NANOS: Curriculum Outline

The NANOS Curriculum Outline:

The NANOS Curriculum Outline has been published in JNO:
Biousse V, for the Curriculum Committee of the North American Neuro-Ophthalmology Society (NANOS). The Neuro-Ophthalmology Curriculum. Journal of Neuroophthalmology. 2006; 26: 303-315.

  1. Anatomy and Physiology for the Neuro-Ophthalmologist
    1. Bony anatomy
      1. Orbit
      2. Bony communications
        1. Superior orbital fissure
        2. Optic canal
        3. Inferior orbital fissure
        4. Ethmoidal foramina
      3. Skull
        1. Anterior cranial fossa
        2. Middle cranial fossa
        3. Posterior cranial fossa
    2. Anatomy of the orbit
    3. Anatomy of the Optic Nerve
    4. Anatomy of the eyelids
      1. Anatomy of the lacrimal pathways
      2. Visual Pathways
    5. Neuroanatomy
    6. Afferent visual pathways
      1. Anatomy and physiology of the eye
      2. Retina
        1. Macula
      3. Optic nerve
      4. Optic chiasm
      5. Optic tract
      6. Lateral geniculate
      7. Optic radiations
      8. Calcarine cortex
      9. Association areas
    7. Efferent visual pathways
      1. Supranuclear input
      2. Cerebellar connections
      3. Nuclear centers
        1. Abducens (VI)
        2. Trochlear (IV)
        3. Oculomotor (III)
      4. Ocular motor nerves
        1. Abducens (VI)
        2. Trochlear (IV)
        3. Oculomotor (III)
      5. Extraocular muscles
      6. Vestibular pathways
    8. Facial motor anatomy
    9. Sensory anatomy (trigeminal system)
    10. Autonomic anatomy
      1. Sympathetic
      2. Parasympathetic
        1. Lacrimal
        2. Pupil
    11. Vascular anatomy
      1. Arterial anatomy
        1. Internal carotid arteries and their branches
          1. Ophthalmic artery
          2. Posterior communicating artery
        2. Circle of Willis
        3. xternal carotid arteries and their branches
        4. Vertebrobasilar system
          1. Vertebral artery
          2. Posterior inferior cerebellar artery
          3. Basilar artery and its branches
          4. Posterior cerebellar artery and its branches
        5. Aortic arch
        6. Blood supply of the orbit and eye
        7. Blood supply of the optic nerve
      2. Venous anatomy
        1. Cerebral venous sinuses
          1. Cavernous sinus
          2. Superior and inferior petrosal sinuses
          3. Deep venous system
        2. Cortical veins
        3. Venous drainage in the neck
        4. Venous drainage of the eyes and orbits
        5. Superior and inferior ophthalmic veins
        6. Central retinal vein
    12. Fluids and secretions
      1. Cerebrospinal fluid
  2. Ocular and Neurologic Evaluation
    1. Ocular and neurologic examinations
      1. Ocular evaluation
        1. Evaluation of visual function (visual acuity, stereopsis, color vision, contrast sensitivity, basics of refraction, confrontation visual fields, Amsler grid, photostress testing)
          1. Visual acuity testing
          2. Stereopsis
          3. Color vision testing
          4. Contrast sensitivity
          5. Basics of refraction
          6. Confrontation visual fields
          7. Amsler grid
          8. Photo Stress test
        2. Ocular examination
          1. Intraocular pressure
          2. Resistance to retropulsion
          3. Exophthalmometry
        3. Pupillary examination
          1. Measuring the RAPD
            1. Swinging flashlight test
        4. Funduscopic examination
          1. Normal optic disc
            1. Disc anatomy
            2. Vascular features
            3. Venous pulsations
      2. Slit lamp
        1. Transillumination
        2. Direct and indirect ophthalmoscopes and slit lamp biomicroscopy of the fundus
      3. Ocular motility, use of prisms, cover testing, red glass, maddox rod, forced duction test, sensory testing
      4. Ocular examination of the young child
      5. Neurologic evaluation
        1. Neurologic examination (adult and child)
        2. Basic cognitive evaluation (MOCA)
      6. Neuro-ophthalmic evaluation of the comatose patient
      7. Examination of children
        1. Developmental milestones for children
        2. Visual maturation of children
      8. How to take a Neuro-ophthalmologic history
    2. Ancillary tests obtained in neuro-ophthalmology
      1. Visual field testing
