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The Founding of the International Neuro-Ophthalmology Society

Sanders, Michael D. FRCP, FRCS, HonFRCOphth; Thompson, H. Stanley MD

Section Editor(s): Digre, Kathleen B. MD

doi: 10.1097/WNO.0b013e31828ee279
Worldwide Neuro-Ophthalmology

Address correspondence to H. Stanley Thompson, MD, Department of Ophthalmology, University of Iowa Hospitals, 200 Hawkins Drive, Iowa City, IA 52242; E-mail:

The first formal international meeting of neuro-ophthalmologists took place in April 1976 in the ancient chateau of La Napoule in the south of France (Fig. 1).

The multidisciplinary acorn planted at this meeting has grown into a sturdy oak that encompasses all of the medical and neurological aspects of the visual sensory and ocular motor systems. Initially, neuro-ophthalmology was a clinical subspecialty that entertained a few ophthalmologists, those with a medical orientation, and some neurologists interested in visual examination for cerebral diagnosis, Subsequently, it has expanded dramatically. Major advances in the anatomy and particularly in the physiology of the visual and ocular motor systems, combined with dazzling improvements in neuroimaging, have created a vigorous subspecialty. There are now many active neuro-ophthalmology training programs in clinics and teaching hospitals around the world and several organizations that encourage progress in neuro-ophthalmology both in peer-reviewed journals and in national and international societies.

It was a chance breakfast meeting at the annual meeting of the American Academy of Ophthalmology in 1974, between Tom Hedges of Philadelphia and Freddie Huber of Zürich (Fig. 2), that sowed the seeds for an international meeting of neuro-ophthalmologists.

Tom Hedges had been a fellow with Frank B. Walsh at the Johns Hopkins Hospital in Baltimore, before becoming Professor of Ophthalmology at the University of Pennsylvania, with an interest in neuro-ophthalmology. Freddie Huber had also been interested in the subject and worked closely with Professor Hugo Krayenbühl, the distinguished neurosurgeon in Zürich. Hedges and Huber sensed that it was about time for specialists in neuro-ophthalmology to start thinking about opportunities for international communication, consolidation, and progress.

It was in January 1975 that the University of Pennsylvania became the Trustee of the Chateau of La Napoule. The University wanted to use the facility for meetings because of its attractive position on the coast in the south of France. Tom Hedges saw it as an ideal location for an international gathering of neuro-ophthalmologists.

The Chateau originally was built in the 14th century by the Villeneuve family. Over the centuries, it had served as a fortress, a monastery, a castle, and a seaport and in the 19th century as a glass factory. The chateau has been besieged in turn by the Saracens, the Romans, the Spaniards, the English, and the Germans and has been destroyed and rebuilt eight times.

At the end of the First World War, the chateau was liberated by the American Fleet, and soon thereafter, it was purchased by an artistic American couple, Henry and Marie Clews, who could afford to restore and decorate it in their own special style.

The Clews family had left their pottery business in England and settled in Ohio in 1838, where they continued their craft. A member of the Clews family settled in New York and was able to establish a successful Wall Street firm. It was his son, Henry Clews (1876–1937), an artist, sculptor, and poet, who bought the Chateau in 1918.

Clews and his wife Marie (Fig. 3) set about rebuilding the chateau, creating their romantic home, their idyll, and their life. She did the gardens, and he did the stonework (1) (Fig 4).

The Clews Foundation was created in 1951 by Marie Clews in memory of her husband. Marie Clews died in 1959, and their Foundation still supports the chateau, to foster international and interdisciplinary exchange, and as a museum of the couples' art and creativity. Many of Henry Clews' highly prized sculptures can still be seen at La Napoule, and their quality and eccentricity are well demonstrated in Venneman's crisp images (2).

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Physicians and scientists in the 17th and 18th centuries were interested in properties of light and in the nature of vision, but the 19th century saw an explosion in knowledge that led to the development of compound lenses and the invention of the ophthalmoscope by Helmholtz in 1851.

In the late 19th century, American neuro-ophthalmology stood on the shoulders of European neurologists and ophthalmologists. Then in the 20th century, many full-time American neuro-ophthalmologists devoted their time to clinical practice, teaching, and publishing. They trained interested students from America, Europe, and eventually the rest of the world. The leaders of this movement included Frank B. Walsh at the Johns Hopkins Hospital in Baltimore, David C. Cogan in Boston, and William F. Hoyt at the University of California, San Francisco. The group in Miami led by J. Lawton Smith became known for their skill, their enthusiasm, and their vigorous sense of humor. The neuro-ophthalmologists trained at these institutions introduced neuro-ophthalmology as a recognized subspecialty of both neurology and ophthalmology.

Organizing the meeting at La Napoule in 1975 saw extensive transatlantic correspondence about participants and the inclusion of neurologists, neurosurgeons, and radiologists. The number of attendees was limited to 50 (Fig. 5), the registration fee was $70, and the joint presidents were Tom Hedges and Freddie Huber.

