Neuro-Ophthalmology (6th ed.)
Lanning B. Kline and Frank J. Bajandas. Thorofare, NJ: Slack Inc.; 2008. $50.95.
I read Neuro-ophthalmology many years ago during my residency training in ophthalmology, so it was particularly interesting to return to it after all these years to see what utility it might have for a busy practitioner and to try to gauge its value for trainees. This book by Lanning Kline and Frank J. Bajandas (now deceased) remains a classic, well-organized, easy-to-access review of a difficult subject. It is full of useful mnemonics and other ways to learn neuro-ophthalmology, but despite the clever mnemonics and humor, this book never loses sight of its overall mission.
First, I should mention the hard-to-face truth that I had forgotten some important aspects to neuro-ophthalmology. The section on visual fields is especially useful as a tool for quickly refreshing the memory on various field defects associated with different localizations of lesions or diseases of the brain. Accompanying the examples of visual fields is advice on how and whether to do a workup for various problems. Recommendations to scan (or not) are offered, and methods for performing fields are reviewed in an easy-to-read outline form.
Kline and Bajandas also provide clear associations for cranial nerve palsies, including cranial nerves 2 through 7. Dividing the causes of cranial nerve palsies into mnemonics (e.g., the seven syndromes of the 7th cranial nerve) encourages the reader to remember each possible mechanism for palsies of the 7th and other cranial nerves. Accompanying the chapters on palsies are excellent figures and diagrams, which orient the reader to the intraxial or extraxial site of involvement of diseases of cranial nerves. The authors also carefully describe scenarios for which imaging and other studies should be considered.
The reader is also reminded in many places of conditions that can present as seemingly straightforward clinical problems. Most of us fail to consider important conditions such as myasthenia gravis and temporal arteritis from time to time. This book constantly reminds the reader to be on the lookout for more rare disorders, which may mimic any of a number of ocular motor problems.
A chapter on headaches is especially useful. This is one of the most common presenting complaints for ophthalmologists, even in a pediatric ophthalmology practice, and many children present with curious symptoms. For example, descriptions of seeing colors, or feeling ill before developing a headache, are common in migraine. These various presentations are reviewed, as is differentiating psychological stress or migraine from increased intracranial pressure.
Chapters on optic nerve disease also run the gamut, from normal to bow-tie atrophy. The clinical features of papilledema are worth rereading if you have not thought about this in some time. Optic atrophy is presented in concise fashion, accompanied by an excellent differential diagnosis. Somehow, the authors manage to include problems that are quite rare, although fascinating. Ocular neuromyotonia and superior oblique myokymia, for example, have their own small sections with descriptions.
So who should read or reread this book? For the practicing neuro-ophthalmologist, this book may not offer enough detail. But for the doctor who sees the occasional neuro-ophthalmology patient, the book should be an excellent resource. Residents should read the book, because they can learn the subject material. The book could also be an excellent resource on the general practitioner’s shelf, because it is concise and easy to use. Considering that there are multiple authors, there is surprisingly little redundancy.
Kline and Bajandas should be congratulated for keeping this fine book up to date and in print. I thoroughly enjoyed a second read and found it just right for a refresher on neuro-ophthalmology problems.
William V. Good
Smith-Kettlewell Eye Research Institute
San Francisco, California