Clinical Science Course Research Articles

Combined inferior rectus recession and lower eyelid retractor release in thyroid eye disease

Eyelid retraction and hypotropia are common in thyroid eye disease (TED), but inferior rectus (IR) recession causes or increases lower eyelid retraction that in turn aggravates dry eyes. Standard dogma including the AAO Basic and Clinical Science Course (BCSC) holds that strabismus surgery should precede eyelid surgery.

Panretinal Photocoagulation along the Long Ciliary Nerve in Diabetic Retinopathy

Abstract Patients with a history of pan retinal photocoagulation for proliferative diabetic retinopathy underwent ultra-widefield imaging with identification of the long ciliary nerve. This study found high prevalence of photocoagulation along the nerve despite current guidance. Proliferative diabetic retinopathy is a prevalent disease associated with significant morbidity, reduced quality of life, high costs, and significant visual loss. 1 Panretinal photocoagulation (PRP) is a widely-used technique to decrease neovascularization and bleeding and reduce severe vision loss in proliferative diabetic retinopathy (PDR). 2 , 3 Despite its uses, multiple cases have linked peripheral laser photocoagulation near the long ciliary nerve (LCN) to corneal ulceration, transient accommodative paresis and pupillary disturbances 4 , 5 , 6 . Current guidelines from the Basic and Clinical Science Course recommend that “the long ciliary nerves in the 3 o’clock and 9 o’clock meridians should be avoided” during PRP. 7 The development of ultra-widefield (UWF) fundus imaging offers a unique opportunity to visualize the long ciliary nerve. The aim of this study is to establish the frequency of inadvertent panretinal photocoagulation along the long ciliary nerve through confirmation of laser marks on widefield fundus imaging.

Completing the Basic and Clinical Science Course as a First-Year Ophthalmology Resident

Abstract Background The Basic and Clinical Science Course (BCSC) is the primary educational curriculum for ophthalmology resident physicians in the United States. The Ophthalmic Knowledge Assessment Program (OKAP) examination is an annual evaluation completed by residents that is based primarily on the BCSC curriculum. First-year ophthalmology residents are encouraged to complete the 13 volume BCSC series in preparation for the OKAP examination while balancing a steep clinical learning curve and substantial call schedule. By calculating the daily time commitment necessary to read each volume in the series, we hope to help residents create a realistic study plan to compete the entire BSCS series before the OKAP examination. Methods We determine the word counts of each volume using an electronic copy of the 2018–2019 BCSC series. We include all text sections and legends, and we exclude all figures and tables. We calculate the time per day of dedicated reading required to complete a goal number of BCSC books between the start of ophthalmology residency (postgraduate year 2 [PGY2]) and the OKAP examination by developing a formula that is a function of self-assessed reading speed. Results A first-year ophthalmology (PGY2) resident with an average reading speed of 250 words per minute must read for 25.0 minutes per day to complete the entire BCSC series before the OKAP examination. If studying is initiated at the beginning of intern (PGY1) year, the resident must read for 10.2 minutes per day. We introduce a formula and provide a table to guide residents on the amount of time needed to dedicate to reading the BCSC each day as a function of self-assessed reading speed. Discussion Completion of all volumes of the BCSC requires a daily commitment with little room for missed sessions. The commitment is substantially more realistic if initiated during the PGY1 year; thus, residency programs should encourage an early start to OKAP preparation. We hope with a better understanding of the daily time commitment involved in completing the BCSC series, ophthalmology residents will be able to develop more successful study plans.

Assessing the engagement rates and satisfaction levels of various clinical health science student sub-groups using supplementary eLearning resources in an introductory anatomy and physiology unit

