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ObjectivesQuality assurance (QA) in neuro-ophthalmology (NOPH) is often lacking. We aimed to assess the quality of referral assessment and time-to-consult for common neuro-ophthalmological conditions by implementing a QA registry, NODE (Neuro-ophthalmology Database) in a tertiary Neuro-ophthalmology clinic. Australian standardised triage categories; P1 (consult<=30 days), P2 (consult<=30 to 60 days) and P3 (consult>60 days) were developed and validated for neuro-ophthalmological conditions.MethodsWe collected data in NODE on 676 patients at Alfred Hospital, Melbourne and developed a consensus on the assignation of NOPH conditions to triage categories using a modified Delphi Approach with a panel of seven experienced neuro-ophthalmologists. We analysed the mean days from referral to triage, and from triage to initial consultation and compared these to the Australian standardised triage categories.ResultsCommon diagnoses were Idiopathic Intracranial Hypertension, IIH (19%), Optic Neuropathy, ON (14%), Non-specific Headaches, (11%) Cranial Nerve Defects, CND (8%) and Papilloedema (7%). The mean time from referral to triage was <5 days for all the common diagnoses. The mean days (±standard deviation (SD)) from P1 category triage to initial consult for IIH was 15 (±12), Acute ON 16 (±14), and CND was 20 (±15). For P2 triage-to-consult for Papilloedema was 20 (±19), non-specific Headaches was 22 (±20), and EOMD was 48 (±22). For P3 triage-to-consultant for Non-ocular Myasthenia Gravis was 38 days (±29) and for Visual Snow was 54 (±31 days).ConclusionsWe established a NOPH registry that will serve as a framework to benchmark quality of care between NOPH services and improve clinical outcomes for patients.

ObjectiveQuality assurance (QA) in neuro-ophthalmology (NOPH) is often lacking. The QA registry, NODE (Neuro-ophthalmology Database), was established and implemented in tertiary NOPH clinics in Australia. We developed a consensus on triage categories according to Australian standardised triage categories;P1 (consult<=30 days), P2 (consult<=30-60 days) and P3 (consult>60 days).MethodsData on 410 patients at Alfred Hospital, Melbourne was collected with NODE. We developed a consensus on assignation of NOPH conditions to triage categories using recommendations from a panel of neuro-ophthalmologists with the modified Delphi approach. The average days from referral to triage and triage to the initial consultation were compared to the developed triage category standard.ResultsMost patients presenting to the service were female (n=262, 64%), aged 21 to 30 years. Common diagnoses were Idiopathic Intracranial Hypertension, IIH (24%), Optic Neuropathy, ON (17%), Headaches, (11%) Cranial Nerve Defects, CND (9%) and Eye Movement Disorders, EOMD (9%). The mean time from referral to triage was <2 days for all the common NOPH conditions. The mean time (days, +-standard deviation) from P1 category triage to initial consult for IIH was 26 (±7), ON 27 (±11), and CND was 17 (± 5). The mean time (days) from P2 triage to initial consultant for Headaches was 27 (±12), and EOMD was (±17). The mean time (days) from P3 triage to initial consultant for Myasthenia Gravis was 30 (±10).ConclusionWe have established a consensus agreement on triage categories for neuro-ophthalmological conditions. We established a QA framework for other NOPH clinics in Australia.

Background Idiopathic intracranial hypertension (IIH) is increasingly prevalent, yet longitudinal outcome data are scarce. This study aimed to characterise demographic and longitudinal clinical changes in a cohort of patients with IIH. Methods Retrospective cohort analysis on adult patients diagnosed with IIH (Friedman criteria) enrolled in the neuro-ophthalmology database (NODE) across two tertiary centres. Baseline demographic data was obtained at first assessment, with clinical and paraclinical outcomes collected longitudinally. Multivariable statistical analysis identified factors associated with poorer visual outcomes. Results A total of 221 patients were included. 91.8% were female (ratio 11:1). Mean age at presentation was 29.2 ± 8.1 years with mean body mass index (kg/m 2 ) at diagnosis of 38.7 ± 9.4. Headache was the most common symptom. Papilloedema was found in 95.5% of patients at baseline. Mean CSF opening pressure was 32.67 ± 6.85cmCSF (range 25–76). Visual outcomes remained stable over time. Trajectory plots showed no deviations in visual acuity, while regression models found no associations with sex, site or age. A higher retinal nerve fibre layer thickness and greater baseline Frisen grade were associated with worse outcomes. Baseline papilloedema grade and CSF opening pressure emerged as early prognostic indicators, aiding risk stratification for those with a greater probability of persistent optic nerve abnormalities including higher retinal nerve fibre layer elevation and sustained atrophic changes over time. Conclusions This study offers insights into visual outcomes in IIH, emphasising the importance of early recognition, risk stratification, and intervention in those with a more severe clinical phenotype at presentation.

General neurologists and stroke specialists are regularly referred cases of visual disturbance by general practitioners, emergency doctors and even ophthalmologists. Particularly when the referral comes from ophthalmologists, our assessment tends to focus on the optic nerve; however, retinal conditions may mimic optic neuropathy and are easily missed. Their diagnosis requires specific investigations that are rarely available in a neurology clinic. This article focuses on how a general neurologist can identify retinal problems from the clinical assessment and how to proceed with initial investigations. The following cases were all referred to a consultant neurologist (GTP) from ophthalmology services as optic neuropathies or other neurological disorders. Part A of the summary describes the presentation and findings in the neurology clinic; part B describes the subsequent specialist assessment in the neuro-ophthalmology/eye clinic.