Readers who wish to explore specific topics in greater detail may consult the references cited within each chapter and listed in the Additional Materials and Resources section at the back of the book. These references are intended to be selective rather than exhaustive, chosen by the BCSC faculty as being important, current, and readily available to residents and practitioners.

xvi • Introduction to the BCSC

This edition of Section 5, Neuro-Ophthalmology, includes videos related to topics covered in the book and interactive content, or “activities,” developed by members of the BCSC faculty. The videos and activities are available to readers of the print and electronic versions of Section 5 (www.aao.org/bcscvideo_section05 and www.aao.org/bcscactivity_section05). Mobile device users can scan the QR codes below (a QR-code reader may need to be in­ stalled on the device) to access the videos and activities.

Videos

Activities

Each volume of the BCSC is designed as an independent study activity for ophthalmology residents and practitioners. The learning objectives for this volume are given on page 1. The text, illustrations, and references provide the information necessary to achieve the objectives; the study questions allow readers to test their understanding of the material and their mastery of the objectives. Physicians who wish to claim CME credit for this educational activity may do so by following the instructions given at the end of the book.*

The Basic and Clinical Science Course has expanded greatly over the years, with the ad­ dition of much new text, numerous illustrations, and video content. Recent editions have sought to place greater emphasis on clinical applicability while maintaining a solid foun­ dation in basic science. As with any educational program, it reflects the experience of its authors. As its faculties change and medicine progresses, new viewpoints emerge on controversial subjects and techniques. Not all alternate approaches can be included in this series; as with any educational endeavor, the learner should seek additional sources, including Academy Preferred Practice Pattern Guidelines.

The BCSC faculty and staff continually strive to improve the educational usefulness of the course; you, the reader, can contribute to this ongoing process. If you have any sugges­ tions or questions about the series, please do not hesitate to contact the faculty or the editors.

The authors, editors, and reviewers hope that your study of the BCSC will be of last­ ing value and that each Section will serve as a practical resource for quality patient care.

* This activity meets the Self-Assessment CME requirements defined by the American Board of Oph­ thalmology (ABO). Please be advised that the ABO is not an accrediting body for purposes of any CME program. ABO does not sponsor this or any outside activity, and ABO does not endorse any particular CME activity. Complete information regarding the ABO Self-Assessment CME Maintenance of Certifi­ cation requirements is available at https://abop.org/maintain-certification/cme-self-assessment/.

Since its inception, Section 5, Neuro-­Ophthalmology, has continually evolved. In 2001, the text was reor­ga­nized to take a symptom-­driven approach, focusing on how to approach patients with neuro-­ophthalmic concerns. Accordingly, the emphasis is on the examina­ tion of the patient—­both basic and extended—­and the appropriate use of adjunctive stud­ ies to determine the status of the patient’s visual system as a ­whole. With this edition, we hope the reader ­will find the content to be improved in terms of both the approach to the diagnosis and to the management of a patient with neuro-­ophthalmic disease.

As part of ­every major revision, outdated material is eliminated, and text, ­tables, illus­ trative material, and references are updated. For this major revision, several new features ­were added. Each chapter begins with a list of highlights to pique the reader’s interest. “Clinical pearl” boxes appear throughout the book, presenting information that can be quickly applied to clinical practice. Sidebars emphasize impor­tant concepts or ideas. Also, a significant number of videos and animated figures ­were added to enhance the educa­ tional value of the book.

The titles of several chapters ­were revised to reflect changes to the content. The title of Chapter 2 changed from “Neuroimaging in Neuro-­Ophthalmology” to the broader “Imaging in Neuro-­Ophthalmology,” as an entire section of the chapter is now dedicated to optical coherence tomography (OCT), specifically, how to interpret OCT results. This imaging technique has become an impor­tant part of the evaluation of patients with neuro-­ ophthalmic disorders.

A particularly significant modification for this edition is the division of Chapter 4, previously titled “The Patient With Decreased Vision: Classification and Management,” into 2 chapters, titled “The Patient With Decreased Vision Due to Optic Nerve and Chias­ mal Diseases” and “The Patient With Visual Dysfunction Due to Retrochiasmal Disease.” This was done for 2 main reasons; the first was to simplify the organ­ization. Pre-­chiasmal lesions cause monocular visual loss, whereas chiasmal and post-­chiasmal lesions typically cause binocular visual loss (with the rare exception of the temporal crescent syndrome). Further, dividing vision loss on the basis of the location of the cause is a practical clinical approach. The second reason was to make the content more manageable for the reader, as Chapter 4 in previous editions presented a tremendous amount of information.

Chapter 14, formerly titled “The Patient With Nonorganic Ophthalmic Disorders,” has been substantially updated to align with evolving diagnostic categorization and treat­ ment approaches used by psychiatrists and neurologists for patients with visual symptoms and signs that are incompatible with recognized neurologic or ophthalmic disease and with distress or impairment related to ­these, as well as for patients with excessive thoughts, feelings, or be­hav­iors related to ­either explained or unexplained visual symptoms. The updates—reflected by the new title, “The Patient With Functional Neurological Symptom (Conversion) and Related Disorders”—include an overview of the most recent diagnostic categorization of ­these disorders with a focus on the role of the ophthalmologist in identi­ fying them and supporting care of the patient xvii

xviii ● Introduction to Section 5

Links to the NOVEL (Neuro-Ophthalmology Virtual Education Library) website of NANOS (North American Neuro-Ophthalmology Society) are included in several chap­ ters throughout the book. This is a web-­accessible collection of open-­access, copyrighted resources such as images, videos, lectures, and other digital media. ­After accessing the col­ lections, the user can navigate through to the relevant resources. See the NOVEL website, https://­novel​.­utah​.­edu, for more information.

This book is not meant to be an all-­encompassing or comprehensive treatise; thus, we have included a list of some of the more useful secondary sources of information, as well as references with primary source material. As with all previous major revisions, we have endeavored to make this book more readable as well as clinically relevant and hope that it ­will help instill confidence in ophthalmologists to approach patients with common clini­ cal neuro-­ophthalmic prob­lems.

Fi­nally, we acknowledge all the former Section 5 Committee members for their work, upon which this major revision has been built. Further, we believe it is safe to say that not only is this book a wonderful tool for teaching the next generation of ­great ophthalmolo­ gists, but by contributing to it, we have become better clinicians. The Chair also thanks the current Committee members for their expertise and dedication.