PurposeIntroductory anatomy and physiology provide a core knowledge base to students within clinical health science courses. Increased student numbers, as well as reduced access to laboratory-based cadaveric resources, have created a need for enhanced learning approaches to support learning. The streamlining of courses has also resulted in the need to effectively engage course sub-groups within large units. The purpose of this paper is to utilize the eLearning activities to investigate engagement and satisfaction levels within students undertaking an anatomy and physiology unit.Design/methodology/approachA total of 19 formative quizzes were made available to students. Online practical anatomy laboratories covered anatomical content, and physiology quizzes covered physiological content. Student engagement was compared using frequency analysis across students studying varying courses. Satisfaction was determined by analyzing student’s feedback using frequency analysis.FindingsStudents accessed the learning activities 29,898 times over semester, with the peak access (37 percent) prior to the closed book exams. The resources were utilized primarily as an exam preparation tool rather than consistently throughout semester. Out of the various courses, the Paramedicine, Physiotherapy and Podiatry students were the most engaged, with the highest percent of “engaged/highly engaged” students. Students from various courses shared very similar views of the perceived benefit of the eLearning activities.Practical implicationsThese results indicated a difference in engagement levels between the students of various course sub-groups, and therefore suggests that the development of course-specific eLearning activities is necessary in large, streamlined units to achieve a more focused approach to support students’ learning, engagement and success, so that positive and beneficial learning experiences are ensured for all students.Originality/valueThese results suggest that in the future, development of eLearning activities is necessary to achieve a more focused approach to support students’ learning, engagement and success, so that positive and beneficial learning experiences are ensured for all.

SOAPing in Pharmacology: An innovative Tool to Foster Critical Thinking during Didactic Years in Pharmacy School

During the didactic years of pharmacy education, it is imperative to provide students with tools to enhance their critical thinking skills that involve adequate use of analysis, reflection, open mindedness, and evidence in solving a problem at hand. This kind of training is anticipated to equip the students with the skills to tackle constantly evolving advances in pharmacy, such as availability of new medications as well as changes in delivery of patient care. For decades, such training has been introduced early in the didactic years in Clinical Science courses especially while instructing students to analyze patient cases and write up SOAP (subjective, objective, assessment, plan) notes. Such training has indisputably helped students to transition to their experiential rotations. Our aim was to design and implement a similar critical thinking tool in Basic Science courses, such as pharmacology, thus enabling pharmacy students to broaden their application of critical thinking skills during their didactic training. Towards this end, we have developed an Observational Screening Student Project (OSSP) for the second‐year pharmacy students based on the results of a battery of preclinical tests (termed Hippocratic Screening) originally administered on rats by Malone and colleagues in 1983 to test ethnopharmaceuticals. These tests form a subset of safety pharmacological studies required by the FDA in order to evaluate the non‐clinical safety profiles of pharmaceuticals and their effects on physiological functions.In the OSSP, students are given a worksheet with data containing CNS, respiratory, and autonomic pharmacologic responses in a rat induced by an intraperitoneal injection of a drug covered in prior courses taken in pharmaceutical sciences. After analyzing the data, students are asked to determine the drug class that most likely produced the pharmacological profile depicted by the data in that worksheet. When analyzing the data to determine the drug class, students must consider the signs and symptoms that are present as well as those that are absent. The students are encouraged to use analysis, reflection, open mindedness, and evidence in solving their problem at hand, which gives them an opportunity to develop their critical thinking skills.Survey results of the class demonstrated that over 70% felt that they were able to effectively review and analyze the rat's symptoms after administration of a drug as presented in the worksheet (80% response rate). A similar percentage of students indicated that they were able to keep an open mind and describe the process involved in assessing the data on the worksheet. However, only about 52% of students thought that they were able to develop follow‐up questions based on the evidence provided in the worksheet. Developing follow‐up questions is a higher order critical thinking process, which normally comes with more experience and training. Overall, more than 50% of the respondents felt that OSSP was a valuable educational tool that would better prepare them to progress into their experiential courses. In conclusion, OSSP can be regarded as a pre‐clinical subjective, objective, assessment, and plan (SOAP) tool to improve critical thinking skills that will aid students in analyzing a patient as a whole, working them up, assessing drug therapies, making necessary adjustments, and seeking appropriate literature as evidence to support their findings.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Embracing Active Learning: A Novel Approach to Teaching Embryology at the Larner College of Medicine

The Larner College of Medicine at the University of Vermont is in the process of transitioning to an entirely active learning‐based curriculum by 2019. With this goal in mind, we flipped all of the embryology lectures given in our Foundations of Clinical Science course to large group workshops. We replaced 12 hours of lecture material with 8 self‐directed learning modules and 5 large group workshops. After each learning module, students were given a multiple‐choice quiz. During the workshops, students were asked to develop a linear timeline of embryological development and work through clinical questions related to each topic. We hypothesized that these active learning sessions would assist students in better understanding the main concepts of embryology.Student groups (n=17) each developed a timeline based on embryological development in a OneNote notebook shared by the entire class. Each group's timeline was visible to other groups and faculty. A master timeline was then assembled using parts from each group's timeline and then groups worked together to answer clinically‐relevant questions. Examination scores and end‐of‐course evaluations between 2016, when only traditional lectures were given, and 2017, with the new active learning curriculum, were compared. There was no difference in overall examination scores between 2016 and 2017. While the sessions were well‐reviewed by the students, they would have preferred to have more time during the session to compile the timeline. The students reported that the clinical questions were helpful in integrating embryology. To our knowledge, this is an innovative approach to teaching embryology as well as utilizing OneNote within the classroom. In the future, students will complete a version of their own timeline before each session to better utilize class time. In conclusion, this type of workshop is an excellent approach to teaching a difficult topic and the development of a timeline allows for a better overall view of human development.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Use of Short Animal-Themed Videos to Enhance Veterinary Students' Mood, Attention, and Understanding of Pharmacology Lectures.

Professional DVM training is inherently stressful and challenging for students. This study evaluated a simple intervention-short breaks during a veterinary pharmacology lecture course in the form of funny/cute animal videos (Mood Induction Procedures, or MIP)-to assess for potential impact on students' mood, interest in material, and perceived understanding of material. Ten YouTube video clips showing cats or dogs were selected to influence students' affective states. The videos were shown in a required pharmacology class offered during the fall semester of the second year of the DVM program at a large, land-grant institution in the western US. The student cohort consisted of 133 students (20 males, 113 females). Twenty days of the course were randomly chosen for the study and ranged from weeks 2 to 13 of the semester. Sessions in which the videos were played were alternated with sessions in which no video was played, for a total of 10 video days and 10 control days. There were significant differences in all three post-class assessment measures between the experimental (video) days and the control days. Results suggest that showing short cute animal videos in the middle of class positively affected students' mood, interest in material, and self-reported understanding of material. While the results of this study are limited to one student cohort at one institution, the ease of implementation of the technique and relatively low stakes support incorporation of the MIP technique across a variety of basic and clinical science courses.

Integration of Basic and Clinical Science Courses in US PharmD Programs

Objective. To determine the current status of and faculty perceptions regarding integration of basic and clinical science courses in US pharmacy programs. Methods. A 25-item survey instrument was developed and distributed to 132 doctor of pharmacy (PharmD) programs. Survey data were analyzed using Mann-Whitney U test or Kruskal-Wallis test. Thematic analysis of text-based comments was performed using the constant comparison method. Results. One hundred twelve programs responded for a response rate of 85%. Seventy-eight (70%) offered integrated basic and clinical science courses. The types of integration included: full integration with merging disciplinary contents (n=25), coordinated delivery of disciplinary contents (n=50), and standalone courses with integrated laboratory (n=3). Faculty perceptions of course integration were positive. Themes that emerged from text-based comments included positive learning experiences as well as the challenges, opportunities, and skepticism associated with course integration. Conclusion. The results suggest wide variations in the design and implementation of integrated courses among US pharmacy programs. Faculty training and buy-in play a significant role in successful implementation of curricular integration.

Whence cometh the revolution

Whence cometh the revolution

Flipping the Classroom Experience: A Comparison of Online Learning to Traditional Lecture

Introduction and Review of Literature. Physical therapist education programs are challenged to provide physical therapist students with exposure to an expanding amount of content with little change in time to degree completion. There is a need for evidence to support creative teaching methods to cover basic content and therefore effectively use class time in order to facilitate higher-level thinking. Online learning has become more popular over the past several years and may be an effective means to achieve this goal. The purpose of this study was to compare outcomes of physical therapist students who were exposed to the flipping teaching method versus traditional classroom lecture in a musculoskeletal clinical science course. Subjects and Methods. Fifty-three physical therapist students participated in this study in 2010 and 2011. The 2010 cohort (n = 23) was exposed to traditional in-class lecture and the 2011 cohort (n = 30) was exposed to a flipped classroom in which the content was covered via online lectures. Student outcomes were assessed by scores on written exam questions in the following categories: total score, examination/evaluation score, intervention score, lower-level thinking score, and higher-level thinking score. An analysis of covariance (ANCOVA) was performed to compare the 2 teaching methods. Results. There was no significant difference between teaching methods in any category of student outcomes. Discussion and Conclusion. These results suggest that the hybrid model of instruction via use of online lectures produces similar student outcomes compared to the use of traditional lecture. This will allow physical therapist educators to utilize class time more efficiently and challenge the student to think at a higher level.

