BOOK REVIEW: Pickwell’s Binocular Vision Anomalies, sixth edition

The first and second editions of this textbook were written by Professor David Pickwell, who specialised in binocular vision and ocular anatomy and physiology and was one of the first professors of optometry in the UK. He died in 2005, but editions three to six by Professor Bruce Evans retain much of his original advice, resulting in the book becoming one of the set texts for binocular vision anomalies.


Prof Evans is research director at the Institute of Optometry in London and a visiting professor at City, University of London and London South Bank University. His main areas of research are binocular vision (orthoptics), contact lenses, myopia control, visual factors in dyslexia and glaucoma. So it’s perhaps not surprising that this book is relevant to both clinicians and students.


A binocular vision textbook can seem a daunting read, but the first chapter very simply and clearly classifies the different binocular vision anomalies. As part of this review, I read up on conditions associated with a couple of clinical cases I’d seen in the week prior. These were both adults with longstanding conditions related to childhood binocular vision anomalies. In this book, the conditions were well summarised with detailed methods for assessment and management. Another nice touch is the inclusion of case studies at the end of each section.


Management of accommodative and vergence conditions are organised under the following headings: Removal of the cause; Refractive correction; Eye exercises (vision therapy); Prism; and Referral. This stepwise system underlines the pros and cons of each management option. Tables include methods of assessment, for example how to use a direct ophthalmoscope to test for eccentric fixation; differential diagnoses (for amblyopia we’re reminded to rule out pathology and look for amblyogenic factors); and clinical characteristics. The textbook concludes with a glossary of terms (always helpful for those big words that you don’t know or remember) and some appendices, which are mostly worksheets designed to guide a practitioner through patient evaluations. Examples include a worksheet for investigation of infant/toddler and a worksheet for the investigation of amblyopia.


The book is really easy to navigate, while some great practical links make the accompanying digital resource a valuable inclusion. I particularly liked the motility videos and accompanying Hess screens that were available in the incomitancies tutorial. These included muscle palsies and both Brown’s and Duane’s syndromes. Not only is this a good resource for students, it is also helpful for experienced practitioners needing a quick reminder to help diagnose an incomitancy. Simple videos of common clinical tests, such as the cover test, are also included. My own binocular vision methods and treatments did not always align with those in the book, but this served to remind me to back-up what I do with evolving evidence-based research, especially as the book is easy to refer to on a case-by-case basis.


Behavioural optometrist Kathryn Sands is a professional teaching fellow at the University of Auckland. She worked in private practice for 13 years before joining the School of Optometry and Vision Science team, where she teaches binocular vision in both lab and clinical settings.


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