Pediatric Neuro-ophthalmology

Pediatric neuro-ophthalmology occupies a unique niche within the field of neuro-ophthalmology. Many neurologists, pediatric neurologists, ophthalmologists, pediatric ophthalmologists, and neuro-ophthalmologists see pediatric patients with neuro-ophthalmic diseases, but few dedicate a significant portion of their practice to seeing these children specifically. This field concentrates on the evaluation and diagnosis of children with diseases involving any aspect of the afferent and efferent visual pathways, including but not limited to optic nerve disorders, intracranial disease, and ocular motility disturbances. The field of pediatric neuro-ophthalmology is emerging as a subspecialty of increasing importance.

The study of pediatric neuro-ophthalmic diseases is important as timely diagnosis of potential problems, such as idiopathic intracranial hypertension, or papilledema due to pediatric brain tumors, are potentially vision and life-saving. However, the examination of children from an ophthalmologic or neurologic standpoint often requires subspecialization, as the techniques for examining children are different than those of adults. Also, in comparison to adults, children are often affected by either different disease processes, or different frequencies and presentations of common diseases. Evaluating these children requires extra time, and often requires a multidisciplinary approach, as well as the collection of data from multiple sources (such as outside notes, neuroimaging, and procedures). As a result, children with neuro-ophthalmic disorders are often referred to academic centers for evaluation and treatment.

This is an exciting time to be a member of the community of pediatric neuro-ophthalmologists. The recently formed Consortium of Pediatric Neuro-Ophthalmologists has created a forum for any neurologist or ophthalmologist interested in pediatric neuro-ophthalmology to discuss issues related to the field, and can propose studies for rare or neglected neuro-ophthalmic diseases. The Pediatric Eye Disease Investigator Group in cooperation with the Neuro-Ophthalmology Research Disease Investigator Consortium is currently enrolling patients in a prospective disease registry for pediatric optic neuritis. The results of this registry may demonstrate that a randomized controlled treatment trial for pediatric optic neuritis is feasible.

This issue will focus on not only neuro-ophthalmic disease processes that affect children, but will also discuss pediatric neuro-ophthalmology examination techniques that should be helpful for the neurologist. A special focus on visual field examination in pediatric patients, with a discussion on advances in visual field technique and analysis for those unable to cooperate with formal visual field evaluation, is included. Finally, the majority of this issue will discuss common neuro-ophthalmic disease processes affecting children: congenital optic nerve anomalies, hereditary optic neuropathies, optic pathway gliomas, idiopathic intracranial hypertension, cranial nerve palsies, and myasthenia gravis.

I wish to thank all the authors who worked on this special issue for their hard work and dedication in helping to produce the articles included here. Without the contributions of their time and expertise, this issue would not have been possible.