Field of Vision: A Manual and Atlas of Perimetry,

Field of Vision: A Manual and Atlas of Perimetry, Jason J.S. Barton and Michael Benatar. Totowa, New Jersey: Humana Press, 2003. Pages: 334. Price: $150.00. ISBN 1–58829–175–8. The authors of this book, one a neuro-ophthalmologist the other a neurologist, have set out to produce a special kind of text. They note in their preface that practitioners who have the most expertise using perimeters and performing visual field tests (optometrists and ophthalmologists) often do not have great strength in neurological assessment, and that most neurologists have little experience with perimetry, especially modern and automated methods. This offering is meant to act as a bridge by providing the ocular specialist with a firmer grasp of the subtleties of testing patients with neurological disease while providing the neurologist with the interpretive skills needed to apply automated methods to visual field assessment. The book is exceedingly well written, and it is obvious that the authors are handily equipped in working the English language. There is the occasional sprinkle of humor, but by no means enough to make the reader doubt the mastery the authors have over the difficult material. FIGUREFIGUREIn Field of Vision, Barton and Benatar have produced what the subtitle suggests, and that is to create a short manual of visual field testing combined with an atlas of real cases. As is pleasingly customary in texts of this type, the layout is logical, commencing with a short introduction to perimetry and the normal visual field. This section describes different types of perimetry, including a short discussion of more modern methods such as SWAP, motion perimetry, and frequency doubling perimetry. The next chapter deals with functional visual anatomy. This section is kept as brief as possible while also being as detailed as necessary to help the reader understand why lesions in different parts of the visual system cause such distinctive-looking visual field defects. The treatment commences in the retina and marches posteriorly through the visual system while bringing the relevant vascular supply and neighboring structures into the discussion. This section uses magnetic resonance images and anatomical dissections liberally, but none of it should be unmanageable for an optometrist or upper level optometry student. The next three chapters briefly describe the major classes of visual field examination: visual field examination at the bedside (confrontation methods), manual kinetic (Goldmann) perimetry, and automated perimetry (Humphrey, in this case). If I were to have a complaint about this book, it would be here. Such a complaint would not be about the book per se, but rather how much I think the average optometrist would find use for these chapters. Let’s face it, most optometrists do not do visual field examinations at the bedside unless their practice takes them to retirement communities, on a great many domiciliary visits, or to developing world situations. There is room for confrontation testing in optometric practice, but I would almost always prefer to use a perimeter if I had one handy. While manual kinetic perimtery remains a very flexible tool for visual field examination, this modality is most often used in practices that see a great many brain injured and low vision patients. The chapter on automated perimetry was also sound but perhaps lacked the detail needed by the average optometrist to really get all that they can out of this complex testing modality. The visual field atlas is incredibly extensive, with 120 individual cases. The first 100 cases start anteriorly in the visual system and, much like the second chapter of the manual, march posteriorly back to the striate cortex. All of the hallmark, visual field tell tale signs that we have come to expect from lesions in different parts of the visual system are depicted in real patient cases. Many of the cases have accompanying fundus or nerve head photos, magnetic resonance images, and sundry other clinical information to round them out into complete clinical vignettes. The final 20 cases are to be used as a test set to allow the reader to apply what they have just learned. Field of Vision is a beautifully produced textbook; I enjoyed reading it and working my way through all the cases in the atlas. The authors are to be commended for their work. I feel that it would be of most use to more specialized optometric practices, as outline above, while perhaps lacking a little of what mainstream optometry sees most. I would recommend it as a text in any sort of neuro-optometry course, for an intern or fellow who finds themselves in a disease rich environment (such as a VA hospital), or for the neurologically curious.

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