Best Practices in Undergraduate Clinical Laboratory Science Online Education and Effective Use of Educational Technology Tools

This article discusses the best practices of course design and successful delivery of online clinical laboratory science (CLS) courses, and informs educators about the effective use of currently available educational technology tools used to increase student engagement.

Wake up! Your PDQ is due!

1. Lori A Woeste, EdD MT (ASCP)[⇑][1] 1. is assistant professor, Clinical Laboratory Science Program, Illinois State University 2. Beverly J Barham, PhD MPH MT(ASCP) 1. is associate professor, Clinical Laboratory Science Program, Illinois State University 1. Address for correspondence: Lori A Woeste EdD MT (ASCP), assistant professor, Clinical Laboratory Science Program, Department of Health Sciences, 332 Felmley Hall Campus Box 5220, Illinois State University, Normal IL 61790-5220 (309) 438-8810, (309) 438-2450 (fax). lawoest{at}ilstu.edu. BACKGROUND Student engagement in the classroom can often be an elusive goal. We as faculty in a four-year university-based clinical laboratory science program were noticing a trend of more students coming to class unprepared. In an effort to increase student engagement in two different pre-professional practice clinical laboratory science (CLS) courses, the pre-discussion quiz (PDQ) was implemented as a curricular component for enhancing student engagement. This was done as an active learning strategy to motivate students to read the material and respond to a series of questions in preparation for discussion before they came to class. A review of educational literature suggests intrinsically motivated learning enhances the learning process. It is suggested this intrinsic motivation is linked to such factors as the perception of personal control, self-efficacy, and the perception of relevance.1 These instructional strategies should give the learner some control over sequence of instruction and pace,2 and some even believe they should not be optional.3 The use of incentive-based preparation exercises has been found to significantly improve student engagement and provide an effective means of assessment.4 OVERVIEW The pre discussion quizzes (PDQs) were delivered via WebCT® in undergraduate CLS immunology and chemistry courses. Each course was 16 weeks long, met twice a week at 8:00 AM during the fall semester, and included 24 in the student cohort. Most students were at junior status with a few seniors and an occasional sophomore. The cohort included both native students, e.g., those students who began their post secondary experience at this institution,… ABBREVIATIONS: CLS = clinical laboratory science; PDQ = pre discussion quiz. [1]: #corresp-1

Two Laboratory Exercises Demonstrating Neural Adaptation: Eye-Hand Coordination and Anticipatory Postural Adjustments

