Neuro-ophthalmology in france.

I nterest in neuro-ophthalmology in France dates back to the 19th century with the publications by an ophthalmologist, Henri Parinaud, a collaborator of Jean-Martin Charcot in Paris. At that time, a physiologist, Claude Bernard, and a neurologist, Eugène Devic, participated in the description of various neuro-ophthalmologic syndromes. In the 1930s, academic neurologists in Paris, including Pierre Mollaret, Georges Guillain and later Jérôme Garcin, Jean Lapresle, and Mongi Ben Hamida, worked closely with specific ophthalmologists, like Hoang Xuan Man, and published original clinical cases related to neuro-ophthalmology. In the 1970s, neuro-ophthalmology emerged as a distinct subspecialty practiced by a few nonsurgical ophthalmologists, like Monique Schaison-Cusin, who saw patients in the neurology and neurosurgery departments of Pitié Salpétrière Hospital in Paris. With reform of residency training in the early 1980s, ophthalmology primarily became a surgically oriented specialty and trainees lost the opportunity to choose ophthalmology as a medical specialty, thereby precluding training in neuro-ophthalmology. This led the last generations of French ophthalmologists to have little interest in neuro-ophthalmology, yet at the same time a number of investigators became interested in eye movement disorders. These included Pierre Larmande, Charles Pierrot-Deseilligny, Alain Berthoz, and Marc Jeannerod. They developed eye movement laboratories that attracted a number of neurologists and scientists over the past few decades. French neuro-ophthalmology is usually performed parttime either by ophthalmologists or neurologists or in some locations by combined teams. Approximately, 30 clinicians currently practice neuro-ophthalmology on a regular basis in France. Two thirds of them are ophthalmologists, and most are located in academic medical centers. Three major factors have led to a dramatic increase in educational, clinical, and research activity in neuroophthalmology in France. First was the creation 15 years ago of a post-graduate university diploma in neuro-ophthalmology. Since then, the registration has remained full each year (60 trainees). This program spurred creation of a French textbook of neuro-ophthalmology (1). Currently, neuro-ophthalmology is included in the educational programs of ophthalmology residents and is expected to be part of the curriculum of neurology residents very soon. A number of organizations provide grant support for neuro-ophthalmology training and include Berthe Fouassier Price [Fondation de France], Société Française d’Ophtalmologie, Année recherche; Institut Servier, Fondation Planiol, Fondation Philips. These grants allow young French ophthalmologists or neurologists to train in neuro-ophthalmology centers outside of France, primarily in the United States and United Kingdom.