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Binocular Anomalies: Diagnosis and Vision Therapy, 4th Ed.

Toole, Andrew J.

Optometry and Vision Science: March 2005 - Volume 82 - Issue 3 - p 167
Book Reviews

The Ohio State University College of Optometry Columbus, Ohio

Binocular Anomalies: Diagnosis and Vision Therapy, 4th Ed.

John R. Griffin, J. David Grisham Boston: Butterworth-Heinemann, 2002. Price:$89.95

Are you a clinician looking for a comprehensive reference on the diagnosis and treatment of binocular vision disorders or a student learning or reviewing this material? Then this text is designed with you in mind. In fact, it is dedicated “to students and practitioners of binocular vision.”

The text is divided into three sections. The first section titled Diagnosis covers testing, normative data, criterion for anomalous findings, and how to put it all together to arrive at a concise diagnosis. Part two covers treatments for specific diagnoses. Major emphasis is on orthoptic training; however, optical correction, occlusion, pharmaceutical treatment, surgical correction, and simply monitoring the condition are also discussed. Included is a cost/benefit analysis for these treatments. The final section reviews specific orthoptic training techniques. It is broken down with one chapter for eso deviations and a second for exo deviations. Another chapter covers saccades, pursuits, and accommodation, with a final chapter covering sequencing and practice management.

As acknowledged by the authors, this arrangement of treatments covered in one section and training techniques covered in another leads to much redundancy. There is also redundancy seen within single chapters such as defining “eccentric fixation” multiple times. This redundancy may indeed be helpful for the student who learns through repetition, or for a clinician using the book as a reference. However, others may consider this information surplus as simply book obesity.

This is by far the most comprehensive text on assessment and management of binocular vision conditions that I have come across. The authors have the knowledge, experience, and the “knack” for describing difficult concepts and conditions that many authors tend to avoid. For example, most authors tend to tread lightly when describing anomalous correspondence. However, Griffin and Grisham go boldly forward with their diagnostic review, and the section on treatment of anomalous correspondence is unrivaled. Other examples of well written discussions include “good vergence adaptation” versus “bad prism adaptation,” and relative convergence versus fusional convergence. In my experience, both of these topics cause much confusion with students and clinicians alike.

This fourth edition has been updated with newer topics pertinent to today’s practices; the most notable of which is an in-depth section dedicated to the objective clinical measurement of eye movements using the infrared Visagraph system. Included are proper testing techniques as well as information on interpreting the many values and indices that the system generates. Also included is a commentary on the roles of vision in learning and dyslexia, as well as a chapter by chapter compilation of test questions and answers to assess the reader’s retention of the information provided. These questions should prove challenging and thought provoking for students and clinicians alike. One word of caution though for students, a few minor errors remain in this edition. These will be easily ignored by seasoned clinicians but may be sources of confusion for students. For example, “adduction” substituted for “abduction” when referring to the action of extraocular muscles or stating that yoked prism will shift the eyes and the null point instead of shifting the image towards the null point.

The last item found in the text is a CD-ROM containing a large quantity of therapy instructions and exam forms. The authors graciously provide these to the reader and give free reign to modify them to suit individual situations. These documents should be very valuable for new clinicians and a handy addition to the veterans.

I believe this to be the most inclusive vision therapy compilation available. It may suffer from obesity, but I will likely be exercising it often in the future!

Andrew J. Toole

The Ohio State University

College of Optometry

Columbus, Ohio



© 2005 American Academy of Optometry