        1. Automated perimetry (familiarity with current perimeters and different testing strategies)
        2. Goldmann perimetry (should be able to perform)
        3. Tangent screen (should be able to perform)
        4. Measure the Relative Afferent Pupillary Defect (RAPD)
      2. Electrophysiology
        1. Visual evoked responses
        2. Electroretinogram
        3. Multifocal electroretinogram
        4. Dark adaptation
        5. Eye movement recordings
      3. Ocular and orbital ultrasound
      4. Retinal fluorescein angiography
      5. Nerve fiber layer analysis
        1. Optical coherence tomography (OCT), HRT, GDX
      6. Imaging
        1. Computed tomography
        2. Magnetic resonance imaging
        3. Vascular imaging (ultrasonography)
        4. Ophthalmodynamometry
        5. CTA
        6. MRA
        7. CTV
        8. MRV
        9. Conventional angiogram
        10. Functional neuro-imaging
        11. Diffusion weighted imaging
        12. Diffusion tensor imaging
        13. Functional MRI
        14. PET
      7. Lumbar puncture with opening pressure
  3. Neuro-Ophthalmic Symptoms and Signs
    1. Visual Loss
      1. Transient
    2. Positive Visual Phenomena
    3. Visual hallucinations
    4. Visual Field Loss
    5. Higher cortical dysfunction
    6. Normal and abnormal optic nerve
      1. Edema (disc swelling, papilledema, Pseudotumor Cerebri) and pseudopapilledema/anomalous nerves
      2. Disc swelling
      3. Papilledema
      4. Stages
        1. Unilateral papilledema
        2. Pseudotumor Cerebri
      5. Post papilledema
      6. Brain tumor
        1. Papilledema and resolution
      7. Pseudopapilledema
      8. Congenital blurred disc
        1. Little red discs
        2. Buried drusen
        3. Myelinated nerve fibers
      9. Exposed drusen
      10. Tilted disc
      11. Optic Atrophy
      12. Psuedo atrophy
      13. Glaucoma
      14. Temporal atrophy
      15. Altitudinal atrophy
      16. Hemioptic band atrophy
      17. Optociliary shunt vessels
        1. Shunt Vessels (Glaucoma)
        2. Shunt Vessels (CRVO)
        3. Shunt Vessels (Congenital)
        4. Shunt Vessels (Meningioma)
        5. Shunt vessels (Post-papilledema)
      18. Cupped optic nerve
      19. Optic disc anomalies / pseudopapilledema
    7. Oscillopsia, nystagmus, ocular oscillations
    8. Double vision (diplopia)
    9. Abnormal extraocular movements
    10. Ptosis
      1. Myasthenic
      2. Nuclear third nerve palsy
      3. Fascicular third nerve palsy
      4. With jaw winking
      5. Chronic progressive external ophthalmoplegia
      6. Horner Syndrome
      7. With aberrant reinnervation
      8. Levator Dehiscence
    11. Lid findings
      1. Lid retraction
      2. Lid lag
      3. Lig ophthalmos
      4. Lid twitch
    12. Orbital signs
      1. Proptosis
      2. Enophthalmos
      3. Pulsating exophthalmos
    13. Pupillary changes
      1. Anisocoria
      2. Dilation Lag
      3. RAPD
    14. Abnormal facial movements
      1. Hemifacial spasm
      2. Facial Myokymia
    15. Facial weakness
    16. Speech language disturbance
  4. Disorders of the Afferent and Efferent Visual Pathways
    1. Diseases of the retina
      1. Cone
      2. Rod Dystrophy (RD)
      3. Ganglion cell
      4. Macula
      5. Retinal dystrophy and systemic disease
      6. Usher Syndrome
      7. Bardet-Biedl syndrome
      8. Spinocerebellar ataxia type 7
      9. Mulitfocal chorodiopathy
      10. Stargardt’s
      11. Best macular dystrophy
      12. Occult macular dystrophy (Central cone dystrophy)
      13. AZOOR
      14. Big blind spot syndrome/MEWDS
    2. Diseases of the optic nerve
      1. Optic Neuropathy, Ischemic
        1. Anterior Ischemic Optic Neuropathy (AION)
        2. Posterior Ischemic Optic Neuropathy (PION)
        3. Diabetic papillopathy
        4. Optic Neuropathy with Retinopathy
      2. Inflammation
        1. Non infectious
          1. Idiopathic optic neuritis
          2. Optic neuritis and multiple sclerosis
          3. Neuromyelitis Optica
          4. Periphlebitis in Optic Neuritis
          5. Other inflammatory optic neuritides
          6. Sarcoid
          7. Lupus
          8. Orbital inflammation
          9. Leber’s Optic Neuropathy
        2. Infectious
          1. Optic perineuritis
          2. Neuroretinitis
