Neuro-Ophthalmology in Portugal.

Worldwide Neuro-Ophthalmology Neuro-Ophthalmology in Portugal N euro-ophthalmology in Portugal was initiated in the early 1980s by Faria de Abreu (Fig. 1) who started the neuroophthalmology unit in the Department of Ophthalmology at the University Hospital of Coimbra. He was followed shortly afterward by Ivone Cravo, Manuela Novais, and João Costa in Lisbon and Falcão-Reis and Olinda Faria in Porto. Currently, there are 8 hospitals that have neuroophthalmology clinics and several more have one clinician with an interest in neuro-ophthalmology. Most ophthalmologists and neurologists in Portugal practicing neuroophthalmology do not do so full time. Overall, there are approximately 12 ophthalmologists and neurologists whose main clinical interest is neuro-ophthalmology. Of these, one underwent fellowship training in the United Kingdom (with Michael Sanders) and 2 in the United States (one with Neil Miller and the other with Eric Eggenberger). Many of the others also had periods of training abroad. In Portugal, there are no formal neuro-ophthalmology fellowship programs, but there is a mandatory 3-month FIG. 1. José Rui Faria de Abreu, MD, PhD (1945–2012), a pioneer of neuro-ophthalmology in Portugal. Fonseca et al: J Neuro-Ophthalmol 2017; 37: e1-e2 rotation during the 4-year residency program in ophthalmology. Although it is not a part of the mandatory neurology residency curriculum, there has been an increasing interest by neurology residents in undergoing some form of elective training in neuro-ophthalmology and many have spent a 1- or 2-month observership. This interest has been recognized by the Portuguese Society of Neurology which included a neuro-ophthalmology session at their annual meeting in November, 2015. The annual Portuguese Society of Ophthalmology (PSO) meetings have always included neuro-ophthalmology sessions, with free papers and poster presentations, and have featured courses on neuro-ophthalmology–related subjects. In 2011, Neil Miller was the invited keynote speaker and delivered the annual Cunha-Vaz Lecture. At the 2014 meeting, the neuro-ophthalmology section of the PSO published FIG. 2. Evidence-based Neuro-Ophthalmology, published by the Portuguese Society of Ophthalmology in 2014 and available online. e1 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. Worldwide Neuro-Ophthalmology a Portuguese textbook on evidence-based neuro-ophthalmology that is also available online (http://www.spoftalmologia.pt/ publication/neuroftalmologia-baseada-na-evidencia/) (Fig. 2). In addition to these efforts, the neuro-ophthalmology section of the PSO has organized an annual reunion in the spring every year since 2011, with the participation of approximately 100 attendees and featuring international guests including Aki Kawasaki, Irene Gottlob, and Neil Miller. Other neuro-ophthalmologists who have lectured in Portugal include Michael Sanders, Andy Lee, Anthony Arnold, Anat Kesler, and Mário Monteiro. Portuguese neuro-ophthalmologists have regularly participated in the annual meetings of the Iberian Club of NeuroOphthalmology since its inception in 2012. After the success of previous meetings in Barcelona, Bilbao, Lisbon, and Maiorca, the fifth meeting of the club was held in May 2016 in Coimbra. Most neuro-ophthalmologists in Portugal are involved in clinical research. Over the past 10 years, efforts from the visual neuroscience group in Coimbra under the leadership of Miguel Castelo-Branco have led to multiple publications and several PhD degrees. Current research projects from this group include clinical models of neuronal plasticity in patients with Leber hereditary optic neuropathy mutations, the development of new psychophysical tests for optic e2 neuropathies, and functional neuroimaging of patients with ocular motor disorders and visual hallucinations. Also, Masters and PhD programs in neuro-ophthalmology were established at the University of Lisbon, with 10 students presently enrolled. In conclusion, in a country with 10 million people, there are currently more clinicians practicing neuroophthalmology than ever before. Interest in our subspecialty has been rapidly increasing among young ophthalmologists and neurologists, and we look forward to the future with great promise! Pedro L. Fonseca, MD Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal Ivone V. Cravo, MD Neuro-Ophthalmology Unit, ALM Clinic, Lisboa, Portugal João M. Costa, MD Department of Ophthalmology, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal Fonseca et al: J Neuro-Ophthalmol 2017; 37: e1-e2 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited.