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Essentials of Clinical Binocular Vision
BOOK NOTES
quired, but after all nonsurgical options have been exhausted.
Essentials of Clinical Binocular Vision Weissberg EM and Moore B. St. Louis: Elsevier, 2004. Softcover, 238 pages, $39.99 This diminutive paperback (11 cm ⫻ 18 cm) can easily fit into your lab coat pocket. Written in the style of the Wills Eye Manual, every type of binocular abnormality is presented in an outline format. Several authors contribute the material that is presented, including Dr. Weissberg. The strength of the text is its inclusion of every potential organic and non-organic cause of a binocular abnormality. Accommodative, vergence, and motility disorders are discussed in a logical and efficient manner. Pathologic and nonpathologic causes are reviewed, but the emphasis on functional disorders and the potential for vision therapy are foremost in the authors’ minds. Neurologic and/or vascular causes are briefly discussed (except for myasthenia) and additional tests are mentioned that are relevant to these disorders; however, referral for neurological evaluation is routinely suggested. The authors also recognize that surgery may be re-
Each chapter is presented in the same fashion. General information followed by symptoms and signs is presented first. A differential diagnosis section is then presented and is very nice; however, test norms do not always agree with other sources. For instance, this text suggests a low AC/A is typical with divergence insufficiency, while Borish suggests a normal-to-high AC/A ratio is common. This is followed by the appropriate patient workup, while the great variety of tests that may be performed are limited to the authors’ preferences regarding the potential vision therapy patient. For instance, only one type of test to determine the AC/A ratio is offered and not all clinicians would agree that the Modified Thorington is always the best. Treatment options are discussed last, along with the need for comanagement and followup (as needed). Any redundancy that is often associated with multiauthored chapters is avoided entirely. The last two chapters are devoted to identifying the more common and least expensive devices the average primary care eye doctor might wish to obtain and use. But genuinely knowing what to own, how to prescribe it, and how to incorporate it into a functional therapy program might be difficult for the uninitiated. Throughout the text, recommendations for spectacles and prism are easy to follow and which most optometrists are probably willing to prescribe; however, incorporating therapy into a practice from reading this book alone might be a stretch. Success statistically with any of the different formats for any of
the different disorders is not discussed. This would make it difficult to discuss which option is best for a patient and his or her family. Weaknesses include a limited index. Everything discussed in the book is not referenced and can take time to find. A simple, concise table of norms is also not included for all of the individual tests. For example, the normal for the AC/A ratio is revealed in the symptoms/signs section in the chapter on Convergence Insufficiency. The patient workup conveniently includes those diagnostic procedures that are important for the particular disorder; however, additional testing, such as an OKN flag for subtle internuclear ophthalmoplegias, or a VEP or neutral density filter for malingerers, or diseased eyes that masquerade as amblyopia, are not reviewed. These patient workups are rather specific for the diagnosis and provide the expected results for the disorder being discussed at the time. For students and primary care eye doctors who do not treat and manage binocular disorders, this text is a convenient reference to help differentiate pathologic from nonpathologic binocular disorders and is certainly recommended. It is also a nice review of the more common devices used by vision therapy specialists. It could reasonably spur interest in performing vision therapy. It would require additional support from lengthier and more specific texts for most optometrists to competently offer such a dynamic and challenging service in their practice. George Banyas, O.D. Cranberry Township, Pennsylvania
512 OPTOMETRY
VOLUME 76 / NUMBER 9 / SEPTEMBER 2005
quired, but after all nonsurgical options have been exhausted.
Essentials of Clinical Binocular Vision Weissberg EM and Moore B. St. Louis: Elsevier, 2004. Softcover, 238 pages, $39.99 This diminutive paperback (11 cm ⫻ 18 cm) can easily fit into your lab coat pocket. Written in the style of the Wills Eye Manual, every type of binocular abnormality is presented in an outline format. Several authors contribute the material that is presented, including Dr. Weissberg. The strength of the text is its inclusion of every potential organic and non-organic cause of a binocular abnormality. Accommodative, vergence, and motility disorders are discussed in a logical and efficient manner. Pathologic and nonpathologic causes are reviewed, but the emphasis on functional disorders and the potential for vision therapy are foremost in the authors’ minds. Neurologic and/or vascular causes are briefly discussed (except for myasthenia) and additional tests are mentioned that are relevant to these disorders; however, referral for neurological evaluation is routinely suggested. The authors also recognize that surgery may be re-
Each chapter is presented in the same fashion. General information followed by symptoms and signs is presented first. A differential diagnosis section is then presented and is very nice; however, test norms do not always agree with other sources. For instance, this text suggests a low AC/A is typical with divergence insufficiency, while Borish suggests a normal-to-high AC/A ratio is common. This is followed by the appropriate patient workup, while the great variety of tests that may be performed are limited to the authors’ preferences regarding the potential vision therapy patient. For instance, only one type of test to determine the AC/A ratio is offered and not all clinicians would agree that the Modified Thorington is always the best. Treatment options are discussed last, along with the need for comanagement and followup (as needed). Any redundancy that is often associated with multiauthored chapters is avoided entirely. The last two chapters are devoted to identifying the more common and least expensive devices the average primary care eye doctor might wish to obtain and use. But genuinely knowing what to own, how to prescribe it, and how to incorporate it into a functional therapy program might be difficult for the uninitiated. Throughout the text, recommendations for spectacles and prism are easy to follow and which most optometrists are probably willing to prescribe; however, incorporating therapy into a practice from reading this book alone might be a stretch. Success statistically with any of the different formats for any of
the different disorders is not discussed. This would make it difficult to discuss which option is best for a patient and his or her family. Weaknesses include a limited index. Everything discussed in the book is not referenced and can take time to find. A simple, concise table of norms is also not included for all of the individual tests. For example, the normal for the AC/A ratio is revealed in the symptoms/signs section in the chapter on Convergence Insufficiency. The patient workup conveniently includes those diagnostic procedures that are important for the particular disorder; however, additional testing, such as an OKN flag for subtle internuclear ophthalmoplegias, or a VEP or neutral density filter for malingerers, or diseased eyes that masquerade as amblyopia, are not reviewed. These patient workups are rather specific for the diagnosis and provide the expected results for the disorder being discussed at the time. For students and primary care eye doctors who do not treat and manage binocular disorders, this text is a convenient reference to help differentiate pathologic from nonpathologic binocular disorders and is certainly recommended. It is also a nice review of the more common devices used by vision therapy specialists. It could reasonably spur interest in performing vision therapy. It would require additional support from lengthier and more specific texts for most optometrists to competently offer such a dynamic and challenging service in their practice. George Banyas, O.D. Cranberry Township, Pennsylvania
512 OPTOMETRY
VOLUME 76 / NUMBER 9 / SEPTEMBER 2005