VALÉRIE BIOUSSE, Neuro-ophthalmology

 


Some view the eyes as windows to the soul. For Valérie Biousse, Cyrus H. Stoner Professor of Ophthalmology and Professor of Neurology, the eyes are more like windows to the brain.

Neuro-ophthalmologists identify and diagnose diseases of the brain by looking at the eye. It is a relatively young field of specialization, and Biousse is one of only two neuro-ophthalmologists at Emory (one of five in the state of Georgia). "Around one third of the human brain is involved in vision," Biousse says. "So nearly everyone who suffers a large brain lesion - from stroke, trauma, tumor, or multiple sclerosis, to name the most common causes - will present with some kind of visual dysfunction." Some brain impairments cause patients to go blind. Others destroy the ability to see colors. Still others make it difficult to read or describe what one is seeing. Biousse's task is a demanding one: start with the vision problem and work backwards to diagnose and treat the underlying neurological causes.

This kind of work requires skilled translating as well as sleuthing. Together with Nancy Newman, Section Director of Neuro-Ophthalmology at Emory, Biousse bridges the fields of ophthalmology, neurology, neurosurgery, radiology, and rehabilitative medicine to explain the brain to eye doctors and the eye to brain specialists. "We speak both languages," she says. "We are really a teaching specialty. We teach by seeing patients." To this end, she has been instrumental in establishing a two-year fellowship in neuro-ophthalmology, the first of its kind in the United States. Funded by the School of Medicine and the department of Ophthalmology, the fellowship allows a resident to undergo full immersion in both the neurological and the ophthalmological sides of the clinical specialization.

Biousse also designs teaching simulations. With support from the School of Medicine and the University Teaching Fund, she and colleagues have created a new curriculum and workshop for the School of Medicine, complete with patient heads made of foam and eyes made of plastic canisters. The simulation, which will be piloted next semester, teaches medical students how to detect neurological disorders with an ophthalmoscope, an instrument that examines the eye. Most medical students graduate without really knowing how to use one, a knowledge gap that Biousse sees as unfortunate. "There are many neurological and neurosurgical emergencies that will present with visual symptoms," Biousse says. "For a non-specialist to be able to make the right diagnosis with an ophthalmoscope in an urgent situation could save a patient's life."

At the same time that she trains medical students, residents, and fellows, Biousse is quick to point out that patients also teach her. Each presents a new opportunity for understanding neuro-ophthalmological disorders and designing possible treatments. As such, her clinical role remains inseparable from her commitment to research. Says Biousse: "Basic scientists bring the lab to the patient. We bring the patient to the lab." And while Biousse's own specialty lies in the relationship between the eye and cerebral-vascular disease (or how strokes affect vision), she and her partners support a range of research projects. They designed a clinical trial for the treatment of Leber's Hereditary Optic Neuropathy (LHON), a rare cause of blindness in young people. They often partner with other departments. "Neurology will need us to do the 'eye part' of their study," she says. "Ophthalmology will need us to do the 'brain part.' And rehabilitative medicine will need us to do the 'vision part.'" Over the next five to seven years, she wants to see the Section of Neuro-ophthalmology expand its staffing and resources to allow for more clinical trials and partnerships.

Biousse, who received her medical training in Paris, says she can't imagine being anywhere else than Emory. "Emory believes 'great scholars' are not only great researchers, but also great teachers and clinical investigators," she says. "There aren't many places nowadays where that is still true. It's something you can feel throughout the university."

Such support becomes all the more vital when the patients whom she sees face such devastating illnesses. "We have difficult days," Biousse says. "We're usually the first ones to have to say, 'You're going to have multiple sclerosis,' or 'You may have a brain tumor.'" Being able to make those diagnoses earlier and with greater accuracy means better care for patients and, hopefully, more effective treatments in the future. For Biousse, such aspirations go without saying. Someone has to keep looking through that window.