What is a neuro-ophthalmologist?

Navigating the intricate world where the brain meets the eyes, a neuro-ophthalmologist is a unique subspecialty of neurology and ophthalmology combined.

While an ophthalmologist treats diseases and vision problems caused by the eyes, neuro-ophthalmologists provide specialized care to treat vision issues related to the nervous system and neurological conditions. When a person’s symptoms suggest their condition is something beyond an eye problem, these specialists collaborate with other physicians to solve often complex cases related to vision loss, blurred or double vision, and other issues.

“Neuro-ophthalmology helps bridge the gap between the neurologists, emergency medicine teams, hospitalists and general eye care teams to get to the root of the patient’s problem,” says Dr. Kimberly Cockerham, a neuro-ophthalmologist with Sharp Community Medical Group and affiliated with Sharp Grossmont Hospital.

What does a neuro-ophthalmologist treat?

This dual specialty treats a wide range of conditions, including visual symptoms that are related to stroke or brain tumors. Other conditions neuro-ophthalmologists treat include:

• Abnormal eye movements

• Double vision (diplopia)

• Giant cell arteritis

• Myasthenia gravis affecting the eyes

• Optic neuritis and optic neuropathy

• Orbital cellulitis, an infection of the tissues surrounding the eye

• Orbital tumors

• Swelling of the optic nerve (papilledema)

• Pupil abnormalities

• Thyroid eye disease

Optical coherence tomography (OCT) technology

Dr. Cockerham and her Sharp colleagues use the latest technology to diagnose neuro-ophthalmic conditions. For example, optical coherence tomography (OCT) uses light reflection to photograph the back of the eye.

With OCT, light waves create detailed cross-sectional images to detect changes in retinal structure and nerve fiber layer thickness. This can help identify damage to the optic nerve or retina before vision changes occur.

Another vital use of OCT is to help with the early detection of issues affecting the brain, including potential brain tumors. That OCT technology would prove to be what saved one patient’s vision and, perhaps, her life.

Collaboration with neurosurgery

LaJeanne Garcia was experiencing headaches but didn’t think much of them. However, on the day when she casually rubbed her right eye and then realized she couldn’t see out of it, she knew something was very wrong. She went to the ER and later saw two different retina specialists who provided medication that reduced pressure in her eyes.

After several months of worsening symptoms, LaJeanne saw Dr. Cockerham, who used the OCT technology. The scanner picked up distinct patterns of vision loss that suggested it was related to issues in LaJeanne’s brain. Thanks to that technology, Dr. Cockerham could make a firm diagnosis.

“Dr. Cockerham looked at me and said, ‘I have good news and bad news,’” says LaJeanne. “‘The good news is I know what is wrong with you. The bad news is you have a brain tumor.’”

After delivering that news, however, Dr. Cockerham explained what would happen next. LaJeanne would be in the excellent hands of Dr. Sabareesh Natarajan, a Sharp Community Medical Group neurosurgeon affiliated with Sharp Grossmont Hospital who specializes in treating complex brain tumors. Following an eight-hour surgery, Dr. Natarajan was able to remove LaJeanne’s tumor and restore her vision.

Dr. Cockerham says her goal is to always be part of the team of physicians evaluating patients. Together, they can get to the bottom of eye-related issues and continue to develop protocols for imaging, lab work and other things that can help with quicker diagnoses. This includes collaborating on caring for patients she sees in an outpatient setting and those admitted to the emergency department.

“I’m very excited to be part of the team of San Diego’s only neuroscience hospital, where we can work closely together to optimize the patient experience and outcomes,” says Dr. Cockerham of the new Sharp Grossmont Hospital for Neuroscience. “The San Diego area, like many places, lacks neuro-ophthalmic care needed by so many patients, but by using a team approach at the neuro hospital and clinic, we’ll be able to provide more care for more patients — and provide that care faster.”

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