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Best Neuro Ophthalmologist in Mumbai

What is Neuro Ophthalmology?

Neuro-ophthalmology is a distinct subfield within ophthalmology that deals with a range of conditions involving both the eye and the central nervous system. The optic nerve, originating from the rear of the eye as depicted in the picture, establishes a connection between the eye and the brain, resulting in numerous illnesses impacting both organs simultaneously.
neuro

Neuro Ophthalmology Symptom Checker

Causes of Glaucoma

  • Build-up of aqueous humor inside the eye
  • Genetic reasons
  • Birth defects
  • Blunt or chemical injury
  • Acute eye infection
  • Blockage by blood vessels inside the eye
  • Inflammatory conditions
  • In rare cases, previous eye surgeries

Types of Glaucoma

PRIMARY OPEN ANGLE GLAUCOMA

The most prevalent form of glaucoma is known as primary open-angle glaucoma. In this type, the drainage passage for the fluid within the eye remains open, allowing fluid outflow. However, there may be a flaw in the drainage pathway, resulting in increased resistance to fluid drainage, leading to heightened eye pressure. In a small percentage of cases, increased fluid production can also contribute to the elevated pressure. This type of glaucoma develops slowly and does not initially present any symptoms. It first affects the side vision, gradually progressing towards the center of vision. Due to this gradual progression, many individuals may remain unaware of their condition until they experience significant vision loss that affects their central vision.

Risk factors for primary open angle glaucoma are:

  • Age more than 40 years
  • Race – African Americans
  • Family history of glaucoma
  • Systemic diseases such as diabetes mellitus, hypertension, heart disease
  • High myopia or those with a high minus power
ANGLE CLOSURE GLAUCOMA OR CLOSED ANGLE GLAUCOMA

Angle closure glaucoma, also known as closed angle glaucoma, is the second most common type of glaucoma and is characterized by narrow drainage channels in the eye. If the angle gradually closes over time, it is referred to as chronic angle closure, while a sudden closure of the angle leads to an acute angle closure attack. Acute angle closure glaucoma presents as a medical emergency. During an acute attack, the patient experiences symptoms such as eye pain, nausea, vomiting, redness, blurred vision, and colored halos due to a rapid increase in eye pressure. Immediate treatment by an eye specialist is essential in such cases.

Risk factors for angle closure glaucoma:

  • Age more than 40 years
  • Race – East Asians
  • Family history of glaucoma
  • Women
  • High hypermetropia or those with a high plus power
NORMAL TENSION GLAUCOMA /LOW TENSION GLAUCOMA

Normal tension glaucoma, also referred to as low tension glaucoma, is a type of glaucoma where damage to the optic nerve can occur despite the eye pressure being within the normal range. The exact cause of this condition is not fully understood, but it is believed to stem from either an exceptionally delicate optic nerve that can be harmed even with normal eye pressure or reduced blood flow to the optic nerve. This type of glaucoma is often asymptomatic, and individuals typically do not experience any visual complaints until the disease reaches a very advanced stage.

Risk factors for normal tension glaucoma are:

  • Family history of normal tension glaucoma
  • Race – Japanese ancestry
  • Thinner corneas
  • Heart disease
  • Migraine and peripheral vascular disease
CONGENITAL GLAUCOMA (CHILDHOOD GLAUCOMA)

Glaucoma during infancy and childhood is a relatively uncommon but serious set of diseases that can jeopardize vision. Infants and young children with glaucoma are usually brought for an eye examination because either their parents or pediatricians have observed some peculiarities in their eyes. These signs may include whitish discoloration and enlargement of the eyes, excessive tearing, a tendency to keep the eyes closed, and sensitivity to light. Glaucoma in children may arise if there’s a family history of glaucoma, if the parents have had a consanguineous (close blood relation) marriage, or due to abnormal development during pregnancy.

This type of glaucoma occurs due to an irregular flow of intraocular fluid within the eye caused by a blockage or dysfunction of the trabecular meshwork, which are the drainage canals in the eye with a mesh-like structure. Alternatively, in certain instances, the abnormal drainage system can be a consequence of another eye or body condition, leading to what is known as secondary glaucoma.

