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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.

I. ANATOMY AND PHYSIOLOGY FOR THE NEURO-OPHTHALMOLOGIST

    A. Bony anatomy(1 and 2)
      1. Orbit(2)
      2. Bony communications
        a. Superior orbital fissure(1)
        b. Optic canal(1)
        c. Inferior orbital fissure(2)
        d. Ethmoidal foramina(2)
      3. Skull(2)
        a. Anterior cranial fossa
        b. Middle cranial fossa
        c. Posterior cranial fossa
    B. Anatomy of the orbit, the eyelids, and the lacrimal pathways(2)
    C. Neuroanatomy
    D. Afferent visual pathways(1)
      1. Anatomy and physiology of the eye
      2. Retina
        a. Macula
      3. Optic nerve
      4. Optic chiasm
      5. Optic tract
      6. Lateral geniculate
      7. Optic radiations
      8. Calcarine cortex
      9. Association areas
    E. Efferent visual pathways(1)
      1. Supranuclear input
      2. Cerebellar connections
      3. Nuclear centers
      4. Ocular motor nerves
        a. Abducens (VI)
        b. Trochlear (IV)
        c. Oculomotor (III)
      5. Extraocular muscles
      6. Vestibular pathways
    F. Facial motor anatomy(2)
    G. Sensory anatomy (trigeminal system) (2)
    H. Autonomic anatomy(1)
      1. Sympathetic
      2. Parasympathetic
        a. Lacrimal
        b. Pupil
    I. Vascular anatomy(2)
      1. Arterial anatomy
        a. Internal carotid arteries and their branches
        b. Circle of Willis(1)
        c. External carotid arteries and their branches
        d. Vertebrobasilar system
        e. Aortic arch
        f. Blood supply of the orbit, eye and optic nerve(1)
      2. Venous anatomy
        a. Cerebral venous sinuses and deep venous system
        b. Cortical veins
        c. Venous drainage in the neck
        d. Venous drainage of the eyes and orbits
    J. Fluids and secretions
    1. Cerebrospinal fluid

II. OCULAR AND NEUROLOGIC EVALUATION

    A. Ocular and neurologic examinations
      1. Ocular evaluation
        a. Evaluation of visual function (visual acuity, stereopsis, color vision, contrast sensitivity, basics of refraction, confrontation visual fields, Amsler grid, photostress testing) (1)
        b. Ocular examination, intraocular pressure, resistance to retropulsion, exophthalmometry(1)
        c. Pupillary examination
          i. Measuring the RAPD
        d. Funduscopic examination(1)
          i. Normal optic disc
            a) Disc anatomy
            b) Vascular features
              i) Venous pulsations
      2. Use of lensometer, phoropter, slit lamp, transillumination, direct and indirect ophthalmoscopes and slit lamp biomicroscopy of the fundus(1)
      3. Ocular motility, use of prisms, cover testing, red glass, maddox rod, forced duction test, sensory testing(1)
      4. Ocular examination of the young child(1)
      5. Neurologic evaluation
        a. Neurologic examination (adult and child) (1)
        b. Basic cognitive evaluation (mini mental status) (1)
      6. Neuro-ophthalmic evaluation of the comatose patient(1)
      7. Examination of children:
        a. Developmental milestones for children(2)
        b. Visual maturation of children(1)
      8. The Neuro-ophthalmologic history
    B. Ancillary tests obtained in neuro-ophthalmology
      1. Visual field testing
        a. Automated perimetry (familiarity with current perimeters and different testing strategies)(1)
        b. Goldmann perimetry (should be able to perform)(1)
        c. Tangent screen (should be able to perform)(1)
        d. Measure the Relative Afferent Pupillary Defect (RAPD)
      2. Electrophysiology
        a. Visual evoked responses(2)
        b. Electroretinogram(3)
        c. Multifocal electroretinogram(3)
        d. Dark adaptation(3)
        e. Eye movement recordings(2)
      3. Ocular and orbital ultrasound(2)
      4. Retinal fluorescein angiography(2)
      5. Nerve fiber layer analysis
        a. Optical coherence tomography (OCT), HRT, GDX(3)
      6. Imaging
        a. Computed tomography(1)
        b. Magnetic resonance imaging(1)
        c. Vascular imaging (ultrasonography, CTA, MRA, CTV, MRV, conventional angiogram)(1)
        d. Functional neuro-imaging (MRI, SPECT, PET)(3)
      7. Lumbar puncture with opening pressure(1)

III. NEURO-OPHTHALMIC SYMPTOMS AND SIGNS

    A. Visual Loss
      1. Transient
      2. Permanent
      3. Unexplained visual loss
      4. Non organic visual loss
    B. Positive Visual Phenomena
    C. Visual hallucinations
    D. Visual Field Loss
    E. Higher cortical dysfunction
    F. Normal and abnormal optic nerve
      1. Edema (disc swelling, papilledema, pseudotumor cerebri) and pseudopapilledema/anomalous nerves
      2. Optic atrophic
      3. Optociliary shunt vessels
        a. Shunt Vessels (Glaucoma)
        b. Shunt Vessels (CRVO)
        c. Shunt Vessels (Congenital)
        d. Shunt Vessels (Meningioma)
      4. Cupped optic nerve
      5. Optic disc anomalies/pseudopapilledema
    G. Oscillopsia, nystagmus, ocular oscillations
    H. Double vision (diplopia)
    I. Abnormal extraocular movements
    J. Ptosis
    K. Lid findings
      1. Lid retraction
      2. Lid lag
      3. Lag ophthalmos
      4. Lid twitch
    L. Orbital signs
      1. Proptosis
      2. Enophthalmos
      3. Pulsating exophthalmos
    M. Pupillary changes
      1. Anisocoria
      2. Dilation Lag
      3. RAPD
    N. Abnormal facial movements
    O. Facial weakness
    P. Ocular pain, facial pain and headaches
    Q. Speech disturbances

IV. DISORDERS OF THE AFFERENT AND EFFERENT VISUAL PATHWAYS