I first became interested in neuro-ophthalmology during medical school after deciding to become a neurologist. Neuro-ophthalmology is a fascinating field involving disorders of vision that arise from the optic nerves, brain, eyelids and eye muscles...combining the tools of ophthalmology with the investigative thought processes of neurology. It overlaps every aspect of medicine.
After finishing my fellowship in Neuro-Ophthalmology, I joined the Neurology faculty at SUNY Upstate Medical Center in Syracuse, New York, which is where I became interested in Headache Medicine. Patients with headache disorders and visual symptoms, such as transient visual loss, double vision and visual aura found their way into my practice and many turned out to have migraine. As a neurologist, I had some experience treating headaches during my residency training and started treating their migraines. When they returned for follow up and told me that the treatment had given them their lives back, I was astounded -- this wasn't something that neurologists were used to hearing at the time!
Another condition that neuro-ophthalmologists frequently see that combines neuro-ophthalmology and headache medicine is idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri syndrome. For unknown reasons, the cerebrospinal fluid pressure in the brain is high in IIH. It most often affects obese women of childbearing age and can lead to permanent visual loss and debilitating headaches if not diagnosed early and treated effectively. As the only neuro-ophthalmologist in Syracuse, I saw patients with IIH from all over Central New York and started doing research in the condition. My experience caring for these patients made me realize that most of them continued to experience severe headaches even after their cerebrospinal fluid pressure was controlled and their optic nerve swelling resolved. They also needed someone with expertise in headache treatment.
Realizing the need to provide headache care and motivated to learn more, I attended national meetings of the American Headache Society to learn from experts in headache medicine -- and the rest is history. I was hooked!
After 12 years in Syracuse, I moved slightly farther west and joined the faculty in the Department of Ophthalmology at the University of Rochester. There was, and still is, a strong Neurotherapeutics program there, and I went back to school part-time to get a Masters in Public Health degree with a focus on experimental therapeutics and clinical trials. I directed the fledgling clinical trials unit in Ophthalmology and was on the steering committee for the Idiopathic Intracranial Hypertension Treatment Trial, the second multi-center clinical trial in Neuro-Ophthalmology funded by the National Institutes of Health (the first was for optic neuritis when I was still a resident). As a member of the university's institutional review board, I learned a lot about the ethics and conduct of human research. My leadership roles in the North American Neuro-Ophthalmology Society occurred during these years.
My dream was to start a multi-disciplinary, world-class headache center and I was recruited by the University of Texas Southwestern in 2011 to do that. I am proud of what we built there and the quality of care that my team provided. My experience treating patients at UT Southwestern led to my most recent interest in another cerebrospinal fluid pressure condition in which the spinal fluid leaks out of the spinal column. Called 'Spontaneous Intracranial Hypotension', it causes many different symptoms, including headache (typically worse when upright), imbalance, hearing loss, memory problems and abnormal movements. The symptoms are so varied that it can be very difficult to diagnose and treat; many people suffer for years before being correctly diagnosed. This condition also requires a specialized treatment team and we established a nationally recognized program for "leaks" at UT Southwestern.
There are currently fewer than 500 neuro-ophthalmologists and fewer than 600 headache specialists in the country, so people with the most challenging and complex disorders migrate to us. There are only a handful of physicians in the country that specialize in both neuro-ophthalmology and headache medicine. As one of them, I provide insight and expertise to help patients who need this unique perspective for their diagnosis and treatment. I enjoy seeing patients with neuro-ophthalmic problems and headache disorders, love a challenge and find it very rewarding to help people get better, which I am grateful to experience every day in my practice. I am also passionate about teaching, doing clinical research and writing. I am excited to participate in advances in Neuro-Ophthalmology and Headache Medicine, improving diagnostics and testing new treatments that offer hope and optimism for patients.