Congenital glaucoma is identified through a comprehensive eye examination, typically conducted under sedation in the operating theater for infants and children below the age of 3. Early detection and treatment of congenital glaucoma can help slow down the progression of the condition. Microsurgery is often used to address structural defects in straightforward cases of congenital glaucoma. For more complex cases, a combination of medication and surgery is employed for treatment.

SECONDARY GLAUCOMA

Secondary glaucoma refers to specific types of glaucoma in which the underlying reason for increased eye pressure leading to optic nerve damage and vision loss can be identified. Various factors contribute to secondary glaucoma, such as the prolonged and unregulated use of steroids, severe diabetic retinopathy, eye injuries, inflammation of the eye (uveitis), or advanced stages of cataract.

If you suspect having any of these risk factors, it is important to undergo an eye examination. Remember to inform your eye doctor about your specific risk factors, which will assist them in determining the frequency of your eye check-ups. The type of treatment prescribed will be based on whether you have open-angle or angle-closure glaucoma.

PIGMENTARY GLAUCOMA
Pigmentary Glaucoma is classified as a type of secondary open-angle glaucoma. It occurs when pigment granules from the back of the iris, the colored part of the eye, enter the clear fluid produced inside the eye. Over time, these tiny pigment granules flow towards the drainage canals of the eye, gradually obstructing them and leading to increased eye pressure. As more pigments are released, patients may experience blurred vision during physical exertion or exercise. This type of glaucoma is frequently observed in young males who have high nearsightedness and wear strong minus power lenses.
TRAUMATIC GLAUCOMA

Secondary open-angle glaucoma can be a result of eye injury. Traumatic glaucoma can manifest immediately after the injury or emerge years later. It can be triggered by blunt trauma, which bruises the eye, or by penetrating injuries. In most cases of blunt trauma, the elevated eye pressure is temporary. However, there are instances where the drainage canals in the eye sustain damage and permanent scarring occurs. This scarring obstructs fluid flow and may lead to glaucoma even years after the initial injury.

Furthermore, conditions like myopia (nearsightedness), previous eye injury, infections, or past surgeries can increase the susceptibility of the eye to severe injuries.

PSEUDOEXFOLIATIVE GLAUCOMA

Pseudoexfoliative Glaucoma, a type of secondary open-angle glaucoma, occurs when a flaky material similar to dandruff peels off from the outer layer of the eye’s lens. This material accumulates in the angle between the cornea and iris, potentially blocking the eye’s drainage system and leading to increased eye pressure. Pseudoexfoliative Glaucoma is frequently observed in individuals of Scandinavian descent.

Individuals diagnosed with exfoliative glaucoma commonly experience more instances of elevated eye pressure, greater fluctuations in pressure, and higher peak pressures compared to patients with other forms of glaucoma. Managing this type of glaucoma with medical treatment alone is typically more challenging. Patients with exfoliative glaucoma necessitate aggressive medical therapy and are more likely to require laser or surgical interventions. Regular and frequent visits to their eye doctor are often essential to closely monitor the progression of the disease.

NEOVASCULAR GLAUCOMA

A type of secondary open-angle glaucoma can be triggered by the atypical growth of new blood vessels on the iris and across the eye’s drainage channels.

Neovascular glaucoma is invariably linked to other conditions, most commonly diabetes and hypertension. It never develops in isolation. The emergence of new blood vessels obstructs the normal drainage of eye fluid through the trabecular meshwork, resulting in elevated eye pressure. This type of glaucoma advances swiftly and poses significant challenges in terms of treatment.

Glaucoma Risk Factors

You are most likely to get glaucoma if you:

  • Are you over 60 years of age
  • Have high internal eye pressure
  • Have a family member diagnosed with glaucoma
  • Have certain conditions like diabetes, heart conditions, sickle cell anaemia and high blood pressure.
  • Have thin corneas
  • Have extreme conditions of nearsightedness or farsightedness
  • Have had eye injuries, surgeries
  • Taking corticosteroid medications for a long time

Glaucoma Technology

Zeiss Humphrey Field Analyzer 3

OPTOPOL Revo FC OPTICAL COHERENCE TOMOGRAPHY(OCT)

