Reviewer
Dr. David Damari
Assistant Professor
Southern College of Optometry

Visual & Vestibular Consequences of Acquired Brain Injury Irwin B. Suchoff, Kenneth J. Ciuffreda, and Neera Kapoor, eds., Optometric Extension Program Foundation, Santa Ana, CA., 2001, 244 pp., $35.00.
This book is a compilation of papers from the Academy 1999 symposium in Seattle and a few other articles from other authors that the editors had felt rounded out the discussion well. The topic is ambitious for two reasons: there are untold visual and vestibular consequences of brain injuries and there is very little known and even less that is published on this topic. Traditionally, almost every ophthalmologist and far too many optometrists are content to patch an eye to manage diplopia, ignore any other symptoms, and wait for six months. If the symptoms have resolved, that is wonderful; if not, then there is nothing else to be done. This attitude is far too pervasive for a syndrome in which almost every other area is aggressively treated, not passively ignored. The visual system is the only one traditional medicine expects to get better on its own, which implies that they respect the power of that system for recovery. To say that, in this kind of system, if there is no spontaneous recovery, then there can be no recovery strikes me as seriously flawed logic that is certainly not backed up by research.
This book should serve as a call to action for optometry to halt the undue suffering these patients currently have to undergo in waiting for spontaneous recovery. It is a well-researched, multidisciplinary manifesto for patients who deserve better. The foreword by Freeman sets the tone wonderfully. He writes about his experience with a patient who had suffered traumatic brain injury in a way that will resonate for anyone who has worked with these challenging and rewarding cases. He writes an apology for the “catch as catch can” nature of the book and he is absolutely correct when he states that this “is not offered as a textbook.” In the beginnings of the first six chapters, there are multiple definitions of acquired brain injury (ABI), traumatic brain injury (TBI), etc. The same diagram to illustrate coup and contracoup injury to the brain is shown in two different chapters. However, if you can look past the unusual editorial choice of letting these redundancies stand, you will find much that is challenging and useful. The preface lays out the goals of this book very succinctly: “…to provide optometrists with a broad understanding of ABI, its ocular and visual consequences, the developing clinical strategies that address these consequences, and some of the current pertinent research.” The book meets these goals and more. Among the highlights are the first chapter, which lays out the groundwork and what is known about ABI. It is accompanied by several useful tables and diagrams. The second chapter should be required reading for every optometrist and every member of the health care team who will ever see a patient who has suffered a brain injury. The author, Edwin Richter, M.D., presents the financial and social costs of head trauma. The clinical considerations he outlines are important for anyone who is testing this population to remember. He illustrates a good model of the interdisciplinary rehabilitation team and the appropriate role for the optometrist in that team.
I believe that this is one of the most important books for our profession. It shows why optometry continues to be a viable and valuable health profession, despite the challenges we face from third party payers and some medical specialties. This book brings together viewpoints from several different disciplines, sometimes within the same chapter, and shows how these viewpoints can combine to create a powerful team for the treatment of a difficult set of conditions. It is my hope that every optometrist, and indeed every staff member in every rehabilitation center in the country, would read this book and understand what optometry can offer to patients who may have a best-corrected visual acuity of 20/20 but nonetheless suffer from disabling visual conditions. The Optometric Extension Program has performed our profession an important service by publishing this book.