          3. Optic neuropathy with sinus disease
      3. Compression/Infiltration
        1. Meningioma
        2. Glioma
      4. Paraneoplastic
      5. Traumatic
        1. Traumatic Optic Neuropathy
        2. Optic disc avulsion
        3. Purtcher’s Traumatic Retinopathy
      6. Toxic
        1. BCNU Retinopathy
      7. Nutritional
      8. Metabolic
      9. Hereditary
        1. Leber’s Optic Neuropathy
        2. Dominant optic neuropathy
      10. Congenital
      11. Glaucoma
        1. Classification of glaucoma
        2. Evaluation and basic management of glaucoma
      12. Raised intracranial pressure (papilledema, Pseudotumor Cerebri)
      13. Decreased intraocular pressure (hypotony)
    3. Orbital pathology causing neuro-ophthalmic manifestations
      1. Trauma
      2. Mass lesions
        1. Neoplasms
          1. Orbital tumors
            1. Choroidal Folds from Orbital Mass
          2. Optic nerve tumors
          3. Benign vs malignant neoplasm
          4. Primary vs secondary
          5. Pediatric vs adult tumor
        2. Optic nerve sheath meningioma
        3. Sphenoid wing meningioma
        4. Optic nerve glioma
        5. Orbital lymphangioma
        6. Orbital lymphoma
        7. Orbital neurofibroma
        8. Orbital schwanoma
        9. Orbital rhabdomyosarcoma
        10. Orbital metastasis
        11. Adenoid cystic carcinoma of lacrimal gland
        12. Frontal mucocele
        13. Orbital fibrous dysplasia
      3. Inflammation/Infection
        1. Scleritis
        2. Myositis
        3. Orbital inflammation
        4. Thyroid orbitopathy
          1. Thyroid orbitopathy and myasthenia
        5. Orbital cellulitis
        6. Abscess
        7. Fungal infections of the orbit and orbital apex
      4. Orbital manifestations of dural fistulas
        1. Orbital varix
    4. Diseases of the chiasm
      1. Chiasmal visual field defects
      2. Compression/infiltration
        1. Chiasmal herniation
        2. Hypophysitis, lymphocytic
        3. Pituitary adenoma
        4. Pituitary apoplexy
        5. Craniopharyngioma
      3. Inflammation
        1. Chiasmal Optic Neuritis
      4. Trauma
      5. Ischemia/hemorrhage
    5. Diseases of the retrochiasmal visual pathways
      1. Optic tract
        1. Optic Tract Lesions
      2. Lateral geniculate
      3. Radiations
      4. Calcarine cortex
      5. Association areas
      6. Specialized syndromes
        1. Anton’s syndrome (cerebral blindness)
        2. Riddoch’s phenomena: Statico-kinetic dissociation
        3. Balint syndrome
        4. Gerstmann syndrome
        5. Cerebral achromatopsia
        6. Alexia without agraphia
        7. Acalculia
        8. Agraphia (with associated alexia)
        9. Agnosias
        10. Visual neglect
        11. L-R confusion
        12. Akinetopsia
        13. Concept of "Blindsight"
        14. Apraxia
        15. Palinopsia
        16. Functional visual loss
        17. Sturge Weber
    6. Pupillary pathology
      1. Normal pupillary responses
      2. Effects of drugs on the pupils
      3. Congenital pupillary abnormalities
      4. Pupillary changes secondary to ocular diseases
        1. Traumatic, foreign body
        2. Inflammation
        3. Neovascularisation
          1. Ocular surgery, laser
      5. Traumatic pupillary changes
      6. Evaluation and management of anisocoria
      7. Evaluation and management of a large or a small pupil
      8. Evaluation and management of specific pupillary disorders
        1. Adie’s tonic pupil
        2. Tadpole pupil
        3. Argyll-Robertson pupil
        4. Correctopia
        5. Physiologic anisocoria
        6. Horner’s syndrome
        7. Third nerve palsy
          1. Cyclical
          2. Subnuclear
        8. Afferent pupillary defect
        9. Light near dissociation
        10. Flynn Phenomenon, paradoxical pupillary reflex (not in UMLS)
    7. Eye Movement Systems Pathology
      1. Normal Eye Movements
      2. Vestibular ocular system
      3. Optokinetic nystagmus
      4. Saccades
      5. Pursuit
      6. Convergence
      7. Divergence
      8. Titubation
      9. Specific ocular motor syndromes
        1. Cranial nerve palsies
          1. Third (Oculomotor)
            1. Cyclical
            2. Subnuclear
            3. Ophthalmoplegic Migraine
            4. Nuclear
          2. Fourth (Trochlear)