Optovue RTVue OPTICAL COHERENCE TOMOGRAPHY

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OPTOPOL_Revo_FC-removebg-preview
Optovue_RTVue-removebg-preview
  • Visual Field Testing for the purposes of screening, monitoring, and assisting in the diagnosis and management of ocular diseases such as glaucoma and related neurological disorders.
  • Easy to perform
  • Extremely repeatable
  • Progression mapping :- Provides information about stability/progression of disease
  • OCT ONH (Glaucoma) helps in precise diagnosis and monitoring of glaucoma progression over time
  • Pachymetry and Epithelial Thickness help in Refractive Surgery Assessment as well in detection of Corneal Ectatic Conditions like Keratoconus
  • Gold Standard in Epithelial mapping due to second to none accuracy and precision
  • OCT ONH (Glaucoma) helps in precise diagnosis and monitoring of glaucoma progression over time
  • Pachymetry and Epithelial Thickness help in Refractive Surgery Assessment as well in detection of Corneal Ectatic Conditions like Keratoconus

Glaucoma Diagnosis

Regular eye examinations are crucial for maintaining eye health. At the age of 40, it is recommended to undergo a baseline eye screening to detect any early signs of eye disease or vision changes that may begin to emerge. Based on the results of this screening, your eye doctor will advise you on the frequency of follow-up exams to ensure optimal eye care.

If you possess risk factors for glaucoma, such as diabetes, hypertension, or a family history of the condition, it is advisable to schedule an appointment with an eye doctor promptly. They can assess your situation and recommend the appropriate frequency for your eye examinations.

A thorough glaucoma assessment involves a series of tests that aid in detecting the existence of glaucoma and monitoring its progression during subsequent follow-ups.

Tonometry is a diagnostic procedure utilized to gauge the intraocular pressure (IOP), which is the fluid pressure inside the eye. This test holds significance as it aids the doctor in assessing the potential risk of glaucoma. For individuals already diagnosed with glaucoma, tonometry is crucial in understanding the risk of disease progression and determining the effectiveness of treatment.
Gonioscopy is a painless examination of the anterior chamber of your eye, which allows the doctor to determine whether the drainage angle, where fluid exits the eye, is open or closed. This test is vital as it enables your doctor to diagnose glaucoma accurately and customize the most suitable treatment plan for your condition.
This diagnostic procedure allows the doctor to assess the damage to your optic nerve caused by glaucoma. By using eye drops to dilate the pupil, the doctor can obtain a clear view of the optic nerve, examining its shape and color through your eye.
This diagnostic method assists in assessing the thickness of the cornea, a crucial factor in determining the Corrected IOP (Intraocular Pressure).
This method aids in the assessment of initial glaucomatous alterations on the Optic Nerve head. It provides information about the thinning of the Retinal Nerve Fiber Layer (RNFL) in different quadrants and changes in the Ganglion Cell Layer (GCC).

the visual test field
The Perimetry, also known as the Visual Field test, creates a comprehensive map of your entire field of vision. By examining your peripheral or side vision, which is usually impacted first by glaucoma, your doctor can diagnose and track the progression of the condition. The test results are crucial in assessing the severity of glaucoma, the extent of vision loss, as well as any damage to the visual pathways in the brain and other optic nerve-related disorders.

Once a thorough evaluation of the patients is completed, doctors engage in discussions regarding the most suitable treatment options available. These options may include topical eye drops, oral medications, or interventional procedures such as lasers or surgeries. Patients are encouraged to inquire and express any concerns they may have, and doctors make an effort to address all their queries with care and attentiveness.

The utilization of these novel investigative techniques enables us to identify the disease and its progression at an earlier stage, leading to improved patient management.

NEURO OPHTHALMOLOGY CONDITIONS

Optic Neuropathies

Conditions impacting the optic nerve, such as optic neuritis, ischemic optic neuropathy, autoimmune optic neuropathy, compressive optic neuropathy, nutritional optic neuropathy, and toxic optic neuropathy.

Demyelination Disorders

Disorders involving demyelination that impact the visual pathway comprised of the optic nerve, optic chiasma, optic tract, and optic radiations.

Other Conditions Causing Raised Intracranial Pressure

Additional factors inducing heightened pressure within the skull, such as idiopathic intracranial hypertension and cerebral venous thrombosis, may lead to enduring and significant visual impairment over an extended period.

