How a neuro-ophthalmologist differs from an optometrist

Both specialists have played a role in my journey with NMOSD

Jennifer van Amerom avatar

by Jennifer van Amerom |

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After six hours of sitting in the ER waiting room, I wondered if, instead of coming here, my optometrist could’ve recognized my optic neuritis attack and prescribed me Solu-Medrol (methylprednisolone) and oral steroids.

An emergency appointment with my optometrist certainly would’ve taken less time than waiting for a neuro-ophthalmologist in a packed ER. So what’s the difference between these specialties?

My first encounter with a neuro-ophthalmologist happened almost 15 years ago, when I had my first optic neuritis attack and lost full vision in my left eye. It wasn’t painful, so I waited three days for a neurology checkup that was already scheduled. When I mentioned the vision loss, my neurologist panicked and sent me for an emergency MRI.

I spent the whole day at the hospital, where I met the neuro-ophthalmologist. No one explained what this doctor did or how he could help me, but I was told he was crucial to my care.

It took over a month for my vision to return. During that time, I saw the neuro-ophthalmologist once more for a checkup, where he confirmed I was on the correct dosage of oral steroids.

However, after that initial optic neuritis attack and my diagnosis with neuromyelitis optica spectrum disorder (NMOSD), I didn’t have another optic neuritis episode for years — until the recent one that sent me to the ER. For that reason, it wasn’t necessary to be followed by a neuro-ophthalmologist all those years. Plus, my optometrist has always taken great care of me, monitoring disease progression in both of my eyes.

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Back to a neuro-ophthalmologist

But when the peripheral vision in my left eye disappeared during my recent attack, I decided to see the neuro-ophthalmologist associated with my local ER. During our conversation, I asked, “How are you different from my optometrist?”

Based on her response, my understanding is that an ophthalmologist has a medical degree, which is why they can prescribe NMOSD patients high doses of steroids when we have an attack. Neuro-ophthalmologists have specialized training in neurological conditions affecting the eyes, and so they deal with more complex and systemic issues involving vision and eye movements. They undergo residency training in either neurology or ophthalmology and can interpret neuroimaging studies (like MRI or CT scans) related to visual pathways.

On the other hand, optometrists are primary eye care providers who handle routine eye exams, vision correction, and management of common eye issues. They may prescribe medications for certain eye conditions, though my optometrist hasn’t yet prescribed me anything for NMOSD. I’m grateful for my optometrist, as he’s helped me maintain my visual health, especially in my left eye. He’s also detected other eye conditions, such as the astigmatism I developed after my first optic neuritis attack.

Yet, despite their differences, I’ve undergone the exact same tests with both practitioners.

Both start with a visual acuity test, checking my vision with a standard eye chart. Then, they do a pupil examination where they shine a bright light into each eye, and a slit lamp examination where they check the front part of the eye, including the cornea, lens, and iris. After my eyes are dilated, I’m always asked to do a visual field test, which feels like an old Atari video game because I’m asked to click a handheld controller every time I see the bright light move.

While I wasn’t asked to complete a visual evoked potential test during this last attack, nor is it common practice at my optometrist’s office, I’ve done it with both practitioners before. The test measures the electrical activity in the brain in response to visual stimuli, assessing the function of the pathways from the eyes to the brain.

While both practitioners have offered me similar care, it’s nice to know I’m covered by both. When it comes to NMOSD, more care is better.

During this last optic neuritis attack, the neuro-ophthalmologist I saw at the ER ultimately referred me to another neuro-ophthalmologist who specializes in NMOSD and optic neuritis attacks. The timing of my recent attack coincided with a medical conference where specialists presented information on NMOSD. While I was miserable about my situation, I was pleased that the disease was getting the attention it deserved and that my new doctor was in attendance.

Now, for the first time while living with this disease, I have an assigned neuro-ophthalmologist, who happens to be the top NMOSD specialist in his field here in Canada.

This support is the silver lining of my recent attack, especially because the healthcare system, albeit slow, worked to fully restore my vision. I’ll take that win any day.

Note: Neuromyelitis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Neuromyelitis News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to neuromyelitis optica spectrum disorder.


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