A poet may tell you the eyes are the windows to the soul, but many clinicians are likely to tell you that the eyes are the windows to the brain as, in many cases, acute visual disturbances are indicative of a neurological disorder. As such, referring these cases to neuro-ophthalmology sooner rather than later can prevent vision- and potentially life-threatening complications. However, new research shows referrals to neuro-ophthalmology from optometry are too often delayed. In addition, misdiagnosis before referral is a common problem.

The Atlanta-based investigators reviewed 300 cases seen over 45 randomly chosen days between June 2011 and June 2015 and compiled information on the patients’ demographics. Neuro-ophthalmologists played a major role in directing treatment, such as preserving vision, preventing life-threatening complications or avoiding harmful treatment in 21% patients in this study—yet obtaining the neuro-ophthalmology consult was a challenge.

The researchers found that patients had to travel a median of 36.5 miles for a neuro-ophthalmology consultation, not exactly around the corner. Their median time from symptom onset to that consultation was nearly seven months—210 days to be exact. Patients saw a median of two doctors before getting to their neuro-ophthalmology consultation, and 34% of patients in this study saw multiple providers within the same specialty before even getting a referral. Even after getting that referral, patients often had to wait a median of 34 days before seeing their doctor. Nearly half, 49%, of these patients were initially misdiagnosed before seeing the neuro-ophthalmologist—women were disproportionately misdiagnosed at 57% compared with 35% of men. The team noted mismanagement or delays in care 28% of the time and unnecessary tests in 19% of the patients.

Stunkel L, Mackay D, Bruce B, et al. Referral patterns in neuro-ophthalmology. J Neuro-Ophthalmol. October 11, 2019. [Epub ahead of print].