Ocular Motility Disorders

Ocular movement disorders marked by partial or total incapacity to control the movement of one or both eyes, stemming from diseases affecting the central and peripheral nervous systems, such as myasthenia gravis, or ocular motor cranial nerve impairments arising from factors like trauma, tumors, or systemic conditions like hypertension or diabetes mellitus.

Tumours

Tumors such as pituitary adenoma, craniopharyngioma, and meningioma leading to compressive optic neuropathy by exerting direct pressure on the optic nerve, along with other brain tumors that impact the visual pathway and contribute to increased intracranial pressure.

Cerebrovascular Disorders

Cerebrovascular conditions causing vision loss, transient ischemic episodes resulting in momentary visual impairment.

Neuro Ophthalmology Diagnosis

Neuro Ophthalmology Diagnosis

Neuro Ophthalmology Diagnosis

Tonometry is a diagnostic procedure utilized to gauge the intraocular pressure (IOP), which is the fluid pressure inside the eye. This test holds significance as it aids the doctor in assessing the potential risk of glaucoma. For individuals already diagnosed with glaucoma, tonometry is crucial in understanding the risk of disease progression and determining the effectiveness of treatment.
Gonioscopy is a painless examination of the anterior chamber of your eye, which allows the doctor to determine whether the drainage angle, where fluid exits the eye, is open or closed. This test is vital as it enables your doctor to diagnose glaucoma accurately and customize the most suitable treatment plan for your condition.
This diagnostic procedure allows the doctor to assess the damage to your optic nerve caused by glaucoma. By using eye drops to dilate the pupil, the doctor can obtain a clear view of the optic nerve, examining its shape and color through your eye.
This diagnostic method assists in assessing the thickness of the cornea, a crucial factor in determining the Corrected IOP (Intraocular Pressure).
This method aids in the assessment of initial glaucomatous alterations on the Optic Nerve head. It provides information about the thinning of the Retinal Nerve Fiber Layer (RNFL) in different quadrants and changes in the Ganglion Cell Layer (GCC).

visual field test
The Perimetry, also known as the Visual Field test, creates a comprehensive map of your entire field of vision. By examining your peripheral or side vision, which is usually impacted first by glaucoma, your doctor can diagnose and track the progression of the condition. The test results are crucial in assessing the severity of glaucoma, the extent of vision loss, as well as any damage to the visual pathways in the brain and other optic nerve-related disorders.

The Perimetry, also known as the Visual Field test, creates a comprehensive map of your entire field of vision. By examining your peripheral or side vision, which is usually impacted first by glaucoma, your doctor can diagnose and track the progression of the condition. The test results are crucial in assessing the severity of glaucoma, the extent of vision loss, as well as any damage to the visual pathways in the brain and other optic nerve-related disorders.
Fundus photo yandex

Fundus Photography

Fundus photography is a non-invasive imaging technique that captures high-resolution images of the retina, optic nerve, and blood vessels at the back of the eye. It aids in diagnosing and monitoring various eye conditions, such as diabetic retinopathy and age-related macular degeneration, providing valuable information for effective patient care.

