Instant Clinical Diagnosis in Ophthalmology: Strabismus


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Instant Clinical Diagnosis in Ophthalmology: Strabismus Eric R Crouch and Ewa Oleszczynska Prost New York : McGraw-Hill , 2011 512 pages , RRP $100 Reviewed by : Paul H Croucher , Department of Optometry and Vision Sciences, The University of Melbourne

This book forms part of a series of Instant Clinical Diagnosis in Ophthalmology books by McGraw-Hill. The series has books on instant clinical diagnosis in glaucoma, neuro-ophthalmology, paediatric ophthalmology, refractive surgery, retina, lens diseases and other topics. This book is just over 500 A5 pages and contains many excellent photographs of strabismic conditions and diagnostic equipment. The photographs are probably as comprehensive as I have seen in any textbook including those that are considered strabismus bibles.

As the title states, the book is primarily concerned with diagnosis rather than treatment but having said that, 25 per cent of the book is devoted to treatment. The layout of the chapters is logical.

The first chapter covers non-strabismic binocular vision disorders. Diagnosis and treatment are covered in seven pages and for the optometrist the content is thin. It was with interest that I noted accommodative insufficiency was described and comment was made on its effect on reading including asthenopia, reduced comprehension and reading problems. The recommended treatment was glasses with plus spheres. I believe there are very few ophthalmologists anywhere in the world who test for accommodative insufficiency or who prescribe spectacles for it.

The book has several pages on the Hess-Lancaster test for diagnosis of ocular muscle palsy, but in Australia at least this test is rarely used. The coverage of testing of anomalous correspondence, suppression and stereopsis is extensive and very good. I was pleased to see some acknowledgement of child development. All experienced clinicians know children perform better on acuity and stereo testing as they mature from age three years to age eight years. Expected stereopsis results for children of different ages were addressed.

There are chapters on the diagnosis of all the strabismic conditions, both common and rare. Congenital and accommodative esotropia is covered well, as are the more unusual conditions such as nystagmus blockage syndrome and cyclic esotropia, although there is as much detail on nystagmus blockage syndrome, which occurs in approximately one live birth per year in each major capital city in Australia, as there is for accommodative esotropia, which has an incidence in Australia of approximately 6,000 births per year. There are chapters on the exotropias as well as cranial nerve palsies and special strabismus syndromes, such as Duane's and Brown's syndromes. The coverage of diagnosis and treatment is more appropriate for the primary care practitioner or student than the experienced paediatric optometrist. There are many excellent photographs of testing procedures and of patients with the conditions discussed. This is more extensive than in many much larger textbooks.

The treatment guidelines are ‘dot point’ recommendations with no discussion of the relative merit of each approach. For example, in the case of intermittent exotropia the use of refractive correction, minus overcorrection, orthoptics, Botox and strabismus surgery are all recommended. Yet most patients with this condition never have surgery or Botox.

The book contains a number of idiosyncratic and repetitive spelling errors such as endotropia for esotropia, presbytia for presbyopia and Bogolini for Bagolini. While many of the chapter authors might not have English as a first language, a publishing house of the standing of McGraw-Hill should have higher proofreading standards.

A handful of pages describe the non-surgical treatment of strabismus, yet more than 70 pages are devoted to surgical approaches. Some of these approaches were as novel as LASIK on hyperopic children. This makes the last section on treatment of limited use to the optometrist.

Instant Clinical Diagnosis in Ophthalmology: Strabismus is aimed at the registrar in ophthalmology, the undergraduate optometric student and the primary care practitioner. It gives a concise overview of the important aspects of visual science as it relates to strabismus. It covers all the routine testing procedures and the major diagnostic groups in strabismus well. The photographs are excellent and many unique. It will serve its target audience well for assessment and diagnosis of strabismus, but not for treatment.

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