The brain-vision connection
Neuro-ophthalmologists work to save and improve eyesight of patients with neurological conditions
Enter the team of Padmaja Sudhakar, MD, and Mangayarkarasi Thandampallayam Ajjeya Gowder, MD, neuro-ophthalmologists and neurology faculty at the UK Kentucky Neuroscience Institute (KNI). They treat visual problems related to the nervous system, which includes conditions that affect the optic nerve, the movement of the eyes and areas of the brain where vision is processed.
Drs. Sudhakar and Thandampallayam typically see patients whose vision problems are a result of conditions such as optic nerve disease like optic neuritis and papilledema, brain tumor or stroke, nystagmus and double vision. They also treat patients who have traumatic brain injuries and those with inflammatory diseases like giant cell arteritis, infections and autoimmune disorders such as myasthenia gravis. “Often, a vision problem is the first sign something is wrong neurologically. We are the starting point for many patients,” Dr. Sudhakar said.
A rare and crucial service
While having one neuro-ophthalmologist on staff is uncommon even for large institutions, two is quite rare, the doctors agree. “Many of our patients travel two to three hours to see us,” Dr. Thandampallayam said. “My heart goes out to them. There is such a huge need in Kentucky.”
Kentucky’s high rates of obesity and smoking are contributing factors to a rise in neurological conditions, the doctors said. Coupled with environmental factors and poor access to care for many in rural areas, it’s a problem that continues to worsen.
In the year since Dr. Thandampallayam joined KNI, the wait time for their services has decreased substantially, but it is still longer than the doctors would like, they acknowledge.
“There is the perception that patients have to wait six months to be seen,” Dr. Sudhakar said. “But that isn’t always the case. We have developed a triage system so that we can see the most serious cases first, and we also work closely with the ERs. We are always available to discuss a patient with any doctor who has concerns, to provide clinical advice and to talk them through preliminary workup steps.”
The fellowship-trained neuro-ophthalmologists are also frequently called in by physicians treating patients with medications that may affect vision.
Active in the research arena, Drs. Sudhakar and Thandampallayam are involved in clinical trials related to myasthenia gravis and epilepsy, looking at the link between sleep apnea and vision, and searching for biomarkers that can predict dementia. Much of their work is performed with other neuroscience colleagues. It’s a multidisciplinary team whose collaboration is vital in research and in patient care, they said.
Their love of teaching is also evident as they lead discussions with neurology residents on neuro-ophthalmology and begin work on developing a fellowship program. “You can objectively show the science as you teach,” Dr. Sudhakar said. “It’s not fast-paced. It’s a field that requires you to think things through. Most medical students and residents have not had much exposure to ophthalmology and neuro-ophthalmology.”
As the neuro-ophthalmology program at KNI continues to grow, the doctors focus on providing the highest quality care for patients. “When you save someone’s vision, it is lifechanging for them,” Dr. Thandampallayam said. “It is very satisfying to have such an impact on a patient’s life.”