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The Guest of Honor was Frank B. Walsh who was brought by his previous fellow, Adolphe Neetens, from Belgium to the south of France by car. Dr Walsh made the trip from Baltimore on the condition that he could arrange to visit the grave of his son, who was killed in Holland in the Second World War. Frank B. Walsh was a delightful avuncular Canadian, who trained in Manitoba and after 7 years in general practice, and at the age of 35, began a residency in ophthalmology at the Johns Hopkins Hospital with Dr Wilmer. Progressing to the Consultant Staff, he joined his brilliant and energetic colleagues in neurosurgery, Walter Dandy, and in pediatric neurology, Frank Ford.

Frank B. Walsh produced the first edition of his classic textbook, Clinical Neuro-Ophthalmology, in 1947. It was this book (enlarged later by his students Hoyt and then Miller, and then Nancy Newman, in 1998, to five volumes and almost 6,000 pages) that showed the world how much was included in this subspecialty. It was this pioneering book, combined with his teaching and his charisma, that earned Walsh the approbation of colleagues and the mantle of “Doyen of Neuro-Ophthalmology.”

The first meeting of what was to become the International Neuro-Ophthalmology Society (INOS) was held in 1976 in the hall of the Chateau de la Napoule, surrounded by Clews' sculptures. The moderators of the various sessions were:

1. Frank B. Walsh (United States) and Alfred Huber (Switzerland)

2. Thomas R. Hedges (United States) and Adolphe Neetens (Belgium)

3. Michael Sanders (United Kingdom) and Guy Offret (France)

4. Mark Mishkin (United States) and Arno Nover (Germany)

5. Melvin Alper (United States) and Stan Thompson (United States)

6. Paul Bregeat (France) and Noble David (United States)

7. Fred Simeone (United States) and Donald Smith (United States)

8. L. Guillaumat (France) and Guntram Kommerell (Germany)

9. Joel Glaser (United States) and Lars Frisen (Sweden)

10. Dieter Schmidt (Germany) and Henry Van Dyke (United States)

11. Trevor Kirkham (United Kingdom) and Nancy Newman (United States).

The majority of papers at the meeting were by ophthalmologists, though four were by neurosurgeons and two each by neurologists, pediatric ophthalmologists, and neuropathologists. Frank B. Walsh gave a paper on his experiences with the meningiomas of childhood, and the main clinical theme was the advent of computed tomography with presentations by Alper, Bregeat, Moseley, Sanders, and Trokel. Gastronomic standards for future meetings were set at the highest possible level by the generosity of the Mayor of La Napoule who took us to a 2-star Michelin restaurant, called Oasis. Pink champagne was followed by 6 delicate courses.

The first Council Meeting established the “International Neuro-Ophthalmology Society,” elected officers, and laid down the principle that the incoming President would organize the subsequent meeting and that costs would be kept to a minimum. The incoming president was Mel Alper from Georgetown University in Washington, DC, with the intention of holding the next meeting at an American location.

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INOS 1978–2012

The Council decided that in order to attract new material, meetings of the society should be held biennially, with venues alternating between the United States and Europe. After 10 years, a meeting was held in Hakone, Japan, under the stewardship of Satoshi Ishikawa in response to the great interest in neuro-ophthalmology in that country. Combined meetings with other societies first occurred in 1980 when David Knox brought the Frank B. Walsh Society to the meeting in Valbella under the presidency of Freddie Huber.

In 1988, Bob Hepler and Stan Thompson staged a combined meeting of all groups interested in neuro-ophthalmology. At this meeting, INOS, the International Perimetric Society, the Clinical Eye Movement Society, the Rocky Mountain Neuro-Ophthalmology Society, and the Frank B. Walsh Society all met in Vancouver, Canada. This was a great success, demonstrating the breadth of neuro-ophthalmology, but some smaller societies did feel a bit marginalized.

All INOS presidents have been ophthalmologists, with the exception of two neurologists, Michael Halmagyi from Australia and James Sharpe from Canada. The presidents realized the extra organizational burden involved in setting up a “one-off” meeting. Only two people have organized multiple meetings: Freddie Huber (1976, 1980) and Neil Miller (1982, 1992, 2008).

Guests of Honor have included Frank B. Walsh (1976), David Cogan (1982), and William F. Hoyt (1990). INOS meetings subsequently have taken place every two years and spread over most parts of the globe (Table 1). Those countries interested in neuro-ophthalmology have received full support of the international community. And that community owes a tremendous debt of gratitude to the visionary efforts of Tom Hedges and Alfred Huber.

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2. “Henry Clews Sculpture,” photos by W. Venneman, a 12×15 in soft cover (no date) published by E. Defossés-Néogravures, Paris.
© 2013 by North American Neuro-Ophthalmology Society