Neuro Ophthalmology Doctors

Frame 1

Dr. Nitin
Balakrishnan

Cataract & Refractive Surgeon

Frame 2

Dr. Nikhil Nitin Balakrishnan

Cataract & Refractive Surgeon
Frame-3

Dr. Pavitra Patel Balakrishnan

Cataract & Refractive Surgeon

Neuro Ophthalmology Reviews

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Karan Kothari

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Tan

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Sakshi Shetty

Frequently Asked Questions

WHEN SHOULD I CONSULT A NEURO OPHTHALMOLOGIST?
When confronted with abrupt vision loss, sudden appearance of visual field abnormalities, double vision, gradual and continuous vision decline, eyelid drooping, momentary vision loss, or uneven pupil sizes, it is advisable to seek advice from a neuro-ophthalmologist, among other instances.
WHAT DOES A NEURO OPHTHALMOLOGICAL EXAMINATION INCLUDE?
This encompasses the evaluation of visual sharpness, color perception, responsiveness of the pupils, examination of the optic nerve’s condition and functionality, appraisal of the visual pathway extending from the eye to the brain’s visual cortex, examination of eye movement coordination, scrutiny of the visual field, and any necessary additional tests.
WHAT SPECIAL TESTS ARE REQUIRED IN VISUAL LOSS /BLURRING?
Each of these examinations might be necessary on its own or in conjunction.
  1. Automated visual field assessment
  2. Visual Evoked Potentials (VEP) evaluation
  3. Optical Coherence Tomography (OCT) imaging
  4. Doppler scans for Carotid and Vertebral arteries
  5. Computed Tomography (CT) scans of the brain and eye socket
  6. Magnetic Resonance Imaging (MRI) scans of the brain and eye socket
  7. Magnetic Resonance Angiography (MRA) of brain and neck vessels
  8. Magnetic Resonance Venography (MRV) of the brain
  9. CT angiography of the brain and neck vessels
  10. Blood tests when deemed essential
WHAT IS THE OPTIC NERVE?
The optic nerve comprises a collection of nerve fibers that transmit visual data from the eyes to the brain’s visual cortex.
WHAT IS OPTIC NEURITIS?
Optic neuritis refers to an inflammation affecting the optic nerve. Individuals may encounter abrupt vision blurriness in one or both eyes, accompanied by eye or eyes discomfort, painful eye movements, disturbances in color vision, and occasionally, occurrences of flickering lights.
WHAT ARE THE COMMON CAUSES OF OPTIC NEURITIS?
The primary factors often stem from demyelinating conditions such as multiple sclerosis and neuromyelitis optica, along with viral-induced demyelination. Additionally, infectious diseases and autoimmune disorders contribute to other underlying causes.
DO PATIENTS WITH OPTIC NEURITIS RECOVER VISION?
Absolutely, this is indeed the case. However, it’s crucial that they promptly seek advice from both a neuro-ophthalmologist and a neurologist. Initiating treatment at the earliest opportunity leads to improved results.
ONCE THE OPTIC NERVE IS DAMAGED, CAN IT RECOVER?
Regrettably, harm to the nerve fibers of the optic nerve is permanent and cannot naturally regenerate.
WHERE IS THE VISION CENTER IN THE BRAIN?
The visual fibers within the optic nerves create the optic pathways, the optic pathways then extend as optic radiations, ultimately culminating in the visual cortex located in the occipital lobe situated at the rear of the brain.
CAN DOUBLE VISION BE TREATED?
Certainly, treatment is viable for this condition. The majority experience recuperation within one to two months. Occasionally, double vision resulting from trauma or accidents might not completely restore, necessitating specialized prisms or surgical intervention for correction.
WHAT ARE THE COMMON CAUSES OF HEADACHE IN NEURO OPHTHALMOLOGY?
Headache can manifest in various forms, including migraines, vascular headaches, tension headaches, cluster headaches, meningitis, elevated intracranial pressure from various sources, double vision, eye inflammation which may encompass optic neuritis, inflammation at the rear of the eye seen in conditions like para nasal sinusitis, orbital apex syndrome, Tolosa Hunt syndrome, and cavernous sinus syndrome.
WHAT ARE THE COMMON CAUSES OF RAISED INTRACRANIAL PRESSURE?
Typical origins encompass idiopathic intracranial hypertension, cerebral venous thrombosis, intracranial tumors, meningitis, intracranial bleeding, and traumatic brain injury.
WHAT DOES THE PATIENT EXPERIENCE WHEN THERE IS RAISED INTRACRANIAL PRESSURE?
Typical signs of heightened intracranial pressure involve intense headaches accompanied by nausea, forceful vomiting, momentary visual disturbances, ringing in the ears, dual vision, and loss of consciousness.
CAN STROKE CAUSE LOSS OF VISION?
Indeed, it is possible. If the clot or hemorrhage within the brain affects the optic pathways or the visual cortex, visual impairment will ensue alongside other associated characteristics.
CAN A STROKE CAUSE DOUBLE VISION?
Indeed, it is possible. If the stroke affects the brainstem, where the nerves that govern eye movements originate, the patient may experience a sudden onset of double vision.
WHY DOES SOMEBODY HAVE DOUBLE VISION?
Double vision can manifest as either monocular or binocular. Monocular double vision is generally non-neurological in nature. Conversely, binocular double vision usually originates from neurological causes. When any nerve responsible for controlling eye movements is impacted, double vision may arise.
CAN SMOKING AND ALCOHOL AFFECT VISION?
Indeed, they have the potential to directly or indirectly impact your vision.
Dr. Nitin Balakrishnan

