To the Editor.
—The article by Dr Vazquez1 in the January Archives on the use of a graphic technique to analyze cyclovertical muscle palsies represents another in a series of mnemonics and props designed to simplify interpretation of the three-step test. Vazquez states: "An advantage of this method is that knowledge of the actions of the cyclovertical muscles, when analyzing the Bielschowsky head tilt test, is not required." He contends that this method is an improvement over a similar technique described in the Ophthalmology Basic and Clinical Science Course2 in which one must know the muscles that have a vertical action with head tilt.I am disturbed by statements such as these that de-emphasize or allow one to circumvent a thorough knowledge of the physiology underlying the three-step test. Despite enormous increases in the amount of information that residents and practicing ophthalmologists must assimilate, I do not think
Ruttum M. Graphic Three-Step Test. Arch Ophthalmol. 1984;102(6):824. doi:10.1001/archopht.1984.01040030650005