          3. Sixth (Abducens)
        2. Nuclear/Supranuclear palsies
          1. Internuclear ophthalmoplegia
          2. One and half syndrome
          3. Horizontal gaze palsy
          4. Monocular elevation deficit
          5. Vertical gaze palsy
          6. Skew deviation
          7. Ocular tilt reaction
          8. Upgaze palsy
          9. Downgaze palsy
          10. Lateropulsion
        3. Ocular motor apraxia
        4. Spasm of the near triad
        5. Convergence insufficiency
        6. Divergence insufficiency
        7. Decompensation of phorias
        8. Restriction syndromes
        9. Ocular neuromyotonia
        10. Cyclic oculomotor paresis
      10. Classical brain stem syndromes
        1. Foville
        2. Millard-Gubler
        3. Duane’s syndrome
          1. Synergistic Divergence
        4. Mobius syndrome
        5. Locked In syndrome
        6. Nothnagel
        7. Benedickt
        8. Weber
        9. Claude syndrome
        10. Wallenberg syndrome
        11. Syndrome of the anterior inferior cerebellar artery
      11. Ocular motility disturbance by location
        1. Medulla
        2. Pons
        3. Mesencephalon
        4. Dorsal midbrain syndrome
        5. Cerebellar pathology
    8. Nystagmus and disorders of ocular stability
      1. Jerk nystagmus
      2. Pendular nystagmus (binocular & monocular)
      3. Congenital vs acquired nystagmus
      4. Central vs peripheral nystagmus
        1. Vestibular nystagmus
      5. Specific types of nystagmus and their localizing value(1 if common & 2 if rare)
        1. Downbeat nystagmus
        2. Upbeat nystagmus
        3. Left beat nystagmus
        4. Rebound nystagmus
        5. Brun’s nystagmus
        6. Periodic alternating Nystagmus
        7. Convergence retraction nystagmus
        8. See saw nystagmus
        9. Divergence nystagmus
        10. Sensory nystagmus
        11. Congenital motor nystagmus
        12. Spasmus nutans/dissociated nystagmus/monocular nystagmus
        13. Rotary (torsional) nystagmus
        14. Abducting nystagmus
        15. Latent nystagmus
        16. Vestibular nystagmus
        17. End-gaze nystagmus
        18. Gaze-evoked nystagmus
        19. Voluntary nytagmus
      6. Induced nystagmus
        1. Valsalva
        2. Sounds (Tullio’s phenomena)
        3. Calorics: hot or cold water in ear
      7. Ocular oscillations
        1. Superior oblique myokymia
        2. Square wave jerks
        3. Opsoclonus
        4. Flutter
          1. Other saccadic abnormalities (dysmetria, macrosaccadic oscillations, etc)
        5. Ocular bobbing
          1. Ocular dipping, inverse bobbing, etc.
        6. Oculopalatal myoclonus
        7. Oculomasticatory myorhythmia
    9. Eyelid position abnormalities
      1. Eyelid retraction
      2. Ptosis
        1. Pseudoptosis
        2. Congenital
        3. With elevator palsy
        4. Marcus Gunn Jaw Wink
        5. Blepharophimosis
        6. Levator dehiscence
        7. Myopathic
          1. CPEO
          2. Myotonic dystrophy
          3. Oculopharyngeal
        8. Neuro-muscular transmission
          1. Myasthenia gravis
            1. Lambert-Eaton
        9. Neuropathic
          1. Apraxia of eyelid opening
          2. Third nerve dysfunction
          3. Aberrant reinnervation of third nerve
          4. Horner Syndrome
        10. Blepharospasm
      3. Eyelid nystagmus
      4. Lid twitch
      5. Lid bobbing
    10. Facial nerve dysfunction
      1. Central and peripheral facial palsy
      2. Aberrant Regeneration
      3. Blepharospasm
      4. Hemifacial spasm
      5. Facial myokymia
      6. Oculomasticatory myorhythmia (Whipple’s)
      7. Facial tics
      8. Facial dystonia (Meige’s syndrome)
  5. Systemic, Neurologic, and Ophthalmic Disorders Commoly Associated with Neuro-Ophthalmic Manifestations
    1. Developmental and congenital anomalies with neuro-ophthalmologic consequences
      1. Complications of prematurity
      2. Cerebral palsy
      3. Complications of birth injuries
      4. Congenital hydrocephalus
      5. Cranial dysostoses (craniosynostosis)
      6. Amblyopia
      7. Other disc anomalies
        1. Congenital optic nerve anomalies
          1. Bergmeister papilla
          2. Basal encephaloceles
          3. Chiasmic optic nerve hypoplasia / Aplasia
          4. Optic nerve dysplasia and aplasia/hypoplasia
