In This Section      
Print This Page

Neuro-Ophthalmology Fellowship

Overview

The Neuro-Ophthalmology Fellowship at the Johns Hopkins Wilmer Eye Institute began in 1976, and was the first program of its kind accredited by the Association of University Professors of Ophthalmology (AUPO). Since its establishment, 90 individuals have completed the program.

This one-year program provides fellows with expert knowledge and comprehensive experience in the diagnosis and management of patients with neuro-ophthalmologic disorders, and develops sound clinical judgment throughout.

The disorders managed include disorders of the visual sensory system, such as optic nerve disorders, chiasmal syndromes, and post-chiasmal visual field loss, as well as disorders of the ocular motor pathways (eg, ocular motor nerve palsies, supranuclear disorders of gaze), and abnormalities of pupil size and reactivity. Specific goals and objectives are based on six core competencies: patient care, medical knowledge, interpersonal skills and communication, professionalism, systems-based practice, and practice-based learning.

Program Curriculum

Clinical and Surgical Services

The fellowship training program in neuro-ophthalmology is organized to provide a stable, well-coordinated, progressive educational experience in the neuro-ophthalmologic spectrum of ophthalmic diseases, so that the fellows may develop diagnostic, therapeutic, and manual skills as well as sound judgment in their application. Fellows are expected to build on existing patient care skills and develop further competency in dealing with medical and surgical conditions of the visual sensory pathway from the optic nerve to the striate cortex, ocular motor nerves, extraocular muscles, and pupils.

Specific skills that are emphasized include testing of visual acuity and color vision, testing of the visual field using various forms of perimetry, including static and kinetic perimetry, assessment of ocular motility and alignment, assessment of pupil size and reactivity, and assessment of the appearance of the optic disc using direct and indirect ophthalmoscopy as well as hand-held lenses. The fellows should reasonably be expected to have mastered these skills within the first quarter of the Fellowship.

Patient Care Responsibilities

Fellows regularly perform patient assessments in the daily neuro-ophthalmology clinic; however, full-time division faculty supervise all clinic experience by fellows. Fellow night and weekend calls occur from home, with minimal activity. Nevertheless, a faculty second-call individual is always available. All emergency or urgent cases are triaged in the Wilmer Emergency Room located in the Main Emergency Ward of the Johns Hopkins Hospital. Any cases discussed with the fellow are discussed either immediately or the next day with the program director or one of the faculty members, all of whom carry a pager and/or a cell phone; the program director carries both national and international telephones. 

All clinics are supervised by a full-time faculty member of the Neuro-Ophthalmology division. Fellows are  required to review all clinic patients whom they evaluate with that faculty member. In addition, whenever a fellow is consulted by a resident or by a faculty member from another division regarding a patient with a known or presumed neuro-ophthalmologic disorder, the fellow is required to discuss that patient with a designated neuro-ophthalmology faculty member.

Didactic Components

Didactic sessions for fellows include nightly teaching/work rounds, at which each patient is reviewed and formal presentations are given by the fellows relating to conditions that they have encountered during the prior week. There are nightly fellow teaching conferences presented by the faculty to enhance knowledge of neuro-ophthalmologic disorders and their management. There are also monthly journal article reviews for the fellows,  with fellows being expected to review all pertinent material. In addition, all fellows are expected to attend weekly neurosurgery grand rounds and weekly neurovascular conferences, and to attend and participate in neuro-ophthalmology grand rounds.

Research

Fellows are educated in basic and clinical sciences through a structured regularly-scheduled series of conferences and lectures. The Program will increase the fellow's knowledge about the diseases of the visual sensory pathway, ocular motor system, and pupils, including their epidemiology, risk factors, diagnosis, medical and surgical treatment and prognosis. 

During the course of the fellowship, the fellows spend a minimum of 20% of their time participating in various research  activities of neuro ophthalmologic importance. Their preceptors for these projects depend on the nature of the project but include full-time and part-time faculty of the Johns Hopkins School of Medicine.

Teaching

Fellows play a major role in teaching residents and medical students who may wish to actively evaluate patients in the clinic, although the faculty also always evaluates these patients and makes the final decisions regarding diagnosis and management. As the fellows alternate calls with the faculty, they have the potential to teach when they are contacted by the residents in the emergency room. In addition, they are invited to participate in conversations with the residents when the faculty is asked by one of the residents or by another faculty member to consult on a patient in his or her clinic.

Evaluation

Faculty conduct monthly one-on-one meetings with individual fellows. At these meetings, curriculum and performance are addressed. A fellow's performance is addressed quarterly with input from all neuro-ophthalmology faculty and other divisional staff with whom they interact. An evaluation is completed by each faculty member by hand and summarized by the fellowship director for the quarterly evaluation. Comments from technicians, clinic staff, and residents on the neuro-ophthalmologic rotation, and patients (if applicable) are also sought and incorporated into the quarterly evaluations to provide 360-degree feedback.

