Pediatric Neuro-Ophthalmology

"Due to the generous representation of the afferent visual system within the brain, neurological disease may disrupt vision as a presenting symptom or as a secondary effect of the disease. Conversely, early developmental disturbances of vision often disrupt ocular motor control systems, giving rise to complex disorders such as nystagmus, strabismus, and torticollis. The signs and symptoms of neurological disease are elusive by their very nature, presenting a confounding diagnostic challenge. Neurological medications and neurosurgical treatments can produce neuro-ophthalmological dysfunction that can be difficult to distinguish from disease progression. Affected patients may experience substantial delays in diagnosis, and are often subjected to extensive (and expensive) diagnostic testing. Scientific articles pertaining to specific disorders are scattered throughout medical subspecialty journals. These children continue to "fall through the cracks" of our medical education system. The increasing recognition that pediatric neuro-ophthalmology comprises a distinct set of diseases from those seen in adults has led to its emergence as a dedicated field of study.

"Since the original publication of Pediatric Neuro-Ophthalmology nearly fourteen years ago, interest in the field has burgeoned. Pediatric ophthalmology and pediatric neurology subspecialty conferences often include symposia dedicated to recent advances in pediatric neuro-ophthalmology. Technical advances in neuroimaging have given rise to a more integrated mechanistic classification of neuro-ophthalmological disease in children. Our understanding of neurodevelopmental disorders of the visual system has expanded, longstanding monoliths have been dissembled into component parts, basic molecular mechanisms have taken center stage, and genetic underpinnings have become definitional. Evolutionary alterations can now be observed at the level of the gene, adding a new dimension to our understanding of disease pathogenesis. New classifications now encompass clinically disparate conditions. Descriptive definitions have been supplanted by mechanistic ones, and clinical definitions superseded by genetic ones. Our concept of disease pathogenesis has been revised and in some cases overturned. Bearing witness to these remarkable advancements has compelled me to enhance and expand the first edition of Pediatric Neuro-Ophthalmology into this new and revised one.

"In the first edition of this book, our goal was to present the clinical characteristics, diagnostic evaluation, and therapeutic options for the common neuro-ophthalmologic disorders of childhood. In so doing, we designed the book to be provide a narrative journey through the thought processes involved in the clinical management of these disorders. In this edition, I have retained the basic narrative format of original book, while expanding the exploration of these complex visual disorders in the context of the many new scientific advancements and discoveries that have come to light. These conditions are fun to diagnose, fascinating to understand, and gratifying to manage." —from the Preface to the 2nd Edition.

The book contains predominantly black-and-white illustrations, with some color illustrations.

"Due to the generous representation of the afferent visual system within the brain, neurological disease may disrupt vision as a presenting symptom or as a secondary effect of the disease. Conversely, early developmental disturbances of vision often disrupt ocular motor control systems, giving rise to complex disorders such as nystagmus, strabismus, and torticollis. The signs and symptoms of neurological disease are elusive by their very nature, presenting a confounding diagnostic challenge. Neurological medications and neurosurgical treatments can produce neuro-ophthalmological dysfunction that can be difficult to distinguish from disease progression. Affected patients may experience substantial delays in diagnosis, and are often subjected to extensive (and expensive) diagnostic testing. Scientific articles pertaining to specific disorders are scattered throughout medical subspecialty journals. These children continue to "fall through the cracks" of our medical education system. The increasing recognition that pediatric neuro-ophthalmology comprises a distinct set of diseases from those seen in adults has led to its emergence as a dedicated field of study.

"Since the original publication of Pediatric Neuro-Ophthalmology nearly fourteen years ago, interest in the field has burgeoned. Pediatric ophthalmology and pediatric neurology subspecialty conferences often include symposia dedicated to recent advances in pediatric neuro-ophthalmology. Technical advances in neuroimaging have given rise to a more integrated mechanistic classification of neuro-ophthalmological disease in children. Our understanding of neurodevelopmental disorders of the visual system has expanded, longstanding monoliths have been dissembled into component parts, basic molecular mechanisms have taken center stage, and genetic underpinnings have become definitional. Evolutionary alterations can now be observed at the level of the gene, adding a new dimension to our understanding of disease pathogenesis. New classifications now encompass clinically disparate conditions. Descriptive definitions have been supplanted by mechanistic ones, and clinical definitions superseded by genetic ones. Our concept of disease pathogenesis has been revised and in some cases overturned. Bearing witness to these remarkable advancements has compelled me to enhance and expand the first edition of Pediatric Neuro-Ophthalmology into this new and revised one.

"In the first edition of this book, our goal was to present the clinical characteristics, diagnostic evaluation, and therapeutic options for the common neuro-ophthalmologic disorders of childhood. In so doing, we designed the book to be provide a narrative journey through the thought processes involved in the clinical management of these disorders. In this edition, I have retained the basic narrative format of original book, while expanding the exploration of these complex visual disorders in the context of the many new scientific advancements and discoveries that have come to light. These conditions are fun to diagnose, fascinating to understand, and gratifying to manage." —from the Preface to the 2nd Edition.

Lawrence M. Kaufman

This is a medical textbook geared for clinicians who care for children with diseases that affect both the eye and brain. To the best of my knowledge, this publication represents the first textbook in the field of pediatric neuro-ophthalmology. Previously, clinicians caring for such patients would need to consult a variety of references to obtain the necessary information that is now succinctly presented in this single source. The book is designed to provide the clinician practical guidelines for the diagnosis and management of children with both simple and complex neuro-ophthalmological diseases. The authors also present detailed background information as well as an extensive review of past and current medical literature on the relevant topics. Practitioners directly involved in the care of children with neuro-ophthalmological problems will want to read this book cover to cover. This includes physicians in the disciplines of pediatric neuro-ophthalmology, pediatric ophthalmology, and neuro-ophthalmology. Resident physicians or practitioners in the field of pediatrics, neuroradiology, general ophthalmology, or general neurology would use this book more as a reference source for information on particular topics. The book is divided into 11 chapters, all of which are problem oriented. For instance, chapter 8 on nystagmus in infancy and childhood is so well and thoroughly presented as to make the most tentative physician comfortable with the diagnosis and management of such a patient. Throughout the book there are excellent color photographs demonstrating various types of optic nerve disease and black-and-white images of relevant CT and MRI brain studies. This is a textbook that islong overdue. The authors are to be commended for their eloquent presentation of what shall be the standard reference on the subject in the future.

Brodsky, Michael C., MD (Univ of Arkansas); Baker, Robert S., MD (Univ of Kentucky); Hamed, Latif M., MD, FACS (Univ of Florida)