          5. Optic nerve aplasia
          6. Septo-optic dysplasia
          7. Optic nerve coloboma
          8. Bridge colobomoa or second disc
          9. Optic nerve pit
          10. Morning glory syndrome
          11. Optic nerve drusen
            1. Buried drusen
            2. Exposed drusen
            3. Drusen complications
          12. Tilted disc
          13. Myelinated nerve fibers
          14. Staphyloma
          15. Congenital (dominant) Optic Atrophy
          16. Laurence-Moon-Biedl Syndrome
          17. Megalopapilla
          18. Papillo-renal syndrome
        2. Optic disc anomalies/pseudopapilledema
          1. Pseudopapilledema
            1. Congenital blurred disc
            2. Little red discs
            3. Buried drusen
            4. Exposed drusen
            5. Tilted disc
            6. Myelinated nerve fibers
      8. Common malformations of the eye and orbit
      9. Skull base malformations. Chiari malformation
      10. Fibrous dysplasia
      11. Ocular manifestations of child abuse
    2. Systemic disorders commonly associated with neuro-ophthalmologic manifestations
      1. Specific hereditary ocular and neurologic diseases with neuro-ophthalmic presentation
        1. Pseudoxanthoma Elasticum
          1. Marfan syndrome
          2. Moyamoya syndrome
          3. Fibromuscular dysplasia
          4. Ehlers-Danlos Syndrome
          5. Olivopontocerebellar Degeneration
      2. Neurocutaneous syndromes
        1. Neurofibromatosis
          1. NF-1
          2. NF-2
        2. Tuberous sclerosis
        3. von Hippel-Lindau
        4. Sturge-Weber
        5. Ataxia telangiectasia
        6. Wyburn-Mason
      3. Vascular disease
        1. Vascular risk factors
        2. Prevention of vascular disease
        3. Neuro-ophthalmic manifestations of vascular diseases
          1. Temporal arteritis
          2. Carotid Occlusive Disease
          3. Vasospastic Amaurosis Fugax
          4. Central/Branch Retinal Artery Occlusion
          5. Saturday Night Retinopathy
          6. Carotid Dissection
          7. Moyamoya Disease
          8. Dolichoectasia
        4. Hypercoagulable states
      4. Systemic hypertension
      5. Metabolic diseases including diabetes mellitus
        1. Diabetic Retinopathy
      6. Autoimmune diseases, classification of vasculitides
        1. Specific vasculitides with ocular and neurologic manifestations
          1. Giant cell arteritis(Temporal arteritis)
          2. Sarcoidosis
          3. Lupus
          4. Antiphospholipid Antibody Syndrome
          5. Wegener granulomatosis
      7. Complications of cancers, paraneoplastic syndromes; principles of treatment
        1. Leukemia
        2. Lymphoma
        3. Histiocytosis
        4. Metastatic Carcinoma
        5. Multiple Myeloma
        6. Paraneoplastic Disease
        7. Lymphomatoid Granulomatosis
        8. Treatment of brain tumors (neoplasms)
      8. Neuro-ophthalmic complications of chemotherapy, and radiation therapies
        1. BCNU Retinopathy
        2. Radiation retinopathy
      9. Complications of infections
        1. Specific infections with common neuro-ophthalmic complications
          1. AIDS
          2. Syphilis
          3. Presumed Ocular Histoplasmosis
          4. Toxoplasmosis
      10. Pregnancy
    3. Neurologic disorders commonly associated with neuro-ophthalmologic manifestations
      1. Head and ocular injury
        1. Recognize and evaluate neurological complications of head injury
        2. Neuro-ophthalmic complications of brain injury (acute and late)
        3. Traumatic optic neuropathies (direct and indirect)
        4. Traumatic cranial nerve palsies (III, IV, and VIth)
          1. Third (oculomotor)
          2. Fourth (trochlear)
          3. Sixth (abducens)
        5. Diagnose and evaluate orbital and facial fractures
        6. Recognized the complications of ocular trauma
        7. Evaluate post-traumatic visual loss
        8. Diagnosis of post-concussion syndrome
      2. Increased intracranial pressure
        1. Differential diagnosis and management of intracranial hypertension
          1. Intracranial mass, infection or bleed
          2. Meningitis
          3. Subarachnoid hemorrhage
          4. Hydrocephalus
          5. Cerebral venous thrombosis
          6. Idiopathic intracranial hypertension
