A Tour of the Neuro-Ophthalmology Virtual Education Library

December 30, 2008

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AAN.com visited the Neuro-Ophthalmology Virtual Education Library. Daniel B. Hier, MD, MBA, FAAN, talked about the site with Eric R. Eggenberger, DO, FAAN, at Michigan State University.

AAN.com: The Neuro-Ophthalmology Virtual Education Library (NOVEL) is an impressive collection of educational materials related to neuro-ophthalmology. What was the reason for creating NOVEL?

Eggenberger: Neuro-ophthalmology has a well-earned reputation for education, and the initial impetus for NOVEL fit into this focus. We wanted a living repository to honor some of our outstanding teachers and share their knowledge with not only other neuro-ophthalmologists, but also with neurologists and ophthalmologists.

NOVEL home page: The Neuro-Ophthalmology Virtual Education Library
(Copyright: North American Neuro-Ophthalmology Society. Reproduced on Creative Commons License.)

AAN.com: What kinds of materials are housed in NOVEL?

Eggenberger: NOVEL is a discipline-specific, open-access repository of digital materials including images, video, lectures, articles, and animations. These materials cover a wide range of neuro-ophthalmic conditions. The topics serve diverse usersincluding clinicians (neurologist, ophthalmologists, neuro-ophthalmologists, house officers and students), researchers, and patients. All materials are copyrighted but can be used at no charge as long as the user cites the source and does not alter the material.

There are images of numerous fundus findings (ranging from disc anomalies to papilledema, optic atrophy and retinocerebral diseases) suitable for downloading into a presentation, video of various types of nystagmus and ocular motor abnormalities, PowerPoint lectures, animation detailing the vestibular ocular reflex, and audio lectures including J. Lawton Smith's original lectures concerning many neuro-ophthalmic topics.

The archives of the Journal of Neuro-Ophthalmology are in the process of being added to the NOVEL library. New collections will include a series of "All Star Grand Rounds," which will include video lectures with supplemental learning materials from leading experts in the field. A Patient Portal has recently been established, offering patient brochures on disease, with additional links into the NOVEL collections as well as links to other existing authoritative information resources.

In addition, we are collecting the Walsh cases from 1969 through last year, with cases from 1984 to present currently available on the website. These cases comprise the neuro-ophthalmic clinicopathologic conference in which cases are presented as unknowns to the audience with diagnosis and discussion following.

A rare disease registry will be available to serves research purposes by collecting data on uncommon conditions (Chiari mimicking pseudotumor cerebri, genetic eye movement disorder, posterior cortical atrophy, sarcoid optic neuropathy, Susac's disease, among others), and a patient portal covering topics to include anisocoria, anterior ischemic optic neuropathy, blepharospasm, optic nerve drusen, dry eye syndrome, hemifacial spasm, homonymous hemianopia, microvascular cranial nerve palsy, migraine, myasthenia gravis, optic nerve glioma, optic neuritis, pituitary tumor, pseudotumor cerebri, and thyroid eye disease.

AAN.com: I noticed that NOVEL is divided into a variety of separate collections including the American Academy of Ophthalmology/North American Neuro-Ophthalmology Society (AAO/NANOS) collection and the collections related to distinguished neuro-ophthalmologists including Wray, Hoyt, Cogan, Kardon, Kennerdell, and others. What is the significance of each of these separate collections?

Eggenberger: Each of the collections, donated by the named author, contains their clinical materials and reflects the unique aspects of their distinguished careers. For example, Hoyt's collection has numerous examples of optic disc and retinal disease, Kennerdell's section concerns orbital diseases, and Wray's compilations include ocular motor and facial movements disorders, to name a just a few of the categories.

The AAO/NANOS Collection is a series of slides or cases covering a wide variety of topics ranging from abducens palsy to Wyburn-Mason syndrome with clinical pictures, videos, and scans. This multi-author collection arose from the slide exchange coordinated through NANOS.

The Moran Collection began with a set of videos from Digre, but includes submissions from all members of the Neuro-Ophthalmology Department at the University of Utah.

AAN.com: Which organizations support NOVEL?

Eggenberger: The original funding for NOVEL came from a grant from the National Library of Medicine for three years (2004–2006). At present, we have obtained support from NANOS, in addition to an educational grant from the Pfizer Corporation for 2008.

In order to grow this resource, we have reached out to the AAN and other interested organizations whose members will be regularly using NOVEL resources.

AAN.com: Are new items being added?

Eggenberger: NOVEL continues to grow and establish itself as the major ophthalmology web-based medical education resource, with over 11,000 hits per month worldwide. NOVEL is continually adding items and would like to grow even more. New items are vetted by a committee in a peer review process. In addition, there is time required for organization, verification, categorization, and tagging of items (for searching accuracy).


Papilledema from NOVEL Collection. Copyright: North American Neuro-Ophthalmology Society. Reproduced on Creative Commons License.

AAN.com: Can anyone access NOVEL? Is a password required to entry?

Eggenberger: Presently NOVEL is not password-protected and is open to all via free access. We would like to maintain this open policy; however, grant support is required to ensure this in the future.

AAN.com: Do you envision practicing neurologists using NOVEL specifically for teaching or does it have applications for clinical practice and patient care?

Eggenberger: NOVEL can serve the practicing neurologist in several ways, including not only teaching and education, but also picture or video verification of clinical diagnosis, and material to use in educational programs. NOVEL also serves as a resource for patients via the Patient Portal, which can supplement a neurologist's patient education efforts. This portal currently has links to a patient information sheet, any support groups, Medline information, and also a PubMed research link, so that anyone can access up-to-date information about the topic.

We are currently working on linking resources from the library with items in the Patient Portal. For example, when a patient looks up a condition like blepharospasm, there will soon be a video link of the condition from the collection.

AAN.com: Do you have any thoughts about the future development of NOVEL?

Eggenberger: We would like NOVEL to continue to grow in the volume and types of material in the collection. We will continue to add materials increasing the scope of diseases covered as well as educational references, and update the site with each year's Walsh meeting. Other future projects include a NOVEL twiki (open source wiki), NANOS Neuro-Ophthalmology Encyclopedia, posting Neuro-Ophthalmology Curriculum, NANOS Archives, and the possibility of adding a catalogue of neuro-ophthalmology clinical research studies, repository for reports on drugs causing visual side effects, and a PowerPoint tutorial.

Recently, NOVEL received the first contribution of a collection of materials from an international member. The Helmut Wilhelm collection will include a set of videos concerning eye movements and pupils, in addition to a PowerPoint-based quiz for self assessment, on the pupil.

The NOVEL Patient Portal (for education) will continue to add topics of interest to our patient, and the rare disease registry will not only grow in registered cases but also add additional conditions for research purposes.

Author Disclosures

Dr. Eggenberger has received personal compensation for activities with Biogen Idec, Teva Neuroscience, and Allergan, Inc. as a speaker's bureau member. Dr. Eggenberger has received research support from Allergan, Inc., Biogen Idec, and Teva Neuroscience.

Within the past 24 months, Dr. Hier received personal compensation for medical legal consulting to legal firms regarding medical malpractice issues. In the same period, he was paid for his role as editor of MDnetguide. Additionally, Dr. Hier has given expert testimony in medical malpractice cases.