Neuro-ophthalmology sits at one of medicine’s most complex crossroads, where neurology, ophthalmology, and internal medicine converge. Vision engages an enormous share of the brain, roughly one-third to one-half of the cortex, which is why disruptions anywhere along the visual pathways can present with nuanced clinical clues.
In real-world practice, diagnostic tools have limits: orbital MRI is highly sensitive but can be normal in a meaningful minority of optic neuritis cases (≈84–90% sensitivity overall; ~16% with normal MRI in a large series), and structure–function “mismatch” between OCT and visual fields is well-documented.
Access is also constrained: a recent NANOS workforce analysis counted ~386 neuro-ophthalmologists in active practice in the U.S. (≈187 clinical FTE), with median new-patient waits of 6 weeks and >20% of practices reporting >3-month waits, underscoring the subspecialty’s scarcity. Source: PMC
For Dr. Fatima Tun Nissa Raza, now in her second fellowship at Henry Ford Hospital, this landscape is both an intellectual challenge and a human mission. With an MBBS from King Edward Medical University, house-job training at Mayo Hospital Lahore, and residency at LRBT Township, her career has been defined by disciplined clinical reasoning, interdisciplinary collaboration, and a determination to solve medicine’s diagnostic blind spots.
Let’s start with your journey, Fatima. What drew you into medicine and, eventually, neuro-ophthalmology?
I trained in Lahore, beginning with my MBBS at King Edward Medical University, followed by a house job at Mayo Hospital, and then a residency in ophthalmology at LRBT Township. Alongside this formal training, I’ve always been passionate about science and learning. I represented Pakistan at the International Biology Olympiad in South Korea in 2010 and also won the Dawn Lahore regional spelling bee that same year. Those early experiences shaped both my academic foundation and my drive for excellence. Neuro-ophthalmology came later, almost unexpectedly.
During residency, we saw hundreds of patients every day. Yet, the diagnoses we studied in textbooks, optic neuritis, intracranial hypertension, and cranial nerve palsies, were rarely identified in practice. I noticed that patients presenting with double vision, unexplained visual loss, or optic disc swelling were often inadequately assessed. These weren’t rare diseases; they were under-recognized. That disconnect fascinated me. I wanted to bridge the gap to give these patients the attention and clarity they deserved.
Medicine is rarely a straight path. What obstacles did you face along the way?
Several. Early in my career, I had to navigate poorly structured teaching environments, which meant a lot of self-directed study. As a woman in medicine, I also encountered both overt and subtle forms of misogyny. In some rural clinical settings, female doctors’ input was trivialized.
Even among trained colleagues, bias persisted. At one hospital, an anesthesiologist refused to provide anesthesia for my patients simply because I was a female surgeon. Add to that the nepotism that often influences advancement in medical institutions, and it’s been a long road to being recognized solely on merit. But I stayed focused. I worked hard to fund my own training and exams, which taught me discipline and the value of every opportunity. Those challenges made me independent and resilient. They shaped not just my career, but who I am as a person.
Neuro-ophthalmology thrives on research and case-based learning, given the complexity of its presentations. Could you tell us about your research contributions and why they matter to the field?
One of my most significant projects examined ophthalmic toxicity from cobalt exposure, particularly in patients with orthopedic joint replacements. Cobalt toxicity is known to cause cardiomyopathy and hearing loss, but its impact on the optic nerve and retina has been largely overlooked. Our paper Cobalt Toxicity Presenting as Bilateral Optic Neuropathy highlighted how cobalt ions can damage retinal ganglion cells, causing optic neuropathy and visual decline. It was well received because it bridged orthopedics, ophthalmology, and internal medicine, alerting clinicians to a systemic issue with visual consequences.
I also presented a poster on diplopia in a patient with long-standing orbital varices. These cases are usually explained as structural problems where the varices compress orbital tissues. But I proposed that benzodiazepine-induced changes in cerebral blood flow might have worsened the diplopia. That hypothesis generated meaningful discussions about the role of systemic medications in neuro-ophthalmic symptoms. Most recently, I managed a case of IgG4-related disease presenting with orbital involvement. This condition mimics tumors and can cause optic nerve compression, but unlike malignancies, it responds well to immunosuppression. Publishing such cases is crucial to ensure that treatable conditions are not misclassified as untreatable or idiopathic.
Professional development often extends beyond the clinic and the lab. How have professional networks or communities influenced your journey?
For me, being part of the North American Neuro-Ophthalmology Society (NANOS) has been nothing short of transformative. It isn’t just a professional association; it’s a community that is actively shaping the future of neuro-ophthalmology. Through NANOS, I’ve had access to educational resources, mentorship opportunities, and case discussions that continually expand my perspective. Their focus on collaborative learning and cross-disciplinary dialogue has helped me grow into a more well-rounded clinician. In such a niche specialty, it’s incredibly motivating to know that I am part of a network where innovation and support are constant. It reassures me that I’m not walking this path alone.
Similarly, being affiliated with the American Academy of Ophthalmology (AAO) has offered global exposure and continuing education opportunities, connecting me with the latest developments across the wider field of ophthalmology. Beyond what I’ve gained, these memberships have also positioned me to give back. I often serve as an advisor to medical professionals, whether residents, fellows, or colleagues in related specialties helping them navigate complex cases and encouraging them to pursue deeper training in neuro-ophthalmology. That sense of contributing to the growth of others in the field is as fulfilling
Burnout is common in medicine. What advice would you give to doctors or trainees who feel stuck or exhausted?
Burnout is real, and I’ve experienced it. What helps me is remembering that we stand on the shoulders of giants, the legacy of discovery that brought us here. I often think back to the wonder I felt as a medical student, fascinated by the human body. That memory re-centers me.
My advice is simple: master the basics, and do the work. There are no shortcuts to excellence. Consistency, humility, and discipline will move you forward, even when conditions aren’t ideal.
