Neuro-Ophthalmology

Casey's neuro-ophthalmologists Dr. Falardeau and Dr. Hills consult on a patient

The neuro-ophthalmology specialists at OHSU Casey Eye Institute take care of patients with visual problems related to the nervous system. Although these visual problems do not come from the eyes themselves, they do cause visual symptoms. Neuro-ophthalmologists use their expertise in neurology and ophthalmology to diagnose and treat a wide variety of problems.  

We see a broad range of neuro-ophthalmic disorders affecting children and adults. Many of these disorders affect the brain and the optic nerves as well as eye movements, pupils and field of vision. Common problems we treat include optic nerve problems (such as inflammation and constricted blood flow), visual field loss, unexplained or short episodes of visual loss, double vision, abnormal eye movements, thyroid eye disease, myasthenia gravis, unequal pupil size, and eyelid abnormalities.  

As a regional resource for specialized care in neuro-ophthalmology, we offer: 

  • The expertise of the only full- time neuro-ophthalmologists in Oregon, who provide the best possible diagnosis, management and treatment of these complex conditions and see patients throughout the Pacific Northwest. 

  • Collaborative care working with other Casey and OHSU specialists to give you the best treatment plan. 

  • State-of-the-art technology to test the optic nerve and to help us make a more accurate diagnosis 

  • Innovative research and access to clinical trials to learn more about the connection between the eyes and the brain, study new treatments and offer our patients the most advanced options.

Our expertise

When you receive care from our doctors you receive:  

  • Board certified and fellowship-trained expertise and the knowledge and skill to thoroughly care for patients with complex problems. 

  • Access to part of the highly regarded OHSU Pituitary Center care team.  

  • Compassionate care, where your unique eyes, brain and medical history are taken into account as part of a thorough exam. Taking the time to provide a careful evaluation is crucial for patients who often have rare disorders and are referred from many other medical specialties, often with an unknown diagnosis.  

  • Care from highly respected leaders in the field who travel the world to teach and lecture, publish research and have leadership roles in several national ophthalmology organizations, including the North American Neuro-Ophthalmology Society, the American Academy of Ophthalmology, and the American Board of Ophthalmology. 

Our doctors

Coordinated care

Our team approach is a very important part of the care you receive. Most of our patients have complex problems that involve many parts of the eye and brain, so we work closely with other specialists from OHSU Casey Eye Institute as well as from OHSU’s departments of neurology, neurosurgery, and neuro-oncology to give you the best care possible.  

Latest technology

Our doctors and staff use the most advanced technology available to examine your eyes and treat unusual disorders, including: 

  • You have access to state-of the-art imaging devices that test your brain and optic nerve, giving us the best information available to help us determine the cause of your vision symptoms and understand your condition. 

  • We are one of only a few sites that offer videonystagmography (VNG) in the Western United States. VNG can help us know your type of nystagmus, or rapid involuntary eye movement, and it can also help determine what surgical procedures would be best for treatment.  

Neuro-ophthalmic exam and tests

At your appointment we do a very thorough exam that may take 1 to 3 hours. We carefully review your medical history, do an eye exam and often request images of your eyes. Each evaluation is unique to your symptoms.  

A typical neuro-ophthalmic exam includes: 

  • Visual acuity test:  An eye exam using an eye chart that checks how well you see the details of a letter or symbol from a specific distance. 

  • Color vision test: Measures your ability to tell the difference between specific colors. 

  • Pupil testing:  An important part of the neuro-ophthalmic eye exam. Because you do not have voluntary control of your pupils, pupil testing may uncover possible problems with your optic nerve, your retina, or parts of your nervous system, as well as other problems in the rest of your body. 

  • External examination:  We look at your eyelids, the position of your eyes, facial muscle symmetry and function, and skin around the eyes.  

  • Eye movement test: We study your eye muscle movements to look for potential limitations or abnormal movements of your eyes. 

  • Visual field tests: An eye exam that can detect dysfunction in your central or peripheral vision, which can be caused by various eye or neurological disorders in the optic nerve or brain. 

  • OCT:  A computer-guided device that creates a 3-D image map of different parts of your eye and measures different layers. This test can help detect small defects in the retina and optic nerve.  

  • CT and MRI scans: These tests may be needed to complete your evaluation. These scans are obtained in a radiology department and require an additional appointment. CT and MRI provide high quality images of the brain and optic nerves, as well as high quality images of the blood vessels in your brain.  

Research and innovation

Extensive Research: Our doctors are involved in research to improve the understanding, diagnosis, management and treatment of conditions related to the brain and optic nerve, and regularly publish our studies. Learn more.

Clinical trials: Casey’s neuro-ophthalmology team has several ongoing clinical trials in collaboration with OHSU’s neurology, neurosurgery, and interventional radiology departments. Casey scientists and doctors are trying to better understand the conditions affecting the brain and optic nerve, their progression and how to treat them. Find clinical trials.