BOOK REVIEW

The Seventh Edition of the “Neuro- Ophthalmology Review Manual” is a 250- page summary of neuro-ophthalmology, edited by Lanning B Kline and Rod Foroozan and published by Slack. Referred to in the introduction as a “readable compendium of ‘no-nonsense’ neuro-ophthalmology”, this text is a strong reference manual for learning and reviewing this subspecialty. It seems that many ophthalmologists are less comfortable with neuroophthalmology than with most other fields of ophthalmology. We have to adopt an entirely different mindset and another set of tools to arrive at a diagnosis.

In terms of the mindset, we must look at the eye not as the seat of the disease, but as an indicator of what is wrong behind it. For most ophthalmic disease we can simply look inside the eye to make a diagnosis, as an auto mechanic would look under the hood and into the engine.

However, for neuro-ophthalmic disease, there is often nothing wrong within the eye itself. Instead, we must observe how the eye functions in terms of visual fields and motility. This is similar to the same mechanic being forced to watch a car drive from afar in order to determine what is wrong with it. The tools we need are not a slit lamp and an OCT, but rather a pocket lamp and our minds. With this in mind, the book’s structure is simple and concise. As mentioned in the introduction, the book is written in a “clear and direct style in order to demystify but not oversimplify the core material of neuroophthalmology.” As such, the information is organised as a bulleted outline rather than as prose. This allows the reader to quickly find the topic at hand and review the most important points as efficiently as possible.

Chapter 1 starts with what seems to be among the most relevant topics for general ophthalmologists: visual fields. Because of the relative rarity of many neuro-ophthalmic visual field defects, the generalist frequently needs a refresher to get back up to speed, and this book provides it.

The next two chapters cover the supranuclear and internuclear gaze pathways and nystagmus and related ocular oscillations, starting with unambiguous definitions like, “Saccades: purpose is to shift gaze to a new location in the visual scene.”

Chapters 4, 5, 6, 12 and 13 cover the many syndromes of the abducens, oculomotor, trochlear, trigeminal and facial nerves, complete with drawings of the relevant anatomy, syndrome etiology and several charts for use as diagnostic aids.

Specific syndromes

Some chapters cover a single, very specific syndrome, such as Chapter 7: Cavernous Sinus Syndrome. Others tackle a broad topic, like Chapter 8: The Pupil. Particularly interesting are the chapters on the optic disc, whether swollen (Chapter 9) or pale (Chapter 10). These two signs each have a seemingly endless list of etiologies, and this text helps the reader organise his or her observational proficiency, diagnostic process and treatment options.

Other topics receiving full-chapter coverage are myasthenia and other ocular myopathies; eyelid disorders; headache; carotid artery disease and the eye; the phakomatoses; nonorganic visual disorders; and disorders of higher visual function. The last chapter focuses exclusively on neuroimaging, with particular emphasis placed on the most appropriate imaging modality for each of the most common indications. The table titled “General Guidelines for Neuroimaging Studies Depending on Clinical Scenario,” is an especially useful guide for quick reference.

As an outline-structured review text, this book is appropriate for residents preparing for their neuro-ophthalmology rotation or studying for board exams. It is also a good resource for neuro-ophthalmology fellows who need to review and master the material and for general ophthalmologists.