Pediatric Neuro-Ophthalmology: Coming of Age

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Pediatric neuro-ophthalmology is distinct from adult neuro-ophthalmology because the examination, disorders, and treatment issues are different. The goal of this supplement is to review the most recent advances regarding the diagnosis and management of selected congenital and acquired pediatric neuro-ophthalmic disorders.
Pediatric neuro-ophthalmology has come a long way. I first heard the term “pediatric neuro-ophthalmology” when I was a medical student at Columbia University in the late 1980s. A neurology resident with whom I was working proclaimed that he was going to pursue pediatric neuro-ophthalmology as a career. I did not even know it was a subspecialty—I had never heard of it, and there was no faculty member at Columbia at the time who called himself or herself a pediatric neuro-ophthalmologist. To my knowledge and for unclear reasons, however, this resident pursued another subspecialty.
Toward the end of my adult neurology residency in Boston in the early 1990s, once I had committed to neuro-ophthalmology as a career, I started seeking postfellowship faculty opportunities. I truly enjoyed my pediatric neurology rotations, so I approached the chief of ophthalmology at Boston Children's Hospital to ask if there was a need for a pediatric neuro-ophthalmologist in the practice there. He said that there was no need. The discussion was very brief.
Soon after that, seemingly out of the blue, Steve Galetta, MD, contacted me about working at the University of Pennsylvania in 1993, and he said my job at Penn would include seeing adults but also becoming the first on-site pediatric neuro-ophthalmologist at the adjacent Children's Hospital of Philadelphia. The chief of pediatric ophthalmology there at the time questioned the need for a pediatric neuro-ophthalmologist, but the chiefs of pediatric neurology, neurosurgery, and neuro-oncology felt otherwise. In particular, the late Dr. Peter Berman, then the chief of pediatric neurology, allayed any doubts. He said, “Grant, just get started, and the patients will be there.” He was right. Today, there are over 2,000 pediatric neuro-ophthalmic visits per year at the Children's Hospital of Philadelphia. Over 2 decades, the practice became too busy for just 1 person with an increasingly larger demand for outpatient appointments and inpatient consults. I realized I needed help. So in 2015, Robert Avery, DO, who completed his fellowship at Penn in 2010, returned from Washington, DC to join me as the second pediatric neuro-ophthalmologist at the Children's Hospital of Philadelphia.
Brodsky, Hamed, and Baker's book entitled, “Pediatric Neuro-ophthalmology” (1996, Springer) help solidify the subspecialty and give it legitimacy. I remember early in my career how excited I was to absorb the pearls provided in the chapters on congenital optic disc anomalies, optic disc swelling in children, and nystagmus in infancy and childhood, among many others. Michael Brodsky, MD, subsequently wrote the successful and authoritative second (2010, Springer) and third editions (2016, Springer) on his own (oh, my goodness!). Because he was one of the first widely-recognized pediatric neuro-ophthalmologists, in addition to his incredible knowledge and thoughtfulness, (and not because of his age!) many of us consider Mike Brodsky to be the elder statesman of pediatric neuro-ophthalmology.
The timing is right for a pediatric neuro-ophthalmology supplement for the Journal of Neuro-Ophthalmology (JNO). Tremendous scientific and clinical advancements have been made in the conditions covered here. I asked many of my pediatric neuro-ophthalmic, neurologic, and oncologic colleagues to contribute to these reviews in their fields of expertise, and I would like to thank them for their effort, time, and dedication. I would also like to thank Lanning Kline, MD for giving us the opportunity to bring the JNO readership up to date on these topics.

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