Requirements for Applicants

All applicants must have completed an ophthalmology or neurology residency prior to entering the fellowship at a program accredited by the ACGME or the Royal College of Physicians and Surgeons of Canada. Applicants for the fellowship must submit a letter of request. They are then asked to complete an application form and to send it along with their curriculum vitae and three letters of recommendation.

Applications are reviewed by the program director and the division faculty, and appropriate candidates are invited for an interview. Candidates are ranked based on their performance in residency training as evidenced by their CV, letters of recommendation and interview performance. One or two positions are available each year, depending on the number of qualified candidates.

In addition, qualified foreign medical graduates who have done an internship and ophthalmology residency in their home country with a valid Educational Council for Foreign Medical Graduates (ECFMG) certificate are considered for these positions. Interested international applicants can find more information at the Office of International Student, Faculty, and Staff Services.

Please direct all question and applications to:

Neil R. Miller, M.D., FACS, Fellowship Director
Email: nrmiller@jhmi.edu
458 Wilmer Eye Institute
Johns Hopkins Hospital
600 North Wolfe Street
Baltimore, Maryland 21287
Phone: (410) 503-3213
Fax: (410) 503-3214

Neuro-Ophthalmology Fellowship Program Director

Photo of Dr. Neil R Miller, M.D.

Miller, Neil R, M.D.

Professor of Ophthalmology
Professor of Neurology
Professor of Neurosurgery
Frank B. Walsh Professor of Neuro-ophthalmology
Expertise, Disease and Conditions: Neuro-Ophthalmology, Ophthalmology, Orbital Tumors, Thyroid Eye Disease, Von Hippel-Lindau (VHL)
Research Interests: Orbital tumors, Optic Nerve Disease
 

Faculty

Fellows are taught by the faculty of the division of neuro-ophthalmology, some of whom have duel appointments in neurology and neurosurgery.

Photo of Dr. Thomas McCarthy Bosley, M.D.

Bosley, Thomas McCarthy, M.D.

Professor of Ophthalmology
Expertise, Disease and Conditions: Neuro-Ophthalmology
Research Interests: optic neuropathy, neurologic causes of visual loss, diplopia, eye movement abnormalities, genetic abnormalities causing neuro-ophthalmologic problems
 
Photo of Dr. Andrew R Carey, M.D.

Carey, Andrew R, M.D.

Assistant Professor of Ophthalmology
Expertise, Disease and Conditions: Diabetic Macular Edema, Diabetic Retinopathy, Giant Cell Arteritis, Macular Degeneration, Macular Degeneration (Age-Related), Myasthenia Gravis, Neuro-Ophthalmology, Ophthalmology, Optic Neuritis, Retinal Vein Occlusion, Retinitis Pigmentosa, Stargardt Disease, Vision Impairment
Research Interests: Novel treatments for optic neuropathies, Comparative effectiveness and cost-benefit of intravitreal medications, Long term visual outcomes of choroidal neovascularization, Novel retinal and optic nerve imaging modalities, Medical student and resident education
 
Photo of Dr. Amanda Dean Henderson, M.D.

Henderson, Amanda Dean, M.D.

Assistant Professor of Ophthalmology
Expertise, Disease and Conditions: Neuro-Ophthalmology, Ophthalmology
Research Interests: Non-arteritic anterior ischemic optic neuropathy, Visual loss due to optic nerve conditions
 
Photo of Dr. Timothy James McCulley, M.D.

McCulley, Timothy James, M.D.

Associate Professor of Ophthalmology
Vice Chair for Clinical Strategic Planning, Wilmer Eye Institute
Chief, Neuro-Ophthalmology Division
Director, American Society of Plastic and Reconstructive Surgery Fellowship
Expertise, Disease and Conditions: Blepharoplasty, Cosmetic Surgery of the Face, Double Vision, Graves' Disease, Neuro-Ophthalmology, Ocular Plastics, Ophthalmology, Orbital Tumors, Skin Cancer
 
Photo of Dr. Neil R Miller, M.D.

Miller, Neil R, M.D.

Professor of Ophthalmology
Professor of Neurology
Professor of Neurosurgery
Frank B. Walsh Professor of Neuro-ophthalmology
Expertise, Disease and Conditions: Neuro-Ophthalmology, Ophthalmology, Orbital Tumors, Thyroid Eye Disease, Von Hippel-Lindau (VHL)
Research Interests: Orbital tumors, Optic Nerve Disease