354 AMERICAN JOURNAL OF OPHTHALMOLOGY FEBRUARY, 1967

only for the text, he made all but four of the drawings also.

Possibly the book prepares the ophthal­mic surgeon more effectively for the oper­ating room than for the examination room, inasmuch as emphasis is less on discussion of the nearly limitless number of procedures for each condition than on detailed accounts of the author's preferences and techniques. He practices and preaches just such obses­sive attention to details as is necessary to successful ocular surgery; even the de­meanor of the surgeon in the operating room is discussed. Quotations from the classics scattered throughout at the beginning of various sections lighten the text and enlarge the reader's appreciation.

The nature of eye surgery at present is such that several pages have been added on the management of cardiac arrest and mouth-to-mouth resuscitation.

The section on eyelids and reconstructive surgery, which in the first edition reflected the author's wartime experience, has been extensively revised and many pictures of battle injuries have been replaced by di­agrams. The result is one of the most com­plete discussions of the topic in the English medical literature.

The discussion of corneal transplant de­scribes indirect suturing, sometimes com­bined with a fenestrated acrylic splint. Probably the majority of surgeons in this country prefer direct suturing. The superb· section on the lens comprehensively covers all aspects of surgery of the lens with much attention to the minutiae that make for suc­cessful surgery.

Differences between British and Ameri­can practices, the author being a London surgeon, are most apparent in the section on glaucoma. He states that corneoscleral trephination is probably the principal opera­tion for chronic glaucoma in Great Britain, and possibly in the United States ; but here this procedure has probably been largely supplanted by other filtering operations. Go-niopuncture is not mentioned in the manage­

ment of congenital glaucoma, nor is diather­my of the lips of the wound. Minor differences throughout the book in terminol­ogy and the names of drugs used never cause a particularly serious problem, but it seems rather a pity that there is not greater agreement concerning the terminology of glaucoma and that it is necessary to stipu­late the denotation of terms so precisely be­fore communication is possible. But this is indeed carping at trifles. It is quite evident that, apart from semantics, our practice is remarkably similar.

The book remains what it has been since its first edition—a superb exposition of eye surgery for the active surgeon. It is whole­heartedly recommended.

Frank W. Newell

T H E FUNDAMENTAL READING SKILL: AS RELATED TO EYE-MOVEMENT PHOTOG­RAPHY AND VISUAL ANOMALIES. By Earl A. Taylor, Ed.D. Springfield, Illinois, Charles C Thomas, 1966. 157 pages, 63 figures. Price: $11.50 This book purports to explain how instru­

mental techniques can help to improve read­ing skills: first, by measuring certain as­pects of ocular functioning, and then by "training" those same aspects of ocular functioning.

It is the author's conviction that lack of "functional readiness" of the eyes, and sometimes of the body as well, is an impor­tant factor in the etiology of reading disor­ders found at any age. He says that 60% of all students have such functional difficulties in varying degrees and that the incidence appears to be the same in all social classes. He reports having found functional abnor­malities of accommodation, vergence and binocular co-ordination in most students with reading difficulties : "Their focus mecha­nisms tended to react in a more sluggish manner and the majority had more dif­ficulties with the coordination of their vergence and accommodative functions. . . ." The author does not feel that other visual

VOL. 63, NO. 2 BOOK REVIEWS 355

factors are of major significance in poor readers. The "functional difficulties of the body" that cause or contribute to reading problems are not defined.

At the author's clinic, the Taylor Center for Controlled Reading and Research, the functional impediments are detected by the Vismscope, designed by J. Y. Taylor and Carl C. Taylor, the Metronoscope, designed by J. Y. Taylor, Carl C. Taylor and Earl A. Taylor, and the Reading Eye Camera, designed by Stanford I. Taylor. Initial visu­al screening is done with the Visuascope. The dynamic reactions of the divergence and convergence functions are determined with the Junior Metronoscope equipped with Risley rotary prisms or with a prism reader while the individual is reading and rotating his eyes from left to right. Finally, how the individual uses his eyes in reading is determined from eye-movement records taken either with the ophthalmograph or the Reading Eye Camera.

Treatment then consists of visual train­ing, particularly with the Metronoscope or Prism Reader, from two to five hours daily with rest periods every 20 minutes. The ta-chistoscope is also used to train eye move­ments. Eventually the individual with the reading problem may be given some type of "reading program" by an educator, but the author is not clear here. The author feels that the visual training program must be su­pervised or administered by a member of the "optometric or medical profession."