        2. Neuro-ophthalmic manifestations and complications
      3. Vascular disease of the brain and the eye
        1. Classification of stroke
          1. Occipital infarct
          2. Parietal infarct
          3. Thalamic infarct
          4. Pontine infarct
          5. Medula infarct
          6. Cerebellar infarctions
          7. Cerebral hypoxia
          8. Posterior reversible encephalopathy
          9. Midbrain infarct
        2. Diagnosis and evaluation of stroke
          1. Selected causes of stroke
          2. Cervical artery dissection
          3. Vasculitis
          4. Cogan syndrome
          5. Acute posterior multifocal placoid pigment epitheliopathy
          6. Behcet’s disease
        3. Basics of acute treatment and secondary prevention of stroke
        4. Neuro-ophthalmologic manifestations of stroke
        5. Ocular ischemia
          1. Transient visual loss
          2. Central retinal artery occlusions
          3. Branch retinal artery occlusions
          4. Retinal emboli
          5. Cilioretinal artery occlusion
          6. Ophthalmic artery occlusion
          7. Susac syndrome
          8. Ocular ischemic syndrome
          9. Central and branch vein occlusions
        6. Venous sinus thrombosis
          1. Superior Ophthalmic Vein Thrombosis
          2. Cavernous sinus thrombosis
        7. Hemorrhage
          1. Subarachnoid
          2. Terson syndrome
          3. Thalamic hemorrhage
          4. Pontine hemorrhage
          5. Medulla hemorrhage
          6. Cerebellar hemorrhage
          7. Optic nerve hemorrhage
          8. Optic chiasm hemorrhage
          9. Midbrain hemorrhage
        8. Intracranial vascular malformations, diagnosis and neuro-ophthalmologic manifestations
          1. Aneurysms
            1. Ophthalmic Artery Aneurysm
            2. Cavernous sinus aneurysm
          2. Arteriovenous malformations
          3. Retinal arteriovenous malformations
          4. Dural fistulas
          5. Carotid cavernous fistulas (direct, indirect)
          6. Orbital venous malformations
          7. Cavernous hemangiomas
      4. Seizures with neuro-ophthalmologic manifestations
        1. Occipital seizures
        2. Pupillary changes, ocular movement changes during seizures
      5. Neuro-ophthalmic manifestations of neoplasms
        1. Intracranial tumors
        2. Gilomatosis cerebri
        3. Carcinomatous meningitis
        4. Skull base tumors
          1. Cavernous sinus meningioma
          2. Chordoma
        5. Basal and squanamous cell carcinomas of the skin
        6. Orbital Neoplasms
          1. Choroidal Folds from Orbital Mass
      6. Demyelinating disease
        1. Multiple sclerosis
          1. Relationships between optic neuritis and multiple sclerosis
          2. Diagnosis
          3. Treatment strategies
          4. Vision assessment in multiple sclerosis
            1. CT and MS
        2. Devic’s disease
        3. Acute disseminated encephalomyelitis
      7. Infections (neuro-ophthalmic manifestations of localized and systemic infections)
        1. Intracranial infections
          1. Abscess
          2. Cerebritis
          3. Empyema
          4. Meningitis
          5. Meningo-encephalitis
        2. Whipple’s disease
        3. Orbital infections (cellulitis)
        4. Optic nerve infection (infectious optic neuritis and neuroretinitis)
        5. Creutzfeld-Jacob disease
        6. Toxoplasmosis
        7. Lyme disease
      8. Metabolic diseases
        1. Wilson’s disease
        2. Vitamin deficiencies (vitamin A, B1, B12)
        3. Metabolic storage diseases
        4. Amyloidosis
      9. Neuro-degenerative diseases
        1. Parkinson syndromes
          1. Parkinson’s disease
          2. Progressive supranuclear palsy
        2. Alzheimer, Frontotemporal dementia
        3. Vascular dementias
        4. Amyotrophic lateral sclerosis
        5. Ataxia
          1. Hereditary ataxias
        6. Tauopathy
      10. Polyradiculopathies
        1. Guillain-Barré
        2. Miller Fisher variant
      11. Neuro-muscular transmission deficits
        1. Physiology of the neuromuscular transmission
        2. Myasthenia gravis
        3. Lambert-Eaton myasthenic syndrome
        4. Toxic neuromuscular transmission defect (Botulism, medications)
      12. Myopathies (involving the extraocular muscles)
