The Neurology of Eye Movements

The Neurology of Eye Movements, 3rd ed. CD-ROM

Leigh RJ, Zee DS. New York: Oxford University Press; 1999

CD-ROM – ISBN 0-19-512974-1

656 pp. with index – ISBN 0-19-512972-5

The neurology of eye movements sometimes seems to be an esoteric concern to many in the neurosciences. However, the analysis of eye movements often turns out to be extremely valuable in clinical practice. Eye movements are examples of other motor phenomena and, because they are more simple than limb movements, they often give greater insight into problems of paresis, fatigue or coordination. They particularly lend themselves to quantitative evaluation. The knowledge of specific types of eye movement deficiencies is an important tool for localizing disease and diagnosing neurological disorders.

Drs. John Leigh and David Zee have issued the third edition of their highly praised book, The Neurology of Eye Movements. In addition to the classic text, they have also produced, for the first time, a CD-ROM version. Both text and CD versions follow a similar outline, with an initial survey of the basic forms of eye motions. There follows an analysis of the vestibular-ocular system and the classical saccadic and pursuit systems, conjugate gaze, gaze holding, eye-head movements and vergence movements. These are superb chapters and give up-to-date information on the anatomical and physiological basis of these movements. The text is accompanied by excellent tables and figures.

Part II provides 2 sections on diagnosis, the first is on the diagnosis of peripheral ocular motor palsy and strabismus. Many would think of this as the “classical section” of a text on ocular motor problems. It details clinical testing of diplopia and, for neurologists, a must read description on how to diagnose strabismus (which is often left out of the classical neurological education). This is followed by a superb section on central disorders of motility, with enlightening dissections of the various forms of nystagmus and saccadic intrusions, as well as a useful discussion of vertigo and its treatment. Specific disease entities are treated in this latter section. There are discussions on eye movements and psychiatric disorders, stupor and coma, multiple sclerosis and metabolic deficiencies, all of which are excellent.

The CD-ROM version allows easy movement between chapters. It provides excellent access to the often-cited tables and figures that one has to find again when they are referred to in subsequent chapters. This is a more difficult task when reading the book because page headings do not indicate chapter numbers, which would help one locate the tables and figures more easily. The CD version has something that the hard cover version does not have — video clips. The videos, 60 in number, include virtually every sort of eye movement disorder one could want to view. These videos alone are worth the price of the CD; although they are relatively short, each shows the eye movement clearly. My one problem with the CD version is that the key word search feature often failed to reveal all of the important references; I found it much easier to use the index in the back of the book for this endeavour.

The authors suggest that this book is for neurologists, ophthalmologists, otolaryngologists, optometrists, neurosurgeons, psychiatrists and basic researchers. I suspect neurologists and ophthalmologists would enjoy it the most. Otolaryngologists who have a specific interest in vertigo would certainly find this text useful, though the vestibular systems are probably dealt with in more detail in other works. There are likely few neurosurgeons and psychiatrists who will purchase this, which is a shame because I think everyone could learn from this text.

I think everyone in neurology should own a copy of this text. The major question is which version to buy, the hard cover or the CD. I would guess that a neurology resident on a restricted income might want to buy the CD version for the videos alone. However, if you have seen these eye movements many times and just want a review of the neurological basis of eye movements, perhaps the book, which offers a better index, would be easier to read. Whichever one you decide to purchase, the price is quite reasonable for the information enclosed. I would suggest both versions.