Eyes are a Window into the Brain

At 20 weeks pregnant, a woman arrived at the UCI Medical Center emergency department experiencing sudden blindness in one eye and rapidly deteriorating vision in the other. Emergency specialists immediately brought in neurologists and ophthalmologists to help find the source of the problem and give her the best treatment.

“Time is vision,” explains Dr. Vivek Patel, chief of neuro-ophthalmology at the Gavin Herbert Eye Institute. “Every day that the cause of a vision problem like this goes untreated, there’s potential for permanent damage.”

Brain and vision

It is said that the eyes are the window to the soul, but they may more accurately be described as the window into the brain. Our eyes often provide clues about what’s going on deep inside our heads – from changes in blood flow to muscle control.

UCI Health neuro-ophthalmologists work closely with their UCI Health neurosurgery colleagues to treat patients with complex conditions that affect vision, such as multiple sclerosis, brain tumors, double vision, traumatic brain injuries and Parkinson’s disease-like disorders.

“The retina and optic nerve can give us a lot of information about what’s going on in the brain,” says UCI Health neurologist Dr. Claire Henchcliffe, professor and chair of the UCI School of Medicine’s Department of Neurology who specializes in Parkinson’s disease.

“As neurologists, we may have a suspicion of what the diagnosis is, but the eyes are what clinch it for us. We really need to confer with our eye experts.”

For example, one condition easily misdiagnosed as early Parkinson’s disease can be accurately identified by a neuro-ophthalmologist examining the eye for tiny movements — the giveaway that it instead is progressive supranuclear palsy. Making that determination early on helps to get the patient started on the best treatment sooner.

Patel is helping to spearhead more formal collaborations between UCI Health neurologists and neuro-ophthalmologists to further enhance patient care. These include creating a network of multidisciplinary specialists to treat traumatic brain injuries, which often affects sight. Other specialists will collaborate to better serve ataxia patients experiencing balance issues as well as vision problems. Patients with multiple sclerosis and other neurologic autoimmune conditions that can damage vision soon will be able to see a neuro-immunologist and a neuro-ophthalmologist in the same visit.

“As a young and growing department, there’s energy and enthusiasm to activate new services like these,” says Dr. Sam Spiegel, the newest addition to the neuro-ophthalmology team, which includes Patel, Dr. R. Wade Crow and Dr. Lilangi Ediriwickrema.

“In our academic medical system, we share patients, refer within our network and meet periodically to discuss
our patient cases so that every individual gets the highest standard of care, even for the most complex diseases,” Spiegel adds.

Looking ahead

It’s not only current patients who benefit from the eye institute’s neuro-ophthalmologists. “These guys are awesome teachers,” says Henchcliffe. “When we train neurologists, they need to understand a certain amount of neuro-ophthalmology. We’re fortunate that Dr. Patel and Dr. Spiegel are very involved with teaching our residents and even their peers.”

The ophthalmology department recently launched a neuro-ophthalmology fellowship, which offers advanced training to doctors who want to specialize in the field.

Henchcliffe also closely watches the research findings produced by the eye institute.

“We pride ourselves on providing superior clinical care, but we need to improve the options available to patients, and that’s where we need more research,” she says.

“As neurologists, we pay attention to the research in ophthalmology, because where they lead, we can follow.” Henchcliffe is especially excited about neuro-ophthalmology research that is leading to better imaging techniques and identifying new biomarkers for neurological diseases.

She and her colleagues also are closely watching advances in gene therapy being developed by Krzysztof Palczewski, PhD, at the eye institute’s Center for Translational Vision Research.

Restoring sight

When Patel saw the pregnant woman who was losing her sight, he ordered special tests to identify the source of inflammation that was affecting her vision. He also coordinated with neurologists to give her intravenous immunoglobulin (IVIG) to tamp down the inflammation. Within a matter of days, her vision was restored.

“She needed the highest order of care from a team working together across multiple areas of expertise,” says Patel. “That can be more difficult to get in an outpatient setting, but is exactly what an academic medical system like UCI Health can provide.

“As neuro-ophthalmologists, we collaborate with neurologists and neuro-immunologists every day,” he adds. “In this case, we worked together to take her from
blindness to seeing.”