Neuro-Ophthalmology

Sashank Prasad, MD

The ways in which the visual system can manifest neurological diseases are numerous and complex, always intriguing but frequently challenging for most clinicians to diagnose and manage. Familiarity and expertise with neuro-ophthalmologic disorders can significantly mitigate the morbidity that they often impart. Adding to the challenge facing clinicians seeking to stay abreast is the remarkable pace of discovery that has informed a modern approach to these conditions. As a field, neuro-ophthalmology is at a pivotal moment in which decades of nuanced clinical observations and scientific research are culminating in key therapeutic advances. The primary goal in assembling this issue of Seminars in Neurology, therefore, was to provide you, the inquisitive practicing clinician, a concise, practical critique of the many advances that have come to redefine our field.

I think it can be said without exaggeration that the following pages represent the work of an all-star cast of Neuro-Ophthalmologists. The authors of these articles are known not just for their clinical expertise, but for the clarity and precision with which they teach and write. In my role as Guest Editor of this issue, I knew I was going to learn a lot, but looking back on the experience I must admit I significantly underestimated just how much I would learn. I certainly hope that the readers of this issue will feel the same way about the knowledge they glean.

To start things off, Drs. Fein and Ko present the recent advances in the diagnosis and treatment of giant cell arteritis. Drs. Ahmad and Moss discuss important developments in the diagnostic criteria and evidence-based treatment of idiopathic intracranial hypertension (IIH). Drs. Dinkin and Oliveira give an in-depth analysis of the role that venous stenosis can play in the pathophysiology of IIH, and present data that help define the emerging role of venous sinus stenting in select patients. Drs. Gaier and Heidary share their expertise and insights on the problem of pediatric IIH. Dr. Graves provides an illuminating review of the many ways in which optical coherence tomography (OCT) provides quantitative structural imaging that has radically redefined diagnostic methods in neuro-ophthalmology. Dr. Chen and I discuss exciting, ground-breaking developments in the diagnosis and treatment of neuromyelitis optica spectrum disorders caused by anti-AQP4 and anti-MOG antibodies. Drs. Bakaeva, Mallery, and I discuss the intravitreal genetic therapies that appear to be on the cusp of revolutionizing treatment for Leber's hereditary optic neuropathy and other genetic causes of visual loss. Drs. Fraser, Hepschke, Jenkins, and I give a comprehensive overview of the neurobiological underpinnings of migraine aura and other related phenomena, and discuss emerging targeted acute and prophylactic treatments. Drs. Doughty and O'Hare deliver an in-depth update on the diagnosis and management of ocular myasthenia gravis. Drs. Choi and Gold provide an invaluable practical framework for diagnosing neurovestibular disorders. Finally, Drs. Rizzo, Beheshti, Dai, and Rucker highlight the diagnostic utility of quantitative eye movement recording in clinical practice.

I am indebted to the contributing authors for sharing their time and expertise to produce this volume. In addition, heartfelt thanks go to Dr. David Greer, the Editor-in-Chief of Seminars in Neurology, for entrusting me to assemble this issue. I am immensely grateful for his leadership, vision, wisdom, and patience.