Eyeworld

World view Neuro-ophthalmology for the anterior segment surgeon O ften our most challenging patients are those with neuro-ophthalmic findings. These patients may have vision-threat- ening or even life-threatening signs and symptoms. Who should be referred immediately as an emergency, who can be a non-emergent referral, and who can be man- aged in our office is the conundrum. In addition, what are the appropriate tests we should be performing when we encounter these patients? Many patients with neuro-ophthalmic findings will also present to us subsequently for cataract surgery. How should these patients be counseled and managed? All ophthalmologists will deal with these issues during their careers. In this issue of EyeWorld, we provide a primer of neuro-ophthalmolo- gy for the anterior segment surgeon. One of the most devastating diseases we encounter in our offices is nonarteritic anterior ischemic optic neuropathy (NAION). NAION frequently occurs without warning and can cause significant life-changing vision loss. In the past, NAION was found to occur more commonly following cataract surgery, possibly due to high intraocular pressure, increased inflammation, raised intraorbital pressure from a retrobulbar or peribulbar anesthetic, sys- temic perioperative hypotension, or a combination of these factors. A new study by Neil Miller, MD, suggests that with modern cataract surgery the risk of NAION is not increased following second eye surgery. Dr. Miller and co-author Ahmadreza Moradi, MD, discuss their findings and make practi- cal recommendations for cataract surgeons. In an editorial published in the same journal issue as their study, Timothy McCulley, MD, and Byron Lam, MD, make their own recommendations, which they discuss in this issue. Ophthalmologists are often the first physicians to manage patients with varicella zoster, and the ocular complications of this disease are well known. However, many of us are not aware of the neuro-ophthalmic manifestations of varicella zoster. The most common neuro-ophthalmic complications are diplopia and optic neuritis. Karl Golnik, MD, and Sachin Kedar, MD, discuss the management of these patients and specifically who should be referred for hospital admission. Optic neuritis is a relatively common ophthalmic disease that presents to our office. Making the correct diagnosis and proper referral is important for these patients. Twenty percent of patients with multiple sclerosis will present with optic neuritis as their first symptom. Gregory Van Stavern, MD, and Ranya Habash, MD, discuss what we should know about optic neuritis when it presents in one of our patients and what tests we should be performing. Papilledema can be a life-threatening diagnosis. Differentiating papill- edema from pseudopapilledema is an important diagnostic challenge. A re- cent study in Ophthalmology evaluated diagnostic testing in pediatric patients with a diagnosis of papilledema or pseudopapilledema. The authors of the study, Stacy Pineles, MD, and Melinda Chang, MD, share their pearls for the diagnosis and testing of these patients. Neuro-ophthalmology is not often the first thing that comes to mind for anterior segment surgeons, but we all acknowledge its special importance. We appreciate the neuro-ophthalmologists' expertise and the important role they play in caring for our patients. I would like to say a special thank you to all the physicians above for their contributions to this issue of EyeWorld. EW The official publication of the American Society of Cataract & Refractive Surgery A S C R S June 2018 Vol. 23 • No. 6 Publisher Donald Long don@eyeworld.org Editorial Editor Amy Goldenberg amy@eyeworld.org Managing Editor Stacy Jablonski stacy@eyeworld.org Senior Staff Writer/Digital Editor Ellen Stodola ellen@eyeworld.org Senior Staff Writer Liz Hillman liz@eyeworld.org Production Graphic Designer Julio Guerrero julio@eyeworld.org Graphic Design Assistant Susan Steury susan@eyeworld.org Production Manager Cathy Stern cathy@eyeworld.org Contributing Writers Stefanie Petrou Binder, MD Berlin, Germany Vanessa Caceres Bradenton, Florida Rich Daly Arlington, Virginia Lauren Lipuma Washington, D.C. Michelle Stephenson Roanoke, Virginia Senior Contributing Writer Maxine Lipner Nyack, New York Advertising Sales ASCRSMedia 4000 Legato Road Suite 700 Fairfax, VA 22033 703-591-2220 Fax: 703-591-0614 eyeworld@eyeworld.org www.eyeworld.org Paul Zelin paul@eyeworld.org Classified Sales Cathy Stern cathy@eyeworld.org EyeWorld Special Projects and Events Jessica Donohoe jessica@eyeworld.org Shelly Dixon shelly@eyeworld.org Anne Le anne@eyeworld.org ASCRS Publisher: EyeWorld (ISSN 1089-0084) is published monthly by ASCRS Ophthalmic Services Corp., 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; telephone: 703-591-2220; fax: 703-591-0614. 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POSTMASTER: Send change of address to EyeWorld, 4000 Legato Road, Suite 700, Fairfax, VA 22033. Periodical postage paid at Fairfax, VA 22033 and at additional mailing offices. The ideas and opinions expressed in EyeWorld do not necessarily reflect those of the editors, publisher, or its advertisers. P U B L I S H I N G S T A F F Eric Donnenfeld, MD, chief medical editor

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