Professor Prem Subramanian MD PhD is an expert in neuro-ophthalmology as both a medical and surgical subspecialty. He forged an amazing path in ophthalmology and due to his experiences in treating trauma patients, he developed world class skills in orbital surgical treatment. If you have an interest in this field, there are so many great resources such as NANOS, a vitrual library, and more information about the neuro-ophthalmology fellowship at University of Colorado.
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Dr. Steve Young
Dr. Subramanian brought up a very interesting point near the end which I think may have broader application—the idea that a hit to the optic nerve or retina leaves fewer reserves as the eye ages. This made me think of my many aging glaucoma patients who, despite good IOP control, seem to have a slow but inexorable decline in their visual field. The decline may not always be noticeable to the patient. But could it be related to this same concept—i.e., aging changes in the optic nerve and retina produce a more measurable decline in function because they have fewer reserves? This is particularly relevant in glaucoma as I see it, because it may impact how we choose a target IOP. In other words, does a slight decline in the visual field in an 85-year-old always mean that we need to lower our target?
great point and there is a point of diminishing returns as patients get into their 90s.