The author presents his results concisely: "Experiences for 23 years indicate that when this overall plan is followed there are very few pupils who fail to make a satisfac­tory school adjustment." The results are im­possible to evaluate, however, since no nu­merical data are presented and no evalua­tions by standard psychologic and educa­tional tests are made before or after treat­ment. The author's opinions in this area ac­count for lack of such data : he believes that most of the usual evaluations and diagnostic tests give very little information regarding

reading ability. Neither are I.Q.s deter­mined as a part of the usual examination at the Taylor Center, since the author feels that "no test has been found which enables an examiner to determine adequately either the mental ability or the potential capacity of an individual to acquire an education." The only data referred to for comparison are from the W P A remedial reading proj­ect carried on in New York City between 1934 and 1938.

The author speculates on why other read­ing programs (they are unspecified) have such poor results (also unspecified). Un­qualified teachers are given as a factor: "Many so-called reading specialists read inefficiently themselves because they have never been taught the total process of read­ing." Improper emphasis is another factor: teachers are concerned mainly with com­prehension of written material and thus ex­isting remedial reading programs fail to consider the basic cause of reading dif­ficulties ("functional impediments"). The author feels that comprehension will take care of itself once "functional readiness" is attained. He states that controversies in the reading field result from "(a) a misunder­standing of the true aim of reading instruc­tion, (b) insufficient study of the process itself, or (c) a lack of exact information concerning the factors which influence the reader's performance."

The author claims that his methods help some children with other types of ocular problems also. He advises against surgery for strabismus because of the uncertain effects of operations and recommends in­stead using glasses and certainly trying for functional improvement. "A large percent­age of the cases with convergent and diver­gent strabismus can recover single binocular vision with visual training and glasses. This has been a frequent finding at the Taylor Center during the past 23 years, even with cases who had been told previously that nothing could be done." Another ocular problem which the Taylor Center has han-

356 AMERICAN JOURNAL OF OPHTHALMOLOGY FEBRUARY, 1967

died is the training of eye movements of people with aphakia (because, he points out, the lateral movements of their eyes are longer than those of readers who have not had the operation). Their visual training program has also cured children of chronic stomach cramps, nausea and headaches.

The concepts and methods described in this book contrast markedly with those em­phasized by most other texts on reading problems. Moreover, the high incidence of functional ocular abnormalities that the au­thor mentions—60% of all students—has no­where been documented by other investiga­tors.

This book makes it quite clear that the medical profession must take a responsible interest and part in evaluating the ocular status of retarded readers.

Alex E. Krill

READING DISABILITY: DEVELOPMENTAL DYSLEXIA. By Lloyd J. Thompson, A.B., M.D. Springfield, Illinois, Charles C Thomas, 1966. Clothbound, 201 numbered pages, 4 figures. Price: $8.75. This book is a psychiatrist's summary of

the arguments favoring the hypothesis that most reading defects are innate, that they represent a resultant "developmental lag" that is genetically determined.

In a brief historical review of the subject we learn, interestingly, that it was an En­glish ophthalmologist who, in 1896, first re­corded detailed observations on a patient with a reading disorder. Probably the fa­mous Edward Jackson of Denver was the first to cite such observations in this country when he read a paper on "Congenital word blindness" before the Colorado Medical So­ciety in 1905. The use of such a designation by ophthalmologists at that time to describe reading disorder was compatible with their theory that reading defects were usually sec­ondary to brain damage or caused by an or­ganic lesion in the brain. They were almost unanimous in pointing out that the disorder

was not caused by any dysfunction or dis- i ease of the eyes.

Other medical specialties became inter­ested in reading and, in 1925, Orton, a psy­chiatrist, wrote a paper which attributed reading disorders to an innate defect that was expressed as a developmental lag in Ian- ' guage skills. He noted that these children usually have other language disorders as well, including imperfect speech, a poor ear for words and a meager oral vocabulary. Their motor skills develop more slowly and they exhibit more awkward motor control (poor handwriting, etc.), longer retention of tonic-neck reflex-attitude responses and more variable motor tone than normal. They frequently come from families in which there is left-handedness, more than one lan­guage spoken, and reading, spelling and " motor co-ordination defects. Orton and his disciples felt that there was no need to pos­tulate brain damage in these children but rather that these defects all reflected devel­opmental abnormality. Thus the term "de­velopmental dyslexia" originated.

The author of this book is an Orton disci- , pie. He admits, however, that there are, rarely, other possible sources of reading de­fects (organic damage in the central ner­vous system, emotional, environmental or psychologic disturbances). But he feels that these other factors often merely intensify , effects in "a specifically prepared physio­logical soil."

The author likens the inheritance of read­ing abilities to other sensory and motor abil­ities such as a feel for rhythm, an ear for music, memory, emotional expressiveness, . motor co-ordination, depth of feeling and even color vision. His analogy fails with color vision particularly, for there is no sen­sitivity continuum from exquisite discrimi­nation of all shades of color to ability to recognize only shades of black and white ι that is comparable to the apparent grada­tions in the other "abilities."

The crux of the developmental-lag theory is the supposed genetic nature of the defect.