B Evans and S Doshi

Butterworth-Heinemann, Oxford, 2001, £39.99, ISBN 0750647132

This publication is a compilation of 16 articles that were published by various authors in the journal Optician between 1998 and 2000. The articles have been updated to form 16 chapters. There are 11 contributors, mainly optometrists but also an ophthalmologist and orthoptist.

Binocular Vision and Orthoptics is specifically aimed at eye-care professionals who encounter binocular vision anomalies in the primary care sector. It therefore concentrates on binocular vision conditions typically presenting to optometrists, such as heterophoria and convergence insufficiency. Investigation and management of comitant and incomitant strabismus, and chapters giving a basic summary of medical and surgical management of binocular vision anomalies, are also included. The final chapter consists of three detailed case studies. Multiple choice questions and detailed answers are provided for each chapter.

The book is clearly presented incorporating helpful diagrams and plentiful use of check lists and summary boxes. It provides a useful overview of binocular vision anomalies in a concise format, but would provide insufficient detail for those wishing to specialise in the subject.

By the nature of this book’s origin, many topics are covered in more than one chapter leading to repetition of information. The editors acknowledge this by stating that presentation of different authors’ approaches helps to give a balanced perspective. This is true in some instances, however repetition of information, such as AC/A ratio formulae, clinical tests for determining near point of convergence, clinical investigation of suppression, retinal correspondence and stereoacuity, becomes a little tedious.

Chapter 2 describes microtropia as a deviation of between 1 to 10° and not 1 to 10Δ. This may be a typing error but could create confusion. Chapter 3 recommends elimination of suppression in strabismus if the motor deviation can be corrected. However, this is without emphasis on the caution needed to establish whether the patient has potential for stable binocular single vision prior to commencing this treatment. It does however recommend that clinicians with little experience of more complex aspects of binocular vision would be best avoiding this form of treatment, chapter 8 reiterates this point. In chapter 12, Hess chart plots are of disappointing quality; one is presented upside down and the example given for superior oblique palsy shows an exo deviation on down gaze, which is not typical. Chapter 15 discusses the surgical management of strabismus and begins with the structural organisation of the ocular motor system and preoperative assessment of the patient. This section includes a description and diagram of Bielschowsky’s head-tilt test and shows head tilt to the right in a suspected left superior oblique palsy to observe elimination of the deviation. This however is not the correct method and would not be diagnostic. The final part of this chapter outlines the fine detail of the surgical procedure involved in recession and resection operations (eg type of hook, sutures and clamps used), this provides unnecessary detail for the intended reader however it may provide an insight to what happens in theatre.

Chapters 8 and 9 provide excellent résumés of theoretical and clinical aspects of suppression and abnormal retinal correspondence respectively. The use of Botulinum Toxin in strabismus is clearly summarised in Chapter 14.

In spite of some of the aspects outlined above, the book achieves its aim in providing a useful practical guide to investigation and treatment of binocular vision anomalies for practitioners working in primary care.