Dr. Nitin Balakrishnan, Medical Director and Chief of the Cataract & Refractive department at Sai Deep Eye Clinic & Crystal Vision Laser Centre has been in practice for more than 30 years.
He has undergone training in phakoemulsification from international stalwarts in the field, like Dr. David Chang of the United States Of America and Dr. Vittorio Piccardo Of Italy.
He specialises in Laser Vision Corneal Refractive Surgery, and is a member of the expert group of Contoura Lasik Surgeons Of Asia Pacific.
He Has been on the faculty and has presentationsin various National & International Conferences.
He has Been involved in Live surgeries in many Cataract & Refractive Meetings and has Published in various peer reviewed publications.
He was Awarded gold medals for exemplary service in Ophthalmology by IIRSI and by the UKSOS.
HE believes in continuously updating his practise with the latest techniques and has always been amongst the earliest adopters of cutting edge technology.

He Heads the Department of Ophthalmology at Nanavati Superspeciality Hospital Mumbai

  • Member of the American Society of Cataract & Refractive Surgeons
  • Member of All India Ophthalmology Association
  • Member of Indian Intraocular Implant Society
  • Member of Maharashtra Ophthalmology Society & Bombay Ophthalmologist’s Association
Dr. Nikhil Nitin Balakrishnan

Dr. Nikhil Nitin Balakrishnan is a proficient Cataract & Refractive Surgeon at Sai Deep Eye Clinic & Crystal Vision Laser Centre.

He has undergone training in Cataract and Refractive Surgery from the world renowned Narayana Nethralaya Bengaluru. He is a very competent clinician and a surgeon par excellence.

He is competent in both Manual and Femtosecond assisted Cataract Surgery (FLACS). He takes special interest in planning of premium IOL’s like Multifocal, TORIC and cataract in Complex Corneas such as Post Refractive Surgery eyes. He is proficient in the diagnosis and management of Keratoconus with newer treatment modalities such as Collagen Cross Linking (CXL), Topography guided treatments with Cross Linking (TPRK +CXL) and Intra Corneal Ring Segments (ICRS).

Dry Eye Disease, its newer investigation and treatment modalities are other domains he is skilled in. He has thorough knowledge and experience in the usage and interpretation of imaging tools including state of the art Topographers, Aberrometers, Biometers, OCT’s etc. He is an accomplished Translational and Research Clinician and has multiple publications on Cataract, Keratoconus, Refractive surgery in various National and International peer reviewed Journals. He has numerous Paper and Video presentationsin various National & International Conferences for which he has won many accolades.

Dr. Pavitra Patel Balakrishnan

Dr. Pavitra Patel Balakrishnan completed her basic medical education (MBBS) from JNMC, Wardha in 2013. She completed her Masters in Ophthalmology from the same college in 2017. She finished her long termfellowship in Cataract and Refractive Surgery from world renowned Narayana Nethralaya, Bengaluru. To add to her armamentarium, she did an observership in cornea from Cornea Eye hospital, Vadodara, Gujarat. At present, she is a prolific Cataract & Refractive Surgeon at Sai Deep Eye Clinic & Crystal Vision Laser Centre.

She is proficient in both Manual and Laser Assisted Cataract Surgery and takes keen interest in planning Complex IOL power calculations.Her area of expertise includesdiagnosis and treatment modalities of Dry eye, and Keratoconus. She has worked extensively on the latest Refractive Surgery Module- Contoura. She has a number of national and international research publications and has been acclaimed with many awards at national and international podiums.

She is a member of various State, National and International Ophthalmic bodies such as • Member of the European Society of Cataract & Refractive Surgeons (ESCRS) • Member of Asia Pacific Association of Cataract & Refractive Surgeons (APACRS) • Member of All India Ophthalmology Society (AIOS) • Member of Women Ophthalmological Society (WOS) • Member of Young Ophthalmologists Society of India (YOSI) • Member of Indian Intraocular Implant Society (IIRSI) • Member of Indian Society of Cornea &Keratorefractive Surgeons (ISCKRS) • Member of All Gujarat Ophthalmological Society (AGOS)

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