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2013 William F Hoyt Lecture: Neuro-Ophthalmology in Review: Around the Brain with 50 Fellows
Nancy J. Newman, MD, LeoDelle Jolley Chair of Ophthalmology, Director, Section of Neuro-Ophthalmology, Professor of Ophthalmology and Neurology, Emory University School of Medicine, Atlanta, Georgia
No matter what their ultimate specialty, every ophthalmologist needs to master the basics of neuroophthalmology. To that end, we must ensure that we continue to train effective teachers of neuro-ophthalmology. This is William F. Hoyt’s most important lasting legacy and charge. In this same spirit, Emory Neuro-Ophthalmology has tried to carry on this essential mission of training the next generations of neuro-ophthalmologists around the world not only as clinical practitioners of the art but also as academicians and teachers in their own right, contributing greatly to our specialty and at the same time teaching non–neuroophthalmologists the basics of what they need to know about neuro-ophthalmology and creating yet the next generations of neuro-ophthalmologists.
Through the projects and key publications of 50 Emory fellows, this neuroanatomical tour reviews advances in neuroophthalmology over the past 25 years, highlighting common and uncommon disorders affecting the afferent and efferent visual systems. We begin our tour in the eye and how findings in the retina can reflect neurologic disease such as acute posterior multifocal placoid pigment epitheliopathy, carotid–cavernous fistula, cat scratch encephalopathy, and mitochondrial disease, but not migraine. We then move to the optic nerve and contributions to our understanding of optic neuropathies including optic neuritis, its demographics and treatment, anterior ischemic optic neuropathy of the young and in patients with giant cell arteritis, Leber hereditary optic neuropathy, dominant optic atrophy, the risk factors for visual loss from papilledema in patients with idiopathic intracranial hypertension, and the recently appreciated myriad of neuroimaging findings in patients with elevated intracranial pressure. Regarding the retrochiasmal pathways, publications have advanced our understanding of homonymous hemianopias, their detection, causes, congruity, and prognosis for recovery. Studies of cranial nerves 3, 4, and 6 have alerted us to the problems of radiologically unreported aneurysms and dural fistulae, the difficulties in surgically correcting residual ocular misalignment, and the prevalence of these disorders among hundreds of victims of head trauma. A study of visual complaints in patients with Parkinson disease helped neurologists understand that the most frequent causes of visual disability are ocular and potentially quite treatable. Regarding recent technology, we have written on optical coherence tomography and, most prolifically, on the uses of nonmydriatic ocular fundus photography in various settings, including the emergency department, the pediatric ophthalmology clinic, on the iphone through telemedicine, and in the classroom for teaching medical students. Fellows trained at Emory are now scattered across the globe (Fig. 1), but they remain F1 a close-knit family of clinicians, scholars, researchers, and educators.