The role of the neuro-ophthalmologist
Neuro-ophthalmologists are doctors specializing in the neurology of the visual system. This includes the eyes, of course, but also the nerves behind the eyes (the optic nerves), which carry visual information to the brain so you can “see”.
The pituitary gland sits directly beneath the optic chiasm, the place where the two optic nerves cross on their way to the brain. Tumors that arise from the pituitary gland commonly grow upwards, squeezing the optic chiasm and disrupting vision. When a pituitary tumor compromises vision, it affects peripheral (side) vision first, and the changes can be so subtle that patients may not realize they are losing vision.
Right before your visit with the neuro-ophthalmologist, you will be sent for a “visual field test” at the Ivey Eye Institute at St. Joseph’s Hospital. This is an important non-invasive test of your peripheral vision that takes about 15 minutes to complete. A visual field technician will explain the test to you and help you through it. You will be asked to stare at a target while flashes of light appear in your peripheral vision. You must press a button when you see the flash appear. Each eye is tested separately.
What to expect at the neuro-ophthalmology clinic
Following the visual field test, you will go to the neuro-ophthalmology clinic, either at the Ivey Eye Institute (Pod 5) or at London Health Sciences Centre's University Hospital (7th floor). The neuro-ophthalmologist or his resident will take a detailed history from you and will review previous records and tests. Then, he will perform a very detailed physical examination of your eyes. Your eyes may be dilated with drops, so please bring a driver with you as your vision may be blurry for up to six hours afterwards.
Not including the visual field test, your appointment will take one to two hours, so be prepared. Please be sure to bring an up-to-date list of all your medications and your glasses.