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Walsh and Hoyt’s Clinical Neuro-Ophthalmology.
  1. JOHN A OLSON

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    Walsh and Hoyt’s Clinical Neuro-Ophthalmology. 5th ed. Vols 1 and 2. By Neil R Miller, Nancy J Newman. Pp 1116 each. £130 each. Baltimore: Williams & Wilkins, 1998. ISBN 0-683-302302 (Vol 1); 0-683-302310 (Vol 2).

    The fifth edition of Walsh and Hoyt’s Clinical Neuro-Ophthalmology is a very extensive piece of work that consists of five volumes and involves over 70 authors. It is the largest textbook in neuro-ophthalmology and is considered to be the reference standard in this area with appeal not only to ophthalmologists but also to neurologists and neurosurgeons. The fourth edition took two authors 14 years to complete and suffered as a result by quickly becoming out of date. To avoid this, the present edition has multiple authors and was completed in the remarkably short time of two years. Volume one examines the visual sensory system, the autonomic system, the ocular motor system, eyelid function, the sensory innervation of the eye and orbit, and non-organic disease. Volume two examines tumours, paraneoplastic diseases, complications of chemotherapy, phacomatoses, and degenerative diseases. The other three volumes were not available for review.

    This is clearly not a book that can easily be read from cover to cover in one go. Instead I think it is book that one dips into when faced with a difficult management case or where one wishes to find the definitive account of a particular condition or disease. It is extensively illustrated and referenced to the point of exhaustion. Indeed at times the text seems to disappear among the endless list of references that accompanies every statement. Virtually everything one can think of is to be found in this text and usually in great detail. Some of the information and illustrations are duplicated at various points throughout the volumes and perhaps this is to be expected when dealing with a text as large as this. My main criticism is the fact that references are listed without any critical analysis to their worth. Indeed, when looking at topics such as idiopathic intracranial hypertension, it is easy to be fooled by the presence of so many references into the belief that therapies such as acetozolamide, diuretics, steroids, and various surgical therapies are based on good clinical evidence, whereas in fact there is little, if any, clinical evidence for any of the various treatments on offer.

    The fifth edition of Walsh and Hoyt’s Clinical Neuro-Ophthalmology is truly an incredible piece of work and all the authors are to be congratulated for their efforts. It is claimed that this text is the definitive work in this area. One only has to compare the fourth and fifth editions to see the vast leap in our knowledge that has occurred in the past decade and the vast leap that is likely to occur in the next. To date our knowledge has been concentrated on the localisation and structure of diseases. Hopefully, in the near future, techniques such as fMRI and PET scanning will lead to better understanding, not only of the functional abnormalities of disease processes, but also to new avenues of therapy and inevitably a sixth edition.

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