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Book and Software Review
July 2000

Neuro-Ophthalmology: The Requisites in Ophthalmology

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Arch Ophthalmol. 2000;118(7):1010. doi:

From the first moment that I opened this textbook I found it to be a refreshing breath of air compared with many other neuro-ophthalmic textbooks. It is an extremely well-written textbook even for the "non-neuron" ophthalmologist. What impressed me most is how easy it is to read. All of the topics covered in the textbook are concisely and clearly written, but more importantly have well-diagrammed teaching figures. So, where was this textbook during my training?

The intention of the authors is to provide a directed, basic approach that is clinically oriented to the field of neuro-ophthalmology. I would say that they met and surpassed their goals. The textbook is divided into 4 parts: (1) The Neuro-Ophthalmic History and Examination, (2) The Sensory Visual System, (3) The Visual Motor System, and (4) Other Topics. At the end of each chapter major points are isolated in boxes for easy review, and suggested readings are separately listed as books and journals for quick source identification. Part 1, The Neuro-Ophthalmic History and Examination, contains one of the most important chapters in this book, making history-taking fun and exciting. Straight-to-the-point information is conveyed about obtaining a clinical history, with excellent figures and tables that help readers to realize why a detailed history is so necessary. This chapter is a must-read for medical students, ophthalmic residents, and fellows, as well as practicing ophthalmologists. If it has been a while since readers have taken a good yet concise history, then now is the time to read this chapter and find out what questions fail to be asked. Part 2, The Sensory Visual System, is composed of 5 chapters. The first chapter details how to test visual function. One of the best chapters is a well-organized and detailed discussion concerning visual fields with detailed figures demonstrating patterns of visual field loss. The reader will be anatomically led from the nerve fiber layer back to the occipital lobes as the organization of each anatomic area and its associated visual field defect is clearly outlined. Next is a chapter on optic nerve disorders with excellent coverage of optic neuritis and papilledema, specifically pseudotumor cerebri. It is very thoughtful of the authors to have included the black-and-white funduscopic photographs within the text of this chapter, with many of the same photographs in color elsewhere in the textbook in the color plates section. (What a relief not to constantly be flipping back and forth!) The second section ends with a chapter on the neuroanatomic structures and clinical disorders of the chiasm and retrochiasmal visual pathways, and another chapter on unexplained visual loss, with helpful examining hints to best deal with patients with functional or nonorganic causes of visual loss. Part 3, The Visual Motor System, is one of the better written, and once again, better diagrammed texts on motility disturbances. In this section there are 6 chapters. Ocular motility terms are clearly defined with detailed explanations of how to conduct ocular misalignment measurements. Also included is simple, easy to follow text, which explains the red glass and maddox rod tests with an excellent teaching diagram of the Bielschowsky 3-step test. All of one's insecurities concerning ocular motility measurements should begin to dissipate after reading this section of the textbook. The infranuclear pathways are divided into disorders of the extraocular muscles, neuromuscular junction, and cranial nerve palsies. In-depth coverage is provided for cranial nerve III, IV, and VI palsies with an outstanding chart on weighing the relative risk of an aneursym as a cause of a third-nerve palsy. The chapter on the supranuclear motor system and nystagmus is concise and easy to read even for those who try to avoid these "higher" eye movements and "jiggling" eyes. The third section ends with the efferent system of the pupil and facial nerves. Part 4, Other Topics, includes the chapters Pain and Sensation and Neurovascular and Neurocutaneous Disorders.