Looking Beyond the Eyes

By Amy Geiszler-Jones
Monday, April 30, 2018

While ophthalmologists often focus on saving one’s vision, a neuro-ophthalmologist can often help save lives through a diagnosis.

Grene Vision Group ophthalmologist Michele M. Riggins, MD, is a fellowship-trained neuro-ophthalmologist.

Patients who see a neuro-ophthalmologist, such as Michele Riggins, MD, with Grene Vision Group in Wichita, usually have vision problems that are caused by a neurological or physical condition, some of which can be life-threatening.

For example, one of Dr. Riggins’ patients thought a cataract was causing his clouded vision until she discovered a brain tumor had been pressing on his ocular nerve fibers. Within days, he had surgery for the tumor.

“My priority is to make sure the patient doesn’t have a life-threatening or vision-threatening disease,” Dr. Riggins says. She diagnoses at least one patient a day with either of those risks.

Dr. Riggins is one of more than 400 board-certified neuro-ophthalmologists in the U.S. She’s also the only one in Kansas outside of the Kansas City area. With so few neuro-ophthalmologists in the U.S., Dr. Riggins sees patients from not only Kansas, but also from neighboring states and Arkansas, as well.

Most of her patients have seen at least two other doctors, such as their family physician and their general eye doctor, she says, indicating the complexity of diagnosing a neurological condition that can cause vision problems. Some have seen neurologists, infectious disease doctors or other specialists during their search for a diagnosis. Several neurological conditions such as multiple sclerosis or myasthenia gravis (MG) or diseases such as Lyme disease or cat scratch fever can also cause vision problems.

“Every day I hear from at least three to five patients, ‘Well, You’re it. No one has figured out what’s going on so it’s your turn,’” Dr. Riggins says. Most of the time, she says, she can attribute the vision loss to a systemic or neurological condition. For some, stress has led to a visual impairment.

Patients referred to her are those who have vision loss with an unknown etiology, diplopia, abnormal or asymmetrical pupils, or other issues affecting their vision. With a focus beyond the eyes, Dr. Riggins spends as much as an hour with a patient during an initial visit, taking a thorough medical history and recording symptoms, reviewing previous testing and scheduling additional tests, most of which is imaging that involves more than just the eye.

“We can’t discount anything,” she notes. For example, for suspected MG cases, she does a pharmacological test, using Tensilon, to help with diagnosis. “Not many doctors do that in this area,” she says.

When she arrives at a diagnosis, Dr. Riggins considers herself part of a team approach in providing treatment for the patient.

“We definitely get the primary care doctor involved and any other specialist, such as a neurologist, an oncologist if the vision loss is related to cancer, a rheumatologist if it’s an autoimmune disorder, or an ear, nose and throat doctor,” she says.

After attending and earning her undergraduate degree from Texas A&M University the collegiate swimmer earned her medical degree from the Texas A&M Health Science Center, completed an internal medicine internship and ophthalmology residency at Scott and White Hospital in Temple, Texas, and also completed one of the few surgical neuro-ophthalmologist fellowships in the country at Dean A. McGee Eye Institute in Oklahoma City. Dr. Riggins joined Grene Vision Group in 2012 and sees patients at the group’s Wichita and Hutchinson locations.

She Can See Clearly Now

For more than a decade, Jacqueline Cline, 67, had been retreating from doing several things she once enjoyed. Her double vision had led to her being almost home-bound, relying on friends and family for outings and transportation. Even watching television was difficult.

“It was amazing how much I was limiting my lifestyle because of my eyes,” says Cline, whose husband, Byron, is an obstetrician and gynecologist. She saw other doctors who tested her for diabetes, multiple sclerosis and other diseases and underwent three MRIs over the years. Finally, she was connected with neuro-ophthalmologist Michele Riggins, MD, of Grene Vision Group, who diagnosed the cause and provided a treatment option in late 2017.

“No one else had been able to tell me why I had double vision,” she says.

While there are several reasons for double vision or diplopia, Cline’s condition was caused by divergence insufficiency, a rare ophthalmological disorder found in older adults. For Cline, her brain couldn’t get her eyes to line up properly and diverge outward when looking in the distance. For several years, Cline had placed a prism on the eyeglass lens of her left eye to get rid of the second image, but eventually her condition worsened to where she needed to cover the eye completely to avoid double vision.

Specializing in adult strabismus, which is eye misalignment, Dr. Riggins performed a 10-minute surgery on an extraocular muscle to help align Cline’s eyes.

Cline recalled she was told it may take 24 hours for her eyes to align properly, but within hours, “I could see perfectly,” she says. “Not only did it correct my double vision, but I didn’t even need my glasses anymore. Things that others take for granted — like looking at someone and not seeing two of them — are now clear to me. It’s been life-changing.”

Jacqueline Cline will be able to see clearly on the golf course again following surgery by Grene Vision Group’s neuro-ophthalmologist Michele Riggins, MD.

To make a referral to Dr. Riggins for a patient with unexplained vision loss or impairment, call Grene Vision Group at 316-684-5158.