Meet Neuro-Ophthalmologist Dr. Damian Berezovsky
In fact, approximately one-third of the nerve cells in the cerebral cortex—the wrinkled, outermost layer of the brain—are dedicated to visual processing. Carrying the messages from the eyes to the brain are the optic nerves, each consisting of more than 1 million nerve fibers. For comparison, each auditory nerve connecting the inner ear to the brain has about 30,000 nerve fibers.
With this complex process comes the potential for a multitude of problems. Narrowing them down is what Barrow neuro-ophthalmologist Dr. Damian Berezovsky finds so fascinating and rewarding about his work.
What is a Neuro-Ophthalmologist?
“A neuro-ophthalmologist can either be a neurologist or an ophthalmologist, but one who focuses on the cranial nerves that transfer and modulate vision as well as the structures of the brain that help us interpret what we see,” he said.
With many neurological and systemic diseases affecting the eyes, neuro-ophthalmology is not a monotonous practice, he added.
Eye symptoms evaluated by a neuro-ophthalmologist include vision loss, visual disturbances, double vision, abnormal eye movements, unequal pupil size, and eyelid abnormalities. Some of the neurological conditions that can cause eye problems are pituitary tumors, stroke, multiple sclerosis, and Parkinson’s disease.
Dr. Berezovsky’s philosophy of care is to take as much time with his patients as possible and to strive to be the physician that provides an answer when others can’t.
“A lot of patients that come to neuro-ophthalmology have been seen by neurologists, ophthalmologists, optometrists, and others, often without a cohesive diagnosis,” he said. “I enjoy providing some kind of explanation for these patients’ symptoms.”
Neuro-ophthalmology is not a common subspecialty, with many parts of the world still underserved. Dr. Berezovsky suspects this is partially due to a lack of emphasis on neuro-ophthalmology in residency training.
Becoming a Neuro-Ophthalmologist
Dr. Berezovsky became curious about vision as an undergraduate biology student at Emory University. His sophomore year, he took an elective course on the biology of the eye taught by scientists and physicians. His college courses also sparked his interest in medicine.
“I have an aunt who’s a primary care physician back in Argentina where I grew up, but I don’t have very many physicians in the family,” he said. “I didn’t become pre-medicine until probably my junior year in college.”
After earning his medical degree from the Feinberg School of Medicine at Northwestern University in Chicago, he returned to Emory for a four-year postdoctoral research fellowship with a scientist who studies vision.
He underwent residency training in neurology at the University of New Mexico and a clinical fellowship in neuro-ophthalmology at Emory. Last year, he accepted his first faculty position at Barrow Neurological Institute.
“I was looking for a good balance between patient care, research, and education activities,” he said. “I thought Barrow provided a place where one could achieve that balance.”
Advancing the Field
While some neuro-ophthalmological conditions can be improved with treatment, the field is largely diagnostic. Dr. Berezovsky hopes to help change that through collaborative research.
“The optic nerves are, for all intents and purposes, an extension of the brain,” Dr. Berezovsky said. “Just like in other areas of the brain, once there’s been injury to an optic nerve or both, there can be some recovery, but the body has no mechanism to build new neurons to replace what was lost.”
In these cases, he is able to give a diagnosis and prognosis but unable to offer a solution. He says that’s the most difficult part of the job.
He is currently working with endovascular neurosurgeon Dr. Felipe Albuquerque on a study looking at the treatment of severe idiopathic intracranial hypertension, a disorder than can cause swelling of the optic nerve and subsequent vision loss.
“I’m also talking to different groups to see if we can collaborate further,” he said. “I’m interested in just about anything I can help with.”