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Neuro-Optometry · Chandler, AZ

When the problem isn't in the eye.

Double vision. A missing piece of your visual field. A drooping eyelid. Vision that changed after a concussion or a stroke. Some vision problems begin in the optic nerve, the visual pathways, or the nerves that move the eyes — and the eye itself can look completely normal. Neuro-optometric evaluation at My Eye Consultants is designed to find those causes, with an ophthalmologist on site and direct coordination with neurology when findings call for it.

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Visual Field Testing Optic Nerve OCT Imaging Ophthalmologist On Site Physician Referrals Accepted Bilingual EN/ES

Some of these symptoms are emergencies.

Most neuro-optometric problems develop gradually and are appropriately handled with a scheduled evaluation. A few are not. If any of the following describes what is happening right now, do not book an appointment — call 911 or go to an emergency room.

  • Sudden loss of vision in one or both eyes
  • Sudden onset of double vision
  • Vision loss with weakness, numbness, or facial drooping
  • Vision loss with confusion or trouble speaking
  • A severe new headache with vision changes
  • Vision loss with scalp tenderness or jaw pain when chewing
  • A new droopy eyelid together with a dilated pupil
  • Vision that goes dark briefly, then returns

These presentations can indicate stroke, an aneurysm, giant cell arteritis, or raised pressure inside the skull. In several of them, treatment within hours determines whether vision is preserved. An eye appointment next week is not the right response — emergency evaluation is. We would far rather you go to the ER and be told it was nothing.

What is Neuro-Optometry?

Vision is a brain function as much as an eye function.

We tend to think of vision as something the eyes do. In reality the eye is the front end of a much longer system. Light lands on the retina, but the signal then travels down the optic nerve, crosses at the optic chiasm, runs through the brain to the occipital lobe at the back of the head, and gets interpreted there. Meanwhile a separate set of cranial nerves aims and coordinates both eyes so the two images fuse into one.

That means a vision problem can start almost anywhere along that route. Pressure inside the skull can swell the optic nerves. A stroke in the visual pathway takes out a matching section of both eyes' fields. Reduced blood flow can damage an optic nerve overnight. A cranial nerve stops working and the eyes no longer point at the same thing, producing double vision.

In all of those cases, the eye can look structurally healthy on a routine exam. What identifies the problem is a different kind of examination — one that maps the visual field, images the optic nerve, tests the pupils carefully, and studies how the eyes move together. That is what neuro-optometry does.

Symptoms Worth Evaluating

When vision problems don't fit the usual pattern.

These symptoms are not emergencies on their own, but they do warrant a proper evaluation — particularly if a routine eye exam came back normal and the problem is still there.

  • Double vision, constant or intermittent
  • Double vision that resolves when you close one eye
  • A missing or dim area in your side vision
  • Bumping into things on one side
  • A drooping eyelid
  • Pupils that look different sizes
  • Eyes that don't seem to move together
  • Difficulty focusing between near and far since a head injury
  • Eye strain or headaches with reading or screens after a concussion
  • Words that swim or move on the page
  • Trouble in visually busy places like stores or crowds
  • Vision changes since a stroke
  • Colors looking washed out in one eye only
  • Pain with eye movement
  • Involuntary eye movement or shaking
  • Vision symptoms your eye doctor could not explain
What We Evaluate

Conditions a neuro-optometric evaluation is built to find.

These are the categories of problem the evaluation is designed to identify, localize, and route to the right specialist. Some are managed here; others are identified here and referred urgently.

Eye Movement

Double Vision & Cranial Nerve Palsies

When the third, fourth, or sixth cranial nerve is affected, one eye no longer aims where the other does. The pattern of the double vision — horizontal, vertical, worse in certain directions of gaze — tells us which nerve is involved and narrows the possible causes considerably.

Optic Nerve

Optic Neuropathy

Damage to the optic nerve from reduced blood flow, inflammation, compression, or elevated pressure. Often presents as vision loss in one eye, dimmed color perception, or a specific pattern of field loss. Optic nerve OCT and visual fields are central to identifying and tracking it.

Intracranial Pressure

Papilledema

Swelling of both optic nerves caused by raised pressure inside the skull. Patients may report headaches, brief episodes of vision greying out, or whooshing sounds in the ears. Because the underlying cause needs urgent identification, this finding is referred immediately.

Visual Pathway

Visual Field Loss

Damage anywhere along the pathway from optic nerve to occipital lobe produces a characteristic pattern of field loss. Mapping that pattern helps localize where the problem sits — which is why formal field testing is often requested during stroke and tumor workups.

Pupils & Eyelids

Anisocoria & Ptosis

Unequal pupil sizes and drooping eyelids are often benign — and occasionally the first sign of something that is not. The combination matters: which pupil is abnormal, whether the droop is on the same side, and how the pupils respond in light and dark all change the interpretation.

Head Injury

Post-Concussion Visual Dysfunction

Concussion frequently disrupts the focusing and eye-teaming systems even when acuity is 20/20. Patients describe reading fatigue, difficulty shifting focus, screen intolerance, and discomfort in busy environments. Documenting it objectively is the first step toward addressing it.

How the Testing Thinks

The visual field is a map. Where you lose vision says where the problem is.

This is the idea that makes neuro-optometry useful to a neurologist. Because the visual pathway crosses partway back and then splits, damage at different points along it produces distinctly different patterns of loss. The pattern is close to an address.

Before the Crossing

One eye affected

Loss confined to a single eye points to that eye's optic nerve or the retina — ahead of the point where the two nerves meet. Optic neuropathy and retinal disease live here.

At the Crossing

Outer half of both fields

Loss of peripheral vision on both sides suggests compression at the optic chiasm, where the nerves cross. The pituitary gland sits directly beneath it, which is why this pattern prompts imaging.

Behind the Crossing

Same side of both eyes

Losing the same half of the field in both eyes points behind the chiasm, in the brain itself — most commonly from stroke. The affected side is opposite the side of the brain involved.

What the Evaluation Includes

A different examination — not a longer one.

A neuro-optometric evaluation asks different questions than a routine exam and uses different tests to answer them. Plan for 60 to 90 minutes, and expect dilation.

01

History & Symptom Characterization

When it started, how suddenly, what makes it better or worse, whether it affects one eye or both. In neuro-ophthalmic problems the history frequently narrows the diagnosis more than any single test does.

02

Pupil Testing

Careful assessment of pupil size, symmetry, and reaction, including testing for a relative afferent pupillary defect — an objective sign of optic nerve dysfunction that does not depend on what the patient reports.

03

Eye Movement & Alignment

Measurement of how the eyes move in every direction of gaze and how well they stay aligned. This is what identifies which cranial nerve or muscle is involved in double vision.

04

Automated Visual Field Testing

Formal mapping of what you can and cannot see across your whole field of vision. This produces the pattern that localizes the problem, and it establishes a baseline for tracking change over time.

05

Optic Nerve Exam & OCT

Dilated examination of both optic nerves plus OCT imaging of the nerve and the retinal nerve fiber layer — measuring swelling or thinning objectively rather than by appearance alone.

06

Coordination & Referral

Where findings point to a neurological cause, we coordinate imaging and laboratory workup and refer to neurology with our results included — fields, imaging, and the clinical picture, not just a note.

Why Here

An optometrist who looks for this — and an ophthalmologist down the hall.

Neuro-ophthalmic findings have an awkward property: the ones that matter most are the ones that need attention fastest. Having both doctors in the same building changes what happens in the twenty minutes after something turns up.

Primary Evaluation

Dr. Andrew N. Lu, O.D.

Doctor of Optometry · Neuro-Optometry Interest

Dr. Andrew Lu completed a fellowship in Medical Optometry and carries a particular interest in neuro-optometry — the visual symptoms that turn out not to be about the eye. He performs the evaluation: the history, the pupil and motility testing, the visual fields, and the optic nerve imaging that together localize where a problem sits.

Ophthalmic Consultation

Dr. Luis W. Lu, M.D., FACS

Ophthalmologist · 45+ Years

When findings suggest something that needs a physician's eye immediately — a swollen optic nerve, a pupil-involving third nerve palsy, a presentation that could be giant cell arteritis — Dr. Luis Lu is in the same building. Columbia trained, Harvard fellowship, double board certified, and 45 years of pattern recognition. That is a very short hallway when it counts.

