The Neurology of Eye Movements, 3rd ed.

The Neurology of Eye Movements, 3rd ed. R. John Leigh, David S. Zee. New York: Oxford University Press, 1999. Pages: 643. Price: $120.00. ISBN: 0-19-512972-5. In The Neurology of Eye Movements, authors Leigh and Zee have taken on a daunting task. They have endeavored to review a field in which the number of new scientific papers is phenomenal. For example, the chapter on the vestibular-optokinetic system contains 521 references, many of which are less than 10 years old. Furthermore, many disciplines must deal with eye movements, so the text must be written for a broad audience that includes research scientists and clinicians. In fact, in the preface, the authors write that this text is intended for neurologists, ophthalmologists, otolaryngologists, optometrists, neurosurgeons, psychiatrists, and basic researchers in some areas of neuroscience. Given these requirements, this book is a remarkable achievement. Like previous editions, it will probably and deservedly become one of the most cited references in the eye movement field.FIGUREFigureThe book begins with a review of the various classes of eye movements and their functions. I found this chapter to be a succinct review of the key features of each class of eye movements. In subsequent chapters, each class of eye movement is thoroughly discussed. Chapter topics include vestibular-optokinetic eye movements, saccadic eye movements, smooth pursuit eye movements and visual fixation, gaze holding and the neural integrator, synthesis of the command for conjugate eye movements, eye-head movements, vergence eye movements, diagnosis of peripheral ocular motor palsies and strabismus, and diagnosis of central disorders of ocular motility. The book is very well organized and well written and includes a number of diagrams and tables that facilitate understanding. The comprehensive nature of the discussion in each chapter reflects the authors’ desire to reach a very broad audience. Often in the initial paragraphs of each chapter, the origin of the term for an eye movement or some of the classic studies on the eye movement are described. I found this a good way to create interest. The discussion of each eye movement class includes a description of the purpose or function of the eye movement, the neurophysiology of the eye movement, the parameters of the eye movement (i.e., velocity, latency, gain, phase), and then the clinical examination and pathophysiology of the eye movement. The authors do an excellent job of organizing and explaining the relationship between new findings in basic research and tests that allow for clinical diagnosis. Orthoptic treatment of vergence disorders is mentioned. The chapter on gaze holding and the neural integrator is an excellent example of how the authors are able to take a relatively complex topic and make it relevant to basic scientists and clinicians. By reading this chapter, the clinician could gain a thorough understanding of the pathophysiology of gaze-evoked nystagmus. The chapter on eye-head movements is an excellent example how the authors have been able to keep up with a rapidly developing area. Studies of three-dimensional eye and head tracking have become very popular, and this chapter serves as an excellent review of the material on this subject. The authors then explain how eye-head movements can be evaluated in the research (or clinical) laboratory and at the bedside. The chapter on the diagnosis of peripheral ocular motor palsies and strabismus begins with a review of the anatomy of the extraocular muscles (including numerous diagrams and illustrations) and proceeds to a discussion of the pathophysiology and clinical diagnosis of strabismus. A very thorough discussion of the work-up of a patient with diplopia is included in the section on strabismus. The focus of the strabismus discussion is not on the management of strabismus. The final chapter on the diagnosis of central disorders of ocular motility includes a discussion of eye movements that disrupt fixation. Topics include the characteristics and treatment of nystagmus and saccadic intrusions. Virtually every other ocular motor syndrome associated with a central disorder is also discussed in this chapter. This includes a very thorough discussion of vertigo and dizziness, common problems in the elderly. Also included in this chapter are several CT and magnetic resonance imaging (MRI) scans associated with disorders of ocular motility. In addition to the stand-alone book, a CD-ROM is also available. Included on the CD-ROM is the full text of the book. Within the text, one can click on the Figure number or a reference number and a window appears showing that item. The reader may choose to print out the text. The table of contents and index contain search menus that very much reduce the search process. In addition, the CD-ROM has color versions of some of the figures in the text. I enjoyed this feature, as it allowed me to view such things such as anatomical sections in color. Finally, the CD-ROM has more than 60 videos showing disorders referred to in the text. The videos are short but very representative of particular eye movement disorders. Below the video, text describes what is shown in the video. I intend to incorporate these videos routinely into my eye movement course. In summary, the authors of The Neurology of Eye Movements have succeeded in producing a text that is relevant to all those interested in eye movements. The basic researcher can find well-referenced, current reviews of virtually any topic in eye movements. The neurophysiologist can find descriptions of neurological substrates for eye movements. Finally, the clinician can find a description of central and peripheral ocular motility disorders and their diagnosis. The CD-ROM provides real-time videos that are certain to be invaluable learning tools. This book is therefore a valuable resource to any practitioner who must di- agnose and manage disorders of eye movement.