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Guest Editorial

Neuro-ophthalmology in India

The way forward

Nair, Akshay Gopinathan; Gandhi, Rashmin Anilkumar1,2

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Indian Journal of Ophthalmology: October 2014 - Volume 62 - Issue 10 - p 980-981
doi: 10.4103/0301-4738.145984
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Perhaps, it should be neuro-ophthalmology:

The optic nerve, its path, and its pathology.

However, when there's pallor, one asks why?

With CT, PET and MRI …

So why not just go into radiology?[1]

This poetic lament by a resident in ophthalmology reflects the reluctance to select neuro-ophthalmology as a field of specialization after residency. William Hoyt, who needs no introduction to neuro-ophthalmologists, once famously said, “Neuro-ophthalmology is like a harp in an orchestra: Good to have but not always needed.”[2] While Hoyt, for all the pioneering contributions he made to neuro-ophthalmology, may have said it, perhaps in a humorous and self-depreciating manner; the time has conceivably arrived when neuro-ophthalmology today can claim its place as a full-fledged sub-specialty of ophthalmology.

Ophthalmology as a clinical branch of medicine, was, until a few decades ago, clubbed along with otorhinolaryngology.[3] It surely has evolved tremendously; from those days to today, when ophthalmology itself has its own sets of ‘super-specialists.’ Having said that, in the Indian setting, one still does not mention neuro-ophthalmology in the same breath as its glamorous cousins: cornea and refractive surgery and even vitreoretinal surgery. On further analysis, it is clear why. Residency training in India is largely focused, and rightly so, on cataract surgery; given that cataract continues to be the single largest cause of reversible blindness in India.[4] It is in this scenario that, at times, for lack of resources, guidance and infrastructure such as imaging facilities, that training in sub-specialties such as uveitis and neuro-ophthalmology gets neglected. However, in the recent years, world-class tertiary eye care centres in India have identified this void and have initiated training programs in these branches of ophthalmology. The result is that this lacuna of trained neuro-ophthalmologists in India is slowly but surely being addressed.

The All India Ophthalmological Society, too has long recognized the need for a separate platform for neuro-ophthalmologists and instituted the S D Athawale Award for the best paper presented in neuro-ophthalmology at its annual All India Ophthalmic Conference.

While still a fledgling specialty, neuro-ophthalmology in India still has a long way to go and grow. However, this specialty perhaps offers the most opportunities to collaborate with other specialties of medicine: diagnostic and interventional radiology, neurology, neurosurgery, otorhinolaryngology and endocrinology to mention a few. As Spitze et al. have mentioned in their enlightening article on ‘Neuro-ophthalmology as a career,’ in this issue, “There is no other sub-specialty of ophthalmology that relies as heavily on the ophthalmologist's skill in and use of general medicine.”

Probably, the time has come for neuro-ophthalmologists in India to come together and establish a forum; a united platform to exchange thoughts, ideas and give an impetus to neuro-ophthalmology in India that it deserves: An ‘Indian Society of Neuro-Ophthalmology,’ perhaps?

The idea behind this special issue of the Indian Journal of Ophthalmology was to bring eminent neuro-ophthalmologists from India and abroad together and present to the reader, clinically relevant information, which can actually translate into day-to-day practice for both, the general ophthalmologist as well as the practicing neuro-ophthalmologist. The subjects touched upon in the ‘controversies’ section are often discussed at every neuro-ophthalmology meet and yet always end up with polarized opinions: steroids in nonarteritic anterior ischaemic optic neuropathy and steroids in traumatic optic neuropathy.

This issue also has state-of-the-art review articles covering a wide variety of topics including thyroid related orbitopathy and myasthenia gravis which fit in well with the theme of this special issue of presenting technically sound, well-written review articles with a focus on recent advances.

Finally, this issue would not have been possible without the exceptionally insightful and prompt inputs of Sohan Singh Hayreh, Valerie Biousse and Kenneth Steinsapir. Our editorial board comprising of Peter Savino, Karl Golnik, Andrew Lee, Prem Subramaniam and Vimla Menon, too have done a phenomenal job of coming up with the topics that were selected for this issue. We also wish to acknowledge the efforts put in by our reviewer board comprising of Satya Karna, Navin Jayakumar, Rohit Saxena and S. Ambika among others. We wish to sincerely thank the editor-in-chief of the Indian Journal of Ophthalmology, and the entire editorial team for all the assistance provided by them. We hope that the readers of Indian Journal of Ophthalmology find this issue as enriching and insightful as we found the journey of preparing this special edition.

In conclusion, a poetically, befitting reply to answer the confused resident that will perhaps help him make a decision:

Here's why you should choose neuro-opthalmology,

It can even tell you about a systemic pathology.

With pupils, colour vision and visual fields to see;

It's the branch where your clinical acumen is the key.

You might be called on to help diagnose,

In a patient with no history (he might even be comatose)!

Pupils, reactions, reflexes and the lot,

It's the subtle sign that you must be able to spot.

Long fingers, coarse features and an ususual scotoma;

Will help you come up with the easy answer: a pituitary adenoma!

But it's the one case with the confusing ocular motility;

That will give you a check with ground reality.

CT, PET and MRI don’t always give you the answer;

Is it ischemic, metabolic, traumatic or perhaps cancer?

A ‘master of all’ you must be to ace neuro-ophthalmology,

But, it never hurts to take a bit of help from technology!

1. Nair AG, Marmor MF. A resident's lament Surv Ophthalmol. 2011;56:472
2. Schulze Schwering M, Kayange P, Wilhelm H. Neuro-ophthalmology in Malawi J Neuroophthalmol. 2013;33:e11–2
3. Truhlsen SM. Whatever happened to the EENT specialists? Surv Ophthalmol. 2013;58:92–4
4. Thomas R, Paul P, Rao GN, Muliyil JP, Mathai A. Present status of eye care in India Surv Ophthalmol. 2005;50:85–101
© 2014 Indian Journal of Ophthalmology | Published by Wolters Kluwer – Medknow