OGS-600X120-Above Article-Giving2023

In many instances, the topic of ordering neuroimaging has come up in ODs on Facebook, and opinions are all over the board. Some say yes, others say refer. Some seem to order images as if on a fishing expedition. Please allow me to offer some suggestions for neuroimaging ordering.


The indications for ordering usually fall into one of three broad presentations of clinical findings: processes affecting the afferent visual system, those affecting the efferent visual system, and those that present with anatomically identified clinical findings. Diseases affecting the afferent visual system present with visual field defects. Diseases affecting the efferent visual system usually present as motility problems. And those disease processes that present with clinically seen anatomical changes, though often overlapping with diseases affecting the afferent or the efferent system, present as proptosis, disc edema, vascular congestion, and a myriad of other suspicious findings. And there is actually a 4th presentation: those presentations that don’t fall into the above categories but that do arouse suspicion that something is going on warranting further imaging. This particular category can become fishing expeditions, and organic etiologies must be evaluated to reduce unnecessary testing.

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James Fanelli, OD, FAAO
Associate Editor, Systemic Disease for odsonfb.com. Dr. Fanelli has over 25 years of experience in the fields of glaucoma and ocular disease. He has lectured to his colleagues around the world and has published countless articles in educational magazines. Dr. Fanelli was presented with the prestigious John D. Robinson Clinical Excellence Award, one of the highest honors given by the North Carolina State Optometric Society.


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