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What to Expect on Your First Visit

Before your neuro-ophthalmology exam, we ask that you please read the following instructions so you know what to bring and what will happen during the visit. We also recommend that you arrange for transportation home after the exam as your eyesight will be blurry.

If you have any questions or concerns, please call the office and we'll be happy to assist you.

Preparing for the Neuro-Ophthalmology Examination:

Request that your treating physicians send all relevant information to us prior to your appointment, including office notes, results of laboratory tests, visual fields, OCTs, retina pictures, and reports of CT and MRI scans.
If you have had a CT or MRI scan performed, arrange to pick up the actual films or a copy in a CD/DVD and bring them with you at your appointment.
You will probably have your pupils dilated during the visit. The eye drops last about 4 hours and will make things look bright and blurry up close. Have someone else drive you to the appointment and bring your sunglasses.
Ladies, in order for the physician to get a good look at your eyelids and to avoid ruining your appearance when the eye drops are administered, do not wear eye makeup.
Bring a complete list of medications with you, including the name and dosage of prescription and over-the-counter medications.

What happens during the evaluation?

The neuro-ophthalmologic evaluation is one of the most comprehensive examinations you will experience. It may take a few hours to complete. You will be asked to give an account of your current problem and relate your entire medical history, including previous hospitalizations, operations, serious illnesses, medical problems in your family members, and medication allergies.
You will have a complete eye examination. This may include testing of your peripheral vision (visual field test), taking pictures of your eyes and your optic nerves (HRT/OCT), and Ultrasound of your eyes.
You may have a partial or complete neurologic exam to test your strength, sensation, and coordination.
The neuro-ophthalmologist will review the records and scans from previous evaluations, if applicable.
After the examination, the neuro-ophthalmologist will discuss the diagnosis (or possible diagnoses), the need for any additional testing and possible treatment.

What is a Neuro-Opthalmologist?

Neuro-ophthalmologists take care of visual problems that are related to the nervous system; that is, visual problems that do not come from the eyes themselves. We use almost half of the brain for vision-related activities, including sight and moving the eyes. Neuro-ophthalmology, a subspecialty of both neurology and ophthalmology, requires specialized training and expertise in problems of the eye, brain, nerves and muscles. Neuro-ophthalmologists complete at least 5 years of clinical training after medical school and are usually board certified in neurology, ophthalmology or both.

Although some problems seen by neuro-ophthalmologist are not worrisome, other conditions can worsen and cause permanent visual loss, or become life threatening. Sometimes the problem is confined to the optic nerve or the nervous system and other times it is related to a general medical condition. Neuro-ophthalmologists have unique abilities to evaluate patients from the neurologic, ophthalmologic, and medical standpoints to diagnose and treat a wide variety of problems. Costly medical testing is often avoided by seeing a neuro-ophthalmologist.

Some of the common problems evaluated by neuro-ophthalmologists like Dr. Bose include:

optic nerve problems, such as optic neuritis and ischemic optic neuropathy
visual field loss
unexplained vision loss
transient vision loss
visual disturbances, including those associated with stroke, brain tumors, Parkinson’s disease, temporal arteritis, lupus, and multiple sclerosis
evaluation of double vision
cranial nerve disorders
abnormal eye movements
thyroid eye disease
myasthenia gravis
unequal pupil size
eyelid abnormalities
treatment of blepharospasm and hemifacial spasm using Botox injections

What Does an Orbital Surgeon Do?

In addition to neuro-opthamology, Dr. Bose is also trained in orbital surgery. Orbital surgeons are specially trained to diagnose, treat and perform surgery on the supporting tissues surrounding the eye including eyelids, contents and the bony structure of the eye socket or orbit.

Some common adnexal and orbital diseases treated are:

orbital inflammation or cellulitis
protrusion of the eye balls or proptosis
thyroid eye disease
orbital tumors
eyelid tumors
eyelid retraction
droopy eyelids or ptosis
eyelid malpositions including lagophthalmos (from Bell’s palsy)
entropion
ectropion

Dr. Bose also specializes in the assessment and management of eye movement disorders resulting in double vision resulting from paralysis of eye muscles, and scarring of eye muscles from thyroid eye disease by giving prisms and performing surgery if necessary.