglobulins) is also considered evidence of vasculitis. Vasculitis most commonly occurs at filtration sites and blood vessel junctions. Thus, the glomeruli, the choroid plexus, the ciliary body, and arterial branches are the most common target sites

Neuro-Ophthalmology: Transitioning From Old to New Models of Health Care Delivery

In this issue of Journal of Neuro-Ophthalmology, M. Tariq Bhatti, MD and Mark L. Moster, MD will discuss the following 6 articles.ICcarrierrelation