Binocular Vision and Orthoptics: Investigation and Management. Bruce Evans, Sandip Doshi, eds. Boston: Butterworth-Heinemann, 2001. Pages: 147. Price: 70. 00. ISBN 0-7506-4713-2. The authors proclaim, “some practitioners confess to perceiving binocular vision and orthoptics as intimidating subjects. ” I believe there is little doubt that this is true and this book is an attempt to provide the primary care optometrist with the knowledge and confidence to diagnose and treat common binocular vision anomalies. With this goal in mind, a large portion of the book is dedicated to straightforward vergence anomalies such as convergence insufficiency. However, more intricate conditions such as strabismus, adaptations to strabismus, and nystagmus are also covered, with possible treatments and recommendations for referral to more experienced practitioners included where the authors feel appropriate. The book evolved from a collection of 16 articles by several authors. Thus, one advantage of this book is that multiple clinicians present their opinions and techniques throughout the text. This allows readers to compile the differing viewpoints, along with their own clinical experience, and to integrate this data into their diagnostic and treatment methods. Using myself as an example, I believe that I may incorporate more fixation disparity and associated phoria testing into my exams. This is a practice that I have gotten away from over the last few years. One disadvantage of this book is that multiple clinicians present their opinions and techniques throughout the text. If you have been paying attention, you will note that this is in direct opposition to the previous statement, and my reasoning is as follows: because subjects are covered in multiple areas in the book, I do not believe that this would make a good quick reference text. I feel that it is better suited for the optometrist who wants to expand his/her practice, and is looking for a text to get him/her started. As stated earlier, a large portion of the book is dedicated to the understanding, diagnosis, and treatment of convergence and disorders of convergence. Three chapters are on this topic specifically, and several other chapters provide further information. Other topics discussed include classification of comitant deviations, and incomitant deviations. Diplopia, suppression, anomalous correspondence, nystagmus, and amblyopia are each given a chapter. I was intrigued to find that the authors dedicated an entire chapter to microtropia. Medical (including a fine review on the use of botulinum toxin) and surgical management of binocular anomalies are also covered. The book concludes with three case studies and multiple choice questions and answers pertaining to each of the chapters. Because this is a first edition, it is not unusual that a few inaccuracies were missed in the editing process. A few of these could pose a problem for the clinician inexperienced in treating binocular vision cases. One example is a description of the 4 D base-out suppression test found in the first chapter. Here the authors incorrectly state that no eye movement after introducing the prism indicates no suppression. The reader is referred to chapter 11, where an accurate, detailed depiction is found, for further information. A second example is a table of accommodative facility norms. This table is indecipherable because pertinent information has been left out. At one point, a nice review of neuroanatomy is presented. However, it concludes by indicating that cranial nerves three, four, and six enter the orbit via the optic canal. This erroneous information is probably inconsequential to most optometric clinicians, but could be unfortunate for a student studying for an examination. It is worth noting that the authors mostly practice in the United Kingdom. Hence, readers trained in the United States may notice subtle differences in classification of binocular vision anomalies. The main discrepancy that I noticed is with anomalous correspondence. The authors define any anomalous correspondence where diplopia is not present as harmonious, regardless of whether fusional vergence is required to maintain the habitual angle of deviation. I would (as is, to my knowledge, widely accepted in the United States) categorize the above scenario, in which fusional vergence is required to maintain the habitual angle, as typical inharmonious anomalous correspondence. So did the authors accomplish their objectives? I believe that optometrists wishing to expand their treatment of binocular vision cases would benefit from reading this book. I also enjoyed the different perspective that I obtained on diagnosis and treatment, and would recommend Binocular Vision and Orthoptics: Investigation and Management to experienced binocular vision optometrists looking for the same.
Andy Toole (Fri,) studied this question.