Double vision
Missing vision
Multiple Sclerosis


Dr Kenneth Chang, MD



What is neuro-ophthalmology?


You may have heard the saying, “If the only tool you have is a hammer, you might treat everything as if it were a nail.”  This is very applicable in ophthalmology.  Neuro-ophthalmology is a fascinating subspecialty that encompasses both neurology and ophthalmology, and deals with visual problems that do not come from the eyeball itself.

The correct treatment begins with the correct diagnosis; and those with neuro-ophthalmic training have the unique ability to assess the visual system from the eyeball to the brain.



What common problems do neuro-ophthalmologists evaluate?


Nearly 1/2 of the brain is used for vision, so problems in the brain can manifest as visual problems.

Common problems evaluated by neuro-ophthalmologists include:

  • optic nerve problems (such as optic neuritis from multiple sclerosis)
  • vision loss from stroke
  • visual field loss
  • unexplained visual loss
  • transient visual loss
  • visual disturbances
  • double vision
  • abnormal eye movements
  • thyroid eye disease
  • myasthenia gravis
  • unequal pupil size
  • eyelid abnormalities

While many neuro-ophthalmic conditions are not vision threatening, some conditions can cause permanent visual loss, or become life threatening.




What is the value of seeing a neuro-ophthalmologist?


Neuro-ophthalmologists have unique abilities to evaluate patients from the neurologic, ophthalmologic, and medical standpoints to diagnose and treat a wide variety of problems. Costly medical testing is often avoided by seeing a neuro-ophthalmologist.

There are fewer than 200 practicing neuro-ophthalmologists in the United States.  Training involves at least 9 years of formal training after college; including medical school, internship, a residency in either ophthalmology or neurology, and fellowship training.

Dr. Chang completed his neuro-ophthalmology fellowship at Harvard Medical School and then stayed on as a faculty member teaching for 7 years prior to returning to Hawaii.


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