        1. Congenital myopathies/oculopharyngeal muscular dystrophy
          1. Dystrophies/Ion Channel Disorders (Myotonia)
            1. Myotonic dystrophy
              1. Ocular myotonia
        2. Mitochondrial diseases
          1. Sporadic CPEO
          2. Kearns-Saytre
          3. Chronic progressive external ophthalmoplegia (CPEO)
            1. CPEO Plus (MNGIE, MELAS, etc)
        3. Ischemic
          1. Giant cell arteritis (Temporal arteritis)
          2. Orbital ischemic syndrome
        4. Metabolic - Toxic
          1. Drug induced, toxic
        5. Inflammatory
          1. Thyroid orbitopathy
          2. Orbital inflammatory disease
            1. Orbital Myositis
        6. Neoplasm/infiltration
        7. Congenital syndromes involving the extraocular muscles
          1. Anomalous muscle insertions
          2. Brown’s syndrome
          3. Congenital fibrosis of the extraocular muscles (CFEOM)
          4. Duane’s syndrome
            1. Synergistic Divergence
          5. High myopia
      13. Headache and facial pain
        1. Classification of headaches and facial pain proposed by the International Headache Society (IHS)
        2. Migraine
          1. Migraine without aura
          2. Migraine with visual aura
          3. Persistent migraine aura
          4. Migraine aura without headache
          5. Photophobia
          6. Hemianopia after migraine
        3. Tension headaches
          1. Episodic
          2. Chronic
        4. Cluster headache
        5. Headache associated with increased intracranial pressure
        6. Headache and facial pain of vascular origin
        7. Ocular pain related to ocular of optic nerve disease
        8. Trigeminal neuralgia (Fifth nerve)
        9. Herpes zoster (zoster ophthalmicus)
        10. Referred ocular pain
          1. Vascular (i.e. dissection)
          2. Ocular ischemic syndrome
          3. Cavernous sinus syndrome
      14. Psychiatric illness
    4. Ocular diseases commonly associated with- or mimicking neuro-ophthalmologic disorders
      1. Retinal disorders
        1. Vascular
        2. Degenerative/hereditary
          1. Acquired Hyperopia
          2. Retinitis pigmentosa
        3. Inflammatory/infectious
          1. Eales’ disease
          2. Idiopathic retinal vasculitis
          3. AMPPE
          4. Acute retinal necrosis
          5. Pars planitis
          6. VKH
          7. Serpiginous choroidopathy
          8. Birdshot choroidopathy
          9. Syphillis
          10. Histoplasmosis
        4. Outer retinopathies/White dot syndromes
          1. MEWDS
          2. Multi-focal choroiditis panuveitis
          3. White dot syndromes
          4. White in the retina
    5. Neuro-ophthalmic manifestations of iatrogenic diseases
      1. Radiation
        1. Radiation retinopathy
      2. Chemotherapy
      3. Various drugs with specific neuro-ophthalmologic complications, including
        1. Cyclosporine
        2. FK-506 (tacrolismus)
        3. Amiodarone
        4. Sildenafil
        5. Hydroxychloroquine (Plaquenil)
        6. Ethambutol
        7. Vasoconstritors
        8. Steroids
        9. Facial and orbital injections
      4. Alcohol
        1. Thiamine deficiency
        2. Wernicke encephalopathy
        3. Optic neuropathy
      5. Neuro-ophthalmic complications of surgical procedures
        1. Post operative visual loss
        2. Epidural anesthesia
        3. Ocular and orbital surgery
        4. Neurosurgery
        5. Endovascular procedures
    6. Functional disorders
      1. Terminology
        1. Factitious (Münchausen's)
        2. Malingering
        3. Conversion reaction
        4. Exaggeration
          1. Hypochondriasis
          2. Somatization disorder
      2. Clinical presentations
        1. Visual loss
        2. Visual field defects
        3. Spasm of near triad
        4. Voluntary Nystagmus
      3. Specific techniques of evaluation
  6. Procedures Commonly Performed/Obtained in Neuro-Ophthalmology
    1. Surgical and endovascular procedures and their complications
      1. Temporal artery biopsy
      2. Principles and complications of strabismus surgery
      3. Canthotomy, cantholysis
      4. Approaches for orbital biopsies and orbital tumors
      5. Optic nerve sheath fenestration
      6. Orbital decompression
