Neuro Ophthalmologist

All vision problems need not necessarily stem from the eye. Some vision problems involve the brain. Neuro ophthalmology is the sub specialty of both neurology and ophthalmology. A neuro ophthalmologist is a Physician who specializes in the diseases affecting vision that originates from the nervous system. Conditions such as optic nerve disorders, loss of vision from central nervous system disease, double vision diplopia and involuntary movement of the eyes nystagmus are some of the disorders under the purview of a neuro ophthalmologist. An ophthalmologist attends to patients with disease or injury in the eye ball, cornea and the lens or into the eyeball at the retina inside the eye. If any problem occurs behind the eye in the optic nerve or in some distinct visual pathways connecting the brain, it requires the special skills of a neuro ophthalmologist.

A neuro ophthalmologist could be an ophthalmologist or a neurologist with additional special training. After completing a residency program in any one of the two specialty areas, they take a fellowship in neuro ophthalmology for a year or two before starting to practice as a neuro ophthalmologist. A neuro ophthalmologist attends to a full spectrum of neuro ophthalmic conditions including evaluation, diagnostic and referral services of rare and complex disorders. A neuro ophthalmologist caters to:

• Patients who suddenly lose part of their side vision.
  
• Patients suffering from double vision.
  
• Patients with unequal pupils.
  
• A patient suffering form a stroke.
  
• A patient with brain tumor
  
• Patients who suddenly have their vision out of focus
  
• Any and every patient with unusual vision problems.

In addition to the above, a neuro ophthalmologist provides emergency evaluation of a wide variety of disease that can cause visual loss. Unexplained visual loss can arise out of uncommon disease conditions like myasthenia gravis, multiple sclerosis, mitochondrial disease and other muscular diseases that affect the eye. The neuro ophthalmologist uses special testing techniques including visual fields, visual evoked response, imaging studies such as CT, MRI and Angiography and ultrasound to diagnose the disease patterns. It becomes necessary for the neuro ophthalmologist to work closely with other medical specialists to offer multidisciplinary care and solution for complex cases.

Pediatric Ophthalmologist

Pediatric ophthalmology is a sub specialty of ophthalmology concerned with vision care and eye diseases in children. A pediatric ophthalmologist provides comprehensive care in diagnostic, treatment and management of infant vision and common childhood vision disorders. Surgery to correct ocular misalignment and double vision in children are also performed by a pediatric ophthalmologist. Pediatric ophthalmologists are physicians who have completed a three year residency in ophthalmology after the medical school and one year internship and one or two year fellowship in pediatric ophthalmology and strabismus. Pediatric ophthalmology fellowships are accredited by the American Association for Pediatric Ophthalmology and Strabismus in the US.

Role of a pediatric ophthalmologist in child vision care:

• It could be opined that in young infants and children the visual system is not fully mature. As such, equal input from both eyes is required for proper development of visual centers in the brain in a human being. There could be the danger of permanent irreversible loss if the child's growing eye does not provide clear and focused image to the developing brain. A pediatric ophthalmologist provides early detection and effective treatment under such circumstances.
  
• Children suffer from reduced vision in one or both eyes from Amblyopia, uncorrected refractive errors and misalignment of the eyes called strabismus. It is the domain of the pediatric ophthalmologist to detect such innate errors in children and provide effective and efficient treatment. Among the vision problems that the pediatric ophthalmologist evaluates for the child include:
  
• Amblyopia: This is caused in an infant whose brain does not recognize the sight from the eye. In other words, there is poor vision in the eye appearing normal.
  
• Strabismus: This is misalignment of the eyes in any direction. About 4% of the children are affected by this disorder.
  
• Refractive errors: Such errors can cause decreased vision resulting in visual discomfort, eye strain and also Amblyopia.
  
• Genetic disorders: Approximately about 8% of genetic syndromes affect the eyes of children. Examination by a pediatric ophthalmologist helps to diagnose such genetic conditions. Sometimes certain eye conditions such as high internal pressure 'intraocular pressure' which can lead to glaucoma can be inherited in family members even when they are young. It is imperative on the part of the parent to inform the pediatric ophthalmologist about such conditions. Many pediatric ophthalmologists participate with multi disciplinary medical teams that treat children with genetic syndromes.

Tests conducted by pediatric ophthalmologist

• Penlight Eye Inspection: A small penlight is aimed into the child's eye, beginning with the newborn infants. The pediatric ophthalmologist checks and makes sure that the eye structures and eyelids appear normal and also if the eyes react appropriately to the presence of light. The pediatric ophthalmologist also checks for any early signs that eyes might be misaligned.
  
• Red Reflex test: The internal eye structure in particular, the red reflection from the inner back of the eye where the light sensitive retina is located is examined for the presence of any eye disease. This is done using an ophthalmoscope.
  
• Snellen Eye chart: This eye check contains letters and numbers which are used to test the sharpness of vision. This test can be done on children above the age of three years depending upon their comprehension. Sometimes certain cards with pictures are used to test for visual acuity testing.
  

Ophthalmologist

An ophthalmologist combines the diagnostic skills of a clinician, the therapeutic skills of a physician, technical skills of a micro surgeon and psychiatric skills in understanding the patient's psychology in one. Since the eye is structured in such a way that its components are transparent, the ophthalmologist is able to observe directly and read the abnormalities in a manner which is not possible for any other parts of the human body.

Professional qualifications for an ophthalmologist

Ophthalmologists are medical doctors who have completed medical school and four years training schedule in ophthalmology after medical school. An ophthalmologist can be a medical doctor with an M.D. degree in ophthalmology or doctors of osteopathy D.O. In the US, four years of training after medical school is a must. The first year is an internship and then three years of training in ophthalmology in a residency program approved by the Accreditation Council of Graduate Medical Education. An ophthalmologist may develop expertise in a sub-specialty such as:

• Corneal disease
  
• Retina and vitreous disease
  
• Glaucoma
  
• Pediatric eye problems
  
• Plastic surgery

Services rendered by an ophthalmologist

By convention, an ophthalmologist specializes in the medical and surgical care of the eyes. The ophthalmologist aids in prevention of eye diseases and injury to the visual system. The full spectrum of care rendered by an ophthalmologist includes:

• Routine eye examinations
  
• diagnosis
  
• Medical treatment of eye disorders and diseases
  
• Prescription for eye glasses
  
• Surgery
  
• Management of eye problems caused by systemic illnesses

Eye surgeon

An ophthalmologist often performs surgery to prevent or improve vision related conditions. A variety of lasers are used nowadays to perform out-patient procedures which previously required admission to hospital. Also tremendous improvements in microsurgical instrumentation have led to development of operations not considered possible a decade ago. An increasing number of such surgeries are being performed by local anesthesia. The surgical work of a general ophthalmologist includes:

• Cataract extraction
  
• Squint surgery
  
• Glaucoma surgery
  
• Retinal, oculoplastic and nasolacrimal surgery

Some common emergency of the eye that require immediate intervention by an ophthalmologist are:

• simple foreign body on the eye
  
• chemical burns
  
• angle closure
  
• glaucoma
  
• retinal detachment

Medical ophthalmologist

A medical ophthalmologist generally does not perform surgery. The sphere of interest embraces:

• Diabetes and Endocrinology including laser treatment for diabetic retinopathy
  
• Vascular disease of the eye
  
• Uveitis
  
• AIDS
  
• Ramifications of dermatological and rheumatological disorders
  
• Pediatric ophthalmology
  
• Neuro ophthalmology
  
• Genetics