Neuro-ophthalmology Expert Witness Testimony

Expert neuro-ophthalmology testimony can be helpful when analyzing and understanding disorders affecting vision that relate to the optic nerve or brain.  Some of the neuro-ophthalmic eye disorders encountered by board-certified ophthalmologists include optic neuropathy, brain disorders, abnormal pupil reactions, reduced vision without obvious pathology findings, and disorders of the muscles of the eye.

Ocular trauma with decreased vision may involve direct injury to the eye, injury to the optic nerve, or to that brain of the brain responsible for vision.  An examination may be able to differentiate which of these factors is responsible for visual loss.  Sometimes, an examination may show a combination of factors that account for vision loss.  For example,  severe blunt trauma to the head may lead to damage to the optic nerve and cause a condition known as optic neuropathy.  The same forces may also be responsible for vision loss from a retinal detachment.  A review of medical records or an appropriate eye examination may be able to diagnose these findings.

Optic nerve trauma from accident, surgery, or intentional assault may result in decreased vision.  The optic nerve may show signs of swelling (edema) or whiteness (pallor) from trauma.  Quite often it is useful for the ophthalomologist to compare the appearance of the optic nerve in one eye with the optic nerve in the other eye to determine the diagnosis and severity of disease.

Disorders of the brain can also cause vision loss.  Trauma to the brain can cause swelling, hemorrhage, atrophy, or other effects that impact vision.  The occipital cortex is that part of the brain that processes vision ad retains visual memory.  Damage to the occipital cortex may result in blind spots that are known as scotomas.  The pattern of scotomas may provide specific information about the location of a problem within the brain.  Clinical findings can often be corroborated with radiologic findings from a CT scan or MRI scan.

Retinal problems are often encountered during an eye examination involving reduced vision.  Some of these problems range from benign issues without visual significance to issues that signify dramatic loss of vision.  Benign problems include things like myelinated nerve fibers that give the appearance of whitening in the retina.  Conversely, a clot embedded in the circulation of the optic nerve can cause a central retinal artery occlusion with drastic loss of vision.  The retina and optic nerve can become permanently damages from a central retinal artery occlusion.

Treatment for central artery occlusion includes withdrawing fluid from the eye by a technique known as paracentesis.  Intermittent pressure of the eye can potentially cause a clot to dislodge.  Some authors have recommended hyperbaric oxygen therapy.  Reynard at al. described a successful approach to treating this condition with a laser that opens a blood vessel in the eye to release a clot.  Their study was reported in the American Journal of Ophthalmology.

Neuro-ophthalmology witness testimony may elucidate causation and prognosis in may types of eye conditions involving the eye and the nervous system.

 

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