Neuro-Ophthalmology

Neuro-Ophthalmology at Central Valley Eye


Neuro-ophthalmology is a subspecialty within the field of ophthalmology that focuses on the diagnosis and management of brain disorders that affect vision.

At Central Valley Eye Medical Group, Dr. Kimberly Cockerham is a board-certified ophthalmologist with fellowship training in neuro-ophthalmology. Her scope of practice in neuro-ophthalmology focuses on adults with abnormal optic nerve function or double vision.

How do I know I need to see a neuro-ophthalmologist?


Certain conditions will likely lead to your regular ophthalmologist at Central Valley sending you over to Dr. Cockerham for her specialized skills with neuro-ophthalmology. These include:

  • A loss of visual acuity — A loss of clarity and sharpness in your vision can occur due to several reasons: uncorrected refractive errors, retina issues, problems with the optic nerves, and problems inside your skull, such as a tumor or aneurysm.
  • Trouble moving your eyes — If you are experiencing difficulty moving your eyes, this can be due to cranial nerve palsy and myasthenia gravis. Another condition known as nystagmus can cause the eyes to shake suddenly.
  • Tumors are compressing your visual pathways — Even if you haven’t noticed any changes in your vision, if you’ve been diagnosed with a pituitary tumor or another type of tumor in your skull, you need to see Dr. Cockerham to ensure it doesn’t lead to vision loss.
  •  Pressure in your head — If you feel increasing pressure inside your head, this can lead to swelling of your optic nerve and eventual vision damage. This pressure can be caused by brain tumors and also by a condition known as pseudotumor celebri.
  • Uneven pupils — Any sudden change in the size of your pupils is an emergency situation, as it can be caused by a brain aneurysm.

What kinds of neuro-ophthalmology treatments may be used?


Over half of the brain’s function is involved with your vision. That’s what makes the specific training and skills of a neuro-ophthalmologist an important part of our expertise at Central Valley Eye Medical Group.

There aren’t any “typical” treatments, as every patient’s situation is unique. Treatment options run the gamut from corrective lenses to Botox injections to stop muscle spasms to surgical procedures. Often, Dr. Cockerham’s role is finding the source of the vision loss or the problems with the patient’s eye movements. She may use visual restoration therapy if the patient has problems with their visual pathway following a stroke.

What takes place during my neuro-ophthalmology evaluation?


Dr. Cockerham conducts these evaluations at Central Valley Eye Medical Group. These are involved evaluations. Here’s what you can expect. These are the steps involved:

  1. Dr. Cockerham will perform a truly comprehensive evaluation that may take up to a few hours to complete. You will discuss your current problem and detail your entire medical history, including previous hospitalizations, operations, serious illnesses, medical problems in your family members, and medication allergies.
  2. Dr. Cockerham will then perform a complete eye examination. This will include testing of your peripheral vision with a visual field test.
  3. She may perform a partial or complete neurologic exam to test your strength, sensation, and coordination.
  4. Dr. Cockerham will review the records and scans from previous evaluations, if you have them.
  5. The final step will be to discuss your diagnosis, or possible diagnoses. She’ll discuss possible treatment options. If she feels more verification is necessary, she may order additional testing.

What diagnostic tools are used for neuro-ophthalmology?


For these conditions, Dr. Cockerham begins with the patient’s complete medical history, including previous imaging studies and current medications. Complete neurological evaluation may be necessary. These are additional tests that she may perform:

  • Color test
  • Evaluation of eye movements
  • Imaging studies, such as computed tomography (CT) and optical coherence tomography (OCT) scans, magnetic resonance imaging (MRI), or ultrasound
  • Evaluation of ocular alignment
  • Visual acuity
  • Visual field testing

Additional Neuro-Ophthalmology FAQs


Disorders Connected to Neuro-Ophthalmology

The following disorders can cause decreased vision or visual field defects due to optic nerve dysfunction.

  • Unexplained visual loss
  • Papilledema (swelling of the optic nerve head)
  • Optic neuritis (inflammation of the optic nerve)
  • Compressive optic neuropathy
  • Traumatic optic neuropathy
  • Hereditary optic neuropathy
  • Vascular optic neuropathy
    • Acute ischemic optic neuropathy
    • Giant cell arteritis

Additionally, these disorders can cause double vision or diplopia.

  • Thyroid eye disease
  • Myasthenia gravis
  • Multiple sclerosis
  • Idiopathic intracranial hypertension
  • Diabetes
  • Cranial nerve dysfunction
    • Compression
    • Stroke
    • Brain mass

Which diagnostic technique is best for neuro-ophthalmologic disorders?

As a neuro-ophthalmologist, Dr. Cockerham evaluates patients from a unique perspective, combining neurological, ophthalmological, and medical standpoints. There isn’t a single diagnostic tool that is better than another, as different parts of the brain can be involved in these disorders. A patient’s visual symptoms can be divided into visual loss, or problems with eye movements. For visual loss, this often results from problems with the optic nerve or its connections to the visual portions of the brain. For eye movement, several parts of the brain are involved. Medical issues such as a stroke or a tumor can affect these movements.

That’s why neuro-ophthalmologic evaluations are so involved. For some patients a CT scan or MRI is necessary, for others it’s more important to provide advice on the visual disturbances experienced by a migraine sufferer.

What is the difference between an ophthalmologist, a neurologist, and a neuro-ophthalmologist?

Ophthalmologists treat eye and visual problems. Neurologists deal with problems with the brain. A neuro-ophthalmologist straddles these two fields, handling brain issues that affect vision. Dr. Cockerham and other neuro-ophthalmologists treat many vision disorders in addition to those associated with multiple sclerosis.

How do I schedule a Neuro-Ophthalmology examination?

In order to schedule an appointment with Dr. Cockerham, your doctor will need to contact Dr. Cockerham’s administrative assistant, Sonia. All patients need to be referred by an ophthalmologist and/or neurologist. Sonia will coordinate scheduling and determine if the practice is accepting new neuro-ophthalmology patients at this time.

If the practice is accepting new patients they must bring copies of all examinations, laboratory evaluations and imaging reports with CD to their first appointment. We accept Medicare and/or PPO health insurances. During your examination, additional testing, imaging, and laboratory assessments may be necessary to identify the cause of the decreased or double vision.

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If you would like to learn more about Neuro-Ophthalmology call 1-800-244-9907 to make an appointment at Central Valley Eye Medical Group.

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