Academic-focused neuro-ophthalmology expands toward patient treatment
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There are approximately 500 full-time fellowship-trained neuro- ophthalmologists in the U.S. to care for a population of 337 million, or about one per 675,000 population.
This makes a neuro- ophthalmologist the rarest of ophthalmology’s core subspecialists. Most practice in university medical centers, and many have joint appointments in the departments of ophthalmology and neurology. Neuro-ophthalmology is a very academic subspecialty, and in my experience, it is often a neuro-ophthalmology faculty member who wins best teacher award in many ophthalmology residencies and even some medical schools.
In my state of Minnesota, we are fortunate to have a strong contingent of full-time neuro-ophthalmologists with six at the Mayo Clinic, two at the University of Minnesota and nine more with a special interest in the subspecialty active in private practice. This is not the case nationwide. There are six states with no neuro-ophthalmologists, and a 20% nationwide shortage has been suggested. Wait times to see a neuro-ophthalmologist for nonemergency cases are at least 3 months in most cities.
The primary subspecialty society for neuro-ophthalmology is the North American Neuro-Ophthalmology Society (NANOS), which will celebrate its 50th anniversary in 2024. Including international physicians, there are approximately 800 members of NANOS. NANOS is dedicated to achieving excellence in the care of neuro-ophthalmic disease by the support of education, research and the practice of neuro-ophthalmology.
The field’s core publication is the Journal of Neuro-Ophthalmology. I suspect few of us have read an article in this journal since our residency training. Fortunately, major advances are reported in the journals more commonly read by the comprehensive ophthalmologist.
I counted 34 AUPO-compliant neuro-ophthalmology fellowship training programs with 40 potential positions, all at academic medical centers. In general, a neuro-ophthalmologist is compensated similar to a neurologist. According to Medscape, in 2022, the median compensation for a neurologist was $301,000 per year. The median compensation for a comprehensive ophthalmologist in 2022 was $417,000, so high pay is not the key factor attracting new neuro-ophthalmologists.
Neuro-ophthalmology is an intellectually stimulating field with a greater than average opportunity to work collegially with members of other medical specialties in the care of systemic diseases with complex impacts on the visual system. The diseases treated are myriad in nature and often both vision-threatening and potentially fatal. These include optic nerve disorders, stroke, tumors of the brain and visual system, pupil and lid abnormalities, diplopia and oculomotor dysfunction, nystagmus, blepharospasm, seizures, migraine, thyroid eye disease, myasthenia gravis, multiple sclerosis, and many other challenging and often rare diseases, dystrophies and degenerations. In past years, neuro-ophthalmology practice has focused on the diagnosis of complex cases, but today, treatment of neurological diseases affecting the visual system by a neuro-ophthalmologist is becoming more common. The use of biologics such as botulinum toxin and the increasing role of cell therapy and gene therapy in the treatment of neurological diseases suggest to me that the neuro-ophthalmologist of the future will have a growing role in therapy.
While I have no objective data to support this as fact, my impression is that my neuro-ophthalmologist colleagues who work and teach in an academic environment are intellectually stimulated, respected by their colleagues, and happy with their choice of career.
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