By Ragna Godtland, OD
In the primary care practices I’ve worked in, Scheiman and Wick’s Clinical Management of Binocular Vision Heterophoric, Accommodative, and Eye Movement Disorders has been the sole binocular vision textbook represented on those bookshelves. Given its ready availability, over the years, I have used previous editions of this book as a quick reference for normative values of different tests in writing reports and case studies.
There are many different approaches to vision therapy, each with its advantages and limitations. Clinical Management of Binocular Vision presents an Integrative Analysis Approach, which they see as a balance of various approaches. Balance seems to be a theme of this book, presenting a balance of vision therapy approaches, historical and recent literature, and research with clinical experience.
The first section of the book is devoted to Diagnosis and General Treatment Approach. In the first chapter and its appendix, different diagnostic tests are explained, compared, referenced, and illustrated. Expected values are nicely laid out in easy to read tables. Throughout the book, historical information is present along with recent literature, which has been updated for this edition. In the other chapters of this section, they outline their Integrative Analysis approach used throughout the book as well as review general treatment modalities. In contrast to the well-laid out tables Chapter 1 (and beyond), many of the flow charts in Chapter 2 are poorly and oddly formatted. The addition to color to the tables and illustrations helps to make the book more visually appealing than previous editions.
Similarly in section two, different therapy techniques and equipment are described and illustrated. As vision therapy can be full of eponyms and multiple names describing similar tests, techniques and equipment, having illustrations is helpful. This section as well has been updated to include new equipment.
The third section of the book outlines vision therapy for heterophoric, accommodative and eye movements. In these chapters they further explain and differentiate each condition as well as provide tables of patient symptoms and ocular signs, differential diagnoses, and sample therapy programs for each condition. At the end of each described condition a case study is presented to illustrate the condition.
The fourth section of this text cover advanced diagnostic and management issues including discussions of refractive amblyopia, nystagmus, aniseikonia, management of refractive error as well as vision problems associated with computer use and brain injury, learning problems, and refractive surgery. I appreciate that these chapters add to the completeness of the topics, but most of these chapters are covered by other sections of the book. The remaining topics not covered by prior chapters are covered in general detail. As these were overview chapters of advanced diagnostic and management issues, some topics were described in excellent detail other topics were not. For example, in the refractive amblyopia section, electrodiagnostics are described as too expensive to warrant further discussion in this section. There are at least 2 chapters devoted to graphical analysis, which maybe helpful to some, but it is not something I use regularly. The sections on fixation disparity and aniseikonia go into great detail about the different diagnostic tests available. In the primary care and vision therapy practices in which I’ve worked, there have not been Mallet units or Space Eikonometers, but there have been Visual Evoked Potential instruments. Maybe I have worked in abnormal practices, but as much as this book includes, I feel like some discussion on the topic would be appropriate.
The final section goes over vision therapy in practice including patient and practice management. The appendices of this section include sample correspondences to patients, insurance companies and other professionals as well as patient instruction sheets for home activities.
I know that in my practice I used an amalgam of various vision therapy approaches and techniques. I also like reading and seeing how other people approach binocular vision and therapy. I may not agree with all the material presented, especially in some of the sample therapy programs, but I appreciate that they are just that, sample programs meant to illustrate a concept more so than act as a recipe book. I prefer my math conceptual and calculating any specific value when it comes to vision therapy is not something that comes naturally to me. That said, I like having specific metrics especially when it comes to demonstrating improvement from baseline. This book provides a good base for calculations. I found the tables of norms in the book especially helpful for this purpose. This book adds another perspective to the mix of binocular vision and therapy books on my shelf (and E-Reader). Access to full text and image bank online is available with purchase of the paper version of the book. The book is also available in electronic version. As I work in multiple locations, eBooks allow me to have access to texts at each office location.
The back cover describes the book as “easy to read and understand… ideal for faculty when designing courses, students studying these topics for the first time or established practitioners looking for a practical, easy-to-use reference on accommodative, ocular motility and nonstrabismic vision anomalies.” I think this is an appropriate and accurate description.