Connecting the Dots: How Neurology and Optometry Converge

Ophthalmologist
An ophthalmologist attends medical school to learn about fundamental principles of medicine as it applies to all aspects of the body. Once they complete medical school, they spend 3-4 years in a residency learning the various aspects of the eyes.  An ophthalmology residency involves classes, clinical rotations, and surgical training.  Much of an ophthalmology residency involves learning the intricacies of various eye surgeries, such as cataract surgery, LASIK, retinal surgeries, eyelid surgeries, surgeries for eye turns, etc.  Ophthalmology residents also spend time learning about eye diseases and prescribing glasses and contact lenses.

Neuro-Ophthalmologist
A neuro-ophthalmologist typically has one year of specialized training after their residency. Here they learn about eye problems that stem from neurologic issues.  Many of the issues they deal with can be life-threatening or have the potential to cause blindness. They see patients with conditions involving problems with the optic nerve, vision loss, eye movements, and systemic neurologic conditions that affect the eyes such as multiple sclerosis, myasthenia gravis, and brain tumors.

Optometrist
After obtaining an undergraduate degree, an optometrist spends four years in optometry school learning specifically about eye diseases, how the eyes work together, how the eyes interact with the brain to see optimally, and how to maximize visual capacity. Although optometrists do not attend medical school, they do have some training in overall body medicine, mainly focusing on systemic diseases that have potential ocular effects. Because optometry doesn’t involve surgical training, optometry students have time to dive deeper into other aspects of vision, including how the eyes work together and how they work with the brain to help us make sense of vision. Optometrists go into great depth regarding the diagnosis and treatment of eye diseases, as well as prescribing glasses and contact lenses. 

Neuro-Optometrist
Some optometrists who do vision therapy following brain injuries, such as strokes or concussions, call themselves neuro-optometrists. This title requires no additional training beyond optometry school. Vision therapy is similar to physical therapy for the eyes. It helps the eyes work together better and aids the eyes in interacting with the brain processes more efficiently. Although I am often called a neuro-optometrist, and can technically be called a neuro-optometrist, I do not do vision therapy myself.  If during a vision examination, I determine that vision therapy would be beneficial for the patient; I refer them to optometrists who perform vision therapy techniques that have been shown to be effective in various studies.

Question:

How did you become an optometrist who specializes in neuro-opthalmic disease?

Answer:

I became an optometrist who specializes in neuro-ophthalmic disease by training in Seattle, Chicago, Miami, Philadelphia, and Portland with various neuro-ophthalmologists, optometrists specializing in neuro-ophthalmic disease, and neuroradiologists.  Following this training, in 2009, I started the Neuro-ophthalmic Disease Clinic at Pacific University.  Here, we focus on diagnosing neurologic conditions that also affect the eyes. We receive referrals from optometrists, ophthalmologists, neurologists, primary care doctors, and chiropractors. We have seen patients with brain tumors, aneurysms, multiple sclerosis, brain injuries, strokes, unexplained vision loss, double vision, and pupillary issues. There are approximately a dozen or so optometrists in the country who specialize in neuro-ophthalmic disease. We are often called neuro-optometrists even though we don’t do vision therapy ourselves.

Dr. Denise Goodwin is a Doctor of Optometry and a Professor at Pacific University Oregon. She advises third-year students in a primary care clinic and works one day per week in a private practice. In addition to clinical duties, she teaches Functional Neuroanatomy and Neurobiology, Neuro-ophthalmic Emergencies, Optic Nerve Disease, Ophthalmic Imaging, and Ocular Anatomy. 

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