Hello, my name is Dr. Minton, and I'm a Neuro-ophthalmologist and Oculoplastic surgeon. I also see patients in what we term general ophthalmology. But many years ago when I was in medical school, I had a neurology professor who said that he was sad that none of his students ever went into neurology. So I was very interested in ophthalmology since the ninth grade and I decided that once I got into ophthalmology that it would be nice to combine the specialty of neurology and ophthalmology and that, of course, is the Neuro-ophthalmology component of my practice.
What is Neuro-Ophthalmology?
It means that you have training in ophthalmology, but then you have done extra training also in neurology. My extra training was at the Mayo Clinic doing a neuro-ophthalmology fellowship.
What are three types of nerves that create vision?
One set of nerves involves the movement of the eyes and if the eyes don't move together and you don't have good three-dimensional vision, that's a problem. Secondly, if you have a problem with the optic nerve that can cause visual decrease especially in patients that have multiple sclerosis and that has to be, you know, identified, and treated and that's a part of Neuro-ophthalmology.
When light comes into the eye, it comes in as light energy and it's converted in the retina to electrical energy. That electrical energy goes down the optic nerve and then all the way to back of the brain, the very back of the brain. So we call that the visual pathways. So that's the third component of nerves, if there is any problem anywhere along that pathway then that's going to create a problem with the vision. So a Neuro-ophthalmologist identifies what the particular process is and then we try to support the patient and try to treat the patient as best we can to see if we can get back vision or improve the vision at least from when we see the patient.
How common are Neuro-Ophthamolody issues?
Well, I wouldn't say that they are super common to tell you the truth, but the point is that when it happens to somebody then it is 100% for that particular patient. so there are many different things that I see as far as Neuro-ophthalmologic problems and most of the time it's a referral from other doctors who are seeing that patient, whether it's a doctor in the emergency room or an optometrist in a small clinic in rural South Dakota or Minnesota. But they like to have out expertise in that. And there are some problems that they don't know exactly what's going on and it's my job to try to determine what is the particular problem or the underlying cause of the difficulties.
How are neurological vision problems treated?
Well, it depends upon the problem, sometimes it's a matter of identifying what the problem is, such as a diabetic patient who develops double vision, and determining that that is the problem with the nerve involved not getting enough blood supply because diabetes is what's termed a microvascular disease. And then once we make that diagnosis we know most likely that that's gonna heal itself over two, three or four months and then we sometimes have to use temporary prisms to help them so they don't have as much double vision without patching an eye.
So the help that we can give patients is trying to make a correct diagnosis and then trying to improve the functioning during the time of the healing. Another example is a patient with multiple sclerosis that develops an inflammation of the optic nerve, that's called optic neuritis. But those have to be treated with some high dose steroid treatments initially to try to get the vision to return and to decrease the number of re-occurrences over the years that follow the diagnosis.
So there are many different things that we can do. One entity that I haven't touched upon is called myasthenia gravis, and that's where there is a problem with the neurotransmitter at end of the nerve, sending a single signal of the nerve onto the next nerve, and that can involve a systematic body or it can be just the eye nerves, and that creates a problem with fluctuating droopiness of the lids and fluctuating double vision. So it's important to identify that the patient has that because that's a totally different treatment than some of the other treatments that I've mentioned.
What benefits to patients receive from Neruo-Opthamology?
I think the benefit that they receive is that there is a diagnosis as to what exactly is going on for them. sometimes if you can't do something about it at least the patient has a better chance of dealing with it if they know exactly what it is. And then the other benefit is to figure out if there is a reversible process that we can somehow intervene to get the vision back to where it was before or at least markedly improve it. I see a lot of that in patients who have multiple sclerosis and optic nerve problems.
How can patients know if their symptoms require a Neuro-Ophthalmologist?
Well, I find with these two subspecialties that most of the time it's a referral from either an optometrist, or a fellow ophthalmologist, or neurologist, but some patients if they evidently see something like this video, may just schedule appointment directly.