      7. CSF shunting procedures
      8. Monitoring of intracranial pressure
      9. Pituitary surgery (transphenoidal adenomectomy)
      10. Interventional neuroradiology techniques
        1. Cerebral angiography and venography
        2. Embolization
        3. Angioplasty
        4. Stenting
        5. Intravenous and intra-arterial thrombolysis
      11. Tensilon test
      12. Cataract surgery
        1. Intraocular lenses
    2. Botulism toxin therapy
      1. Treatment of blepharospasm, hemifacial spasm, Meige syndrome
      2. Treatment of strabismus
  7. Patients’ Counseling
    1. Definition of legal blindness
    2. Legal requirements for driving (visual) in the state in which you practice neuro-ophthalmology
    3. Counseling of the visually impaired patient
      1. Liaison with rehabilitation services (neurologic and for the visually impaired)
      2. Liaison with a low vision service
    4. Genetic counseling
      1. Principles of genetics, genetic testing, and genetic counseling
  8. Research, Administration, Education Resources
    1. Administration
      1. Credentialing, career development, recruitment, budgeting, health care financing, managed care, public relations, personnel management, marketing, hospital administration, practice management, contracts, work schedule. (3)
      2. JCAHO requirements relating to neuro-ophthalmology. (staffing, equipment and supplies, facilities, quality insurance) (2)
    2. Research
      1. Read and analyze scientific articles
      2. Research funding
      3. Development of a research project
      4. Ethical issues in research, including consent and researchers’ interactions with corporate funding sources (conflict of interest) (2)
      5. Write and publish a manuscript
    3. Large previous and ongoing studies addressing specific neuro-ophthalmic issues
      1. Optic Neuritis Treatment Trial (ONTT)
      2. Longitudinal Optic Neuritis Study (LONS)
      3. CHAMPS study
      4. Ischemic Optic Neuropathy Decompression Trial (IONDT)
      5. IIHTT
    4. Ethics and professionalism
      1. Proper documentation in medico-legal proceedings
      2. Knowledge of cost, resource allocation, quality of care and access to care issues
      3. Basic familiarity with medical malpractice
      4. Physician-physician relationships
      5. Laws relating to drug dispensing, regulation, and abuse
      6. Role of expert witness in medico-legal procedures
    5. Neuro-ophthalmologic resources
      1. Organizations
        1. NANOS
        2. INOS
        3. EUNOS
        4. AAN
        5. ANA
        6. AAO
        7. ARVO
        8. Regional organizations
        9. NEI
        10. NINDS
      2. Journals
      3. NOVEL database
  9. References
    1. American Academy of Neurology. Neuro-Ophthalmology/Neuro-otology Fellowship core curriculum.
    2. American Academy of Ophthalmology. Basic and Clinical Science Course. Neuro-Ophthalmology. Section 5. 2003.
    3. American Academy of Ophthalmology. Basic and Clinical Science Course. Orbit, Eyelids, and Lacrimal System. Section 7. 2003.
    4. Continuum. American Academy of Neurology. Newman NJ, Galetta SL, eds. Neuro-Ophthalmology. 2003.
    5. Glaser JS. Neuro-Ophthalmology. Lippincott Williams & Wilkins, 3rd edition. 1999.
    6. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004; 24 Suppl 1: 9-160.
    7. Liesegang TJ, Hoskins HD Jr, Albert DM, O’Day DM, Spivey BE, Sadun AA, Parke DW, Modino BJ. Ophthalmic education: where have we come from, and where are we going? Am J OPhthalmol 2003; 136: 114-121.
    8. Liu GT, Volpe NJ, Galetta SL. Neuro-Ophthalmology. Diagnosis and Management. WB Saunders, 2001.
    9. Miller NR, Newman NJ, Biousse V, Kerrisson JB. Walsh & Hoyt's Clinical Neuro-Ophthalmology. Lippincott Williams & Wilkins, 6th edition. 2005.
    10. Spivey BE. A technique to determine curriculum content. J Med Educ 1971; 46:269-274.
    11. Society for Academic Emergency Medicine (SAEM) webpage. How to design a curriculum?
  10. History of Neuro-Ophthalmology
    1. Prepared by the Curriculum Subcommittee
      1. V. Biousse (Chair)
      2. N. Newman (Vice Chair)
      3. K. Peele Cockerham
      4. D. Kaufman
      5. Br. Katz
      6. A. Lee
      7. H. Pomeranz
      8. R. Turbin
      9. G. Van Stavern
      10. F. Warren
      11. L. Frohman, (AAO KB)
      12. D. Freidman, ex-officio, Board Liaison