Review ofEye Movement Disorders in Clinical Practice

Shin C. Beh, MD¹

Eye Movement Disorders in Clinical Practice
Shirley H. Wray
448 pp, $125, ISBN 978-0-19992-180-5, New York, New York, Oxford University Press, 2014.

Despite the fact that almost 50% of the brain is dedicated to the visual system, many neurologists feel intimidated by ocular movement abnormalities and consider eye movement disorders to be a difficult, inapproachable subject. This is perhaps unsurprising because the evaluation of eye movements requires a proper and detailed clinical technique, as well as an understanding of the circuitry involved in the important task of moving the eyes to an object of regard and maintaining the eyes in that position. Furthermore, there is often insufficient time to dedicate to learning the correct clinical techniques and the etiopathophysiologic basis of ocular movement disorders in the hectic bustle of medical school and neurology residency training.

Authored by Shirley Wray, MD, PhD, FRCP, a giant in the field of neuro-ophthalmology,Eye Movement Disorders in Clinical Practiceis a great resource for anyone interested in neurology, ophthalmology, and neuro-ophthalmology. It covers the classic and important ocular motor abnormalities (eg, internuclear ophthalmoparesis and nystagmus) and also includes new disease entities such as paraneoplastic syndromes. It is organized into 10 chapters; the first chapter provides a concise overview of the complicated neuronal networks involved in ocular motor functions, and the remaining 9 chapters are arranged according to clinical syndromes (eg, the eyelid and its signs, ptosis and neuromuscular syndromes, and the extraocular muscles and diplopia). Each of these 9 chapters begins with a succinct description of the pertinent anatomy, physiology, clinical manifestations, relevant history, and differential diagnoses. Numerous cases are then presented, each with an analysis of the signs and symptoms, localization, differential diagnoses, relevant investigations, and treatment, mirroring the flow of clinical reasoning clinicians undertake when confronted with a patient with an eye movement disorder.

The layout and organization of the book, based on signs and symptoms, make it easy for clinicians and residents to look up any eye movement disorder to learn more about the clinical entity. It contains concise, informative illustrations, as well as an accompanying DVD containing 54 video clips depicting examination techniques, clinical signs, the relevant eye movement abnormality, and imaging correlates.

This is not a textbook that thoroughly describes the intricate and complex brain networks that control the different classes of eye movements. Instead, it aims to provide simple, pertinent information regarding various ocular motor abnormalities to help clinicians and trainees better understand this difficult subject and to aid them in eliciting an informative history, performing and interpreting the neuro-ophthalmic examination, ordering the requisite investigations, and, finally, treating the disorder.

The importance of the visual system (both the afferent and efferent) in neurologic disease cannot be overemphasized. As neurologists, we can often gain valuable clues from a thorough investigation of the visual pathways to help us diagnose and treat our deserving patients. For us to recognize the eye movement disorders that we encounter in our clinical practices, we must (to paraphrase Dr Wray) let our eye meet the patient’s eye, and understand it more clearly than itself.

JAMA Neurol.2015;72(11):1380. doi:10.1001/jamaneurol.2015.1707.