For Referring Physicians

Referring a patient for neuro-optometric evaluation

We accept referrals from neurologists, primary care physicians, and concussion and rehabilitation providers across the East Valley. Common reasons include documenting visual field defects, baseline and serial optic nerve imaging, characterizing diplopia, evaluating unexplained visual symptoms, and assessing visual dysfunction following concussion or stroke.

You receive a consultation report with our findings, including visual field printouts and optic nerve OCT. Urgent findings are called to your office the same day rather than faxed. Your patient continues under your care.

Fax referrals to (480) 207-1551 or call (480) 590-0505.

Frequently Asked Questions

Real answers about neuro-optometry.

Which symptoms are an emergency?

Call 911 or go to an emergency room immediately for: sudden loss of vision in one or both eyes, sudden onset of double vision, vision loss accompanied by weakness, numbness, confusion, or difficulty speaking, a severe new headache with vision changes, or vision loss along with scalp tenderness or jaw pain when chewing. These presentations can indicate stroke, an aneurysm, giant cell arteritis, or raised pressure inside the skull, and delay can cost vision or life. Do not wait for an eye appointment.

What is neuro-optometry?

Neuro-optometry deals with vision problems that do not originate in the eye itself. Vision depends on the optic nerve, the visual pathways running through the brain, and the cranial nerves that move the eyes. When any of those are affected — by pressure, inflammation, reduced blood flow, injury, or stroke — the symptom shows up as a vision problem even though the eye looks structurally normal. A neuro-optometric evaluation is designed to find those causes.

When should I see a neuro-optometrist instead of a regular eye doctor?

Consider a neuro-optometric evaluation when vision problems do not fit the usual pattern: double vision, loss of part of your field of vision, vision changes that come and go, a drooping eyelid, pupils of different sizes, vision problems after a head injury or stroke, or when a routine eye exam was normal but the symptoms are real. Symptoms that arrive suddenly are a different situation and should be treated as an emergency.

What happens during a neuro-optometric evaluation?

The evaluation includes a detailed symptom history, careful pupil testing, assessment of eye movements and alignment, automated visual field testing to map exactly what you can and cannot see, color vision testing, a dilated examination of the optic nerves, and OCT imaging of the optic nerve and nerve fiber layer. Together these findings localize the problem — meaning they help identify where along the visual pathway something has gone wrong. Plan for 60 to 90 minutes.

Can vision problems be a sign of a brain or nerve condition?

Yes, and sometimes the eye exam is where a systemic or neurological condition is first identified. Swelling of the optic nerve can reveal raised pressure inside the skull. A pattern of visual field loss can point to where a stroke or tumor sits along the visual pathway. A new droopy eyelid with a dilated pupil can indicate an aneurysm. This is why an eye examination is often part of a neurological workup — the optic nerve is the only part of the central nervous system a doctor can look at directly.

Do you treat vision problems after a concussion?

We evaluate them. Visual symptoms after a concussion are common and under-recognized — difficulty focusing between distances, eye strain and headaches with reading or screens, trouble with busy visual environments, and a sense that the eyes tire quickly. A neuro-optometric evaluation documents what is actually happening with focusing, eye teaming, and eye movements, and rules out other causes. Where ongoing rehabilitation is appropriate, we coordinate with your concussion care team.

Will my insurance cover a neuro-optometric evaluation?

Neuro-optometric evaluation is billed to medical insurance rather than vision insurance, because it addresses a medical condition rather than a refractive one. Most major medical plans and Medicare cover the evaluation and the associated testing when medically indicated. Our office verifies coverage before your visit.

Can my neurologist or primary care physician refer me?

Yes. We accept physician referrals for neuro-optometric evaluation and work regularly with neurologists, primary care physicians, and concussion and rehabilitation providers across the East Valley. We document findings and send a consultation report back to the referring office, including visual field results and optic nerve imaging. Referrals can be faxed to (480) 207-1551.

If a normal eye exam didn't explain it, the answer may be further back.

Schedule a neuro-optometric evaluation at My Eye Consultants in Chandler. We'll map what's actually happening — and if it points somewhere beyond the eye, we'll make sure it gets to the right doctor.

Schedule an Evaluation Call (480) 590-0505