Sight Unseen: An Exploration of Conscious and Unconscious Vision

Sight Unseen: An Exploration of Conscious and Unconscious Vision Melvin A. Goodale, PhD, FRCS, and A. David Milner, PhD. Oxford University Press, Oxford, 2004. ISBN: 0-19-851052-7, $37.50. Scope: In this 135-page book, the reader is introduced to a young woman who lost her sight in a tragic accident 15 years ago. We follow her extensive neuropsychologic evaluation and progress, woven into the authors' theory of a dual visual system. “Dee” has lost the ability to recognize shape and form, yet she retains the ability to act on what she sees (picking up a coffee cup, ambulating). The authors postulate a system for action that is separate from a system for conscious vision. They proceed through testing and comparison with patients with opposite defects, concluding with support from newly available neuroimaging studies (functional MRI). Color plates give brilliant examples of face recognition, along with anatomic correlation of areas under discussion. The chapters are in narrative form, interspersed with boxes and figures that detail the neuroscientific principles. One gets the sense this is a work in progress, as advances in neuroscience allow confirmation or refutation of the proposed theories. Strengths: The book can be understood without extensive scientific or neurologic background. The narrative style is appealing and conveys the authors' excitement about their topic. This book is written by consummate teachers with the ability to pass on their delight to their students. Weaknesses: There is excessive repetition, more than is needed to get the points across. One wonders if this isn't the result of expanding a monograph into a book. Recommended audience: Anyone who is fascinated by brain function will enjoy this read. The text is appropriate reading for physicians, neuropsychologists, psychotherapists, and family members of patients with cognitive visual dysfunction. This book should be read by all ophthalmology residents to broaden their perspective and also teach them that there is still a lot to be learned about how and what we see. Critical appraisal: The authors have spectacular credentials: Goodale is Professor of Psychology at the University of Western Ontario, Canada; Milner is Professor of Applied Psychology University of Durham, Queen's Campus, United Kingdom. They began to work together over 30 years ago in St. Andrews, Scotland. This book puts a human touch on their years of research in cognitive vision. It reminds us that there is much to be learned from our patients, those individuals who must live with the visual problems we diagnose. Sharon Kuritzky, MD Amherst, NY

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