This brief manuscript describes two dynamic learning experiences in neuroscience designed to reinforce learning about neural plasticity. These activities require minimal equipment, are fun, and could be integrated within a basic science, clinical science, or clinical laboratory course in neurological rehabilitation. Key Words: Motor control, Posture, Prism-adaptation, Neuroscience laboratory. INTRODUCTION Educators in physical therapy value active participation to facilitate learning.1,2 The creation of experiences that are practical for the instructor and educational for the students, however, is a challenge. Nonetheless, transformation of lecture segments into experiences can make teaching and learning more memorable and fun for the students and the teacher. In this brief report, two laboratory exercises are described that may help students understand adaptation, coordination, and anticipation as elements of motor control. The tasks performed by students for these demonstrations require multiple motor systems, but the focus of the demonstrations is cerebellar function. DEMONSTRATION 1: EYE-HAND COORDINATION The first activity, which was developed and described by others,3'4 is based on a prism adaptation experiment. This activity demonstrates how rapidly the normal nervous system can adapt eyehand coordination following a change in vision. A list of materials required and a basic procedure for this demonstration is provided in Table 1. For baseline performance, a student throws bean bags at a target while the class tracks the student's accuracy over about 30 trials. Then, the student dons a special pair of prismatic goggles that requires the eyes to deviate 15° to the right in order to focus on objects that are straight ahead. Initially, this gazeshift causes the student to throw to the right. With about 30-50 trials of practice, most subjects learn to throw on target. Once the individual has adapted and can throw accurately to the target despite the gaze-shift, the goggles are removed, causing the subject to throw left. Readaptation to natural eyehand coordination occurs after 20-30 more trials. This demonstration is always quite impressive, especially when students are reminded that, despite 20 or more years of functional throwing, their eyehand coordination changed dramatically in a matter of minutes. This experience helps students appreciate adaptation as a form of motor learning. Experiments reported in the scientific literature link this example of adaptation to neural plasticity specifically in cerebellar circuits.3,5 Critical reading of such literature is appropriate for advanced students. DEMONSTRATION 2: ANTICIPATORY POSTURAL ADJUSTMENTS In addition to adaptation, the cerebellum also contributes to coordination and anticipation.5 The prism adaptation experiment provides a clear example of control over eye-hand coordination. Impaired coordination due to cerebellar dysfunction (ataxia, arrhythmia, decreased fine-motor accuracy, and decomposition of movement) can be observed in cases of multiple sclerosis, cerebellar degeneration, or brainstem strokes. Clear examples of isolated problems with anticipatory motor control, however, are less common. To demonstrate anticipation in normal motor control, a new activity was created based on the work of Horak.6 Subjects with intact postural responses are able to scale their reactions so that a larger perturbation elicits a larger reaction.6,7 Horak6 demonstrated that patients with cerebellar loss could not learn to scale their postural responses very well to platform perturbations with consistent velocities and varying amplitudes, even though they could adapt to perturbations with consistent amplitudes and varying velocities. Perturbations with consistent amplitudes and varying velocities did not require anticipation because the initial proprioceptive input was proportional to the response required. When the velocity was consistent, but the amplitude varied, however, anticipation was required because the initial proprioceptive input was not completely informative. …

Poster 192: A CD-ROM-based virtual patient teaching resource on spinal cord injury.

Setting: A US medical school. Program: In consultation with basic scientists and clinicians, a real-life case of a patient with SCI was adapted to ensure that critical basic science and clinical issues emerged. Program Description: The patient ages over time, providing a longitudinal perspective on changes over a 30-year period after injury. Case details were transcribed into a video script, with each scene under 2 minutes in length to allow for ease of insertion into existing curriculum. The video was digitized for ease of access on a CD-ROM that also includes images, radiograms, lab results, and other files that highlight specific aspects of the case. To facilitate access, the CD is indexed by specific topics (eg, sensory nerves) or by course (eg, physiology). For example, a patient’s neurologic findings are used in an anatomy lecture on spinal dermatomes, and used later in clinical clerkships to teach neurologic examination. A scene with the patient refusing to be turned in bed is used to discuss decision-making capacity in a medical ethics course. The same scene is used in clinical rotations to stress positioning after paralysis or to discuss patient compliance. Assessment/Results: Response by faculty to this initiative has been very positive. The virtual patient with SCI has been incorporated into multiple clinical and basic science courses at our institution. Discussion: Based on positive feedback, the CD-ROM is being distributed nationally. Conclusion: This initiative incorporates SCI and disability education in an overflowing medical curriculum by supporting concepts that are already being taught.

Rush Medical College.

Rush Medical College.

Affirmative Action and Other Special Consideration Admissions at the University of California, Davis, School of Medicine

The use of race as a criterion for admission to medical schools and other professional schools has become increasingly controversial. This study documents the experience of students at one medical school, admitted through a special admissions process that included race as one consideration. To examine the medical school, postgraduate training, and career experiences of students admitted by a special consideration admission program that included traditional affirmative action admissions. Twenty-year, retrospective, matched-cohort study. A public medical school. All affirmative action and other special consideration admissions between 1968 and 1987 (20 years). Academic progress, national board examination scores, graduation, residency evaluations, and practice characteristics. During the study period, 20% of students were special consideration admissions (range, 10%-45% per year). Of special consideration admissions, 53.5% were minority students, while 19% of regular admissions were minority students. When only underrepresented minority groups are analyzed, 42.7% of special consideration admissions and 4.0% of regular admissions were minorities. Of special consideration admissions, 94% graduated vs 97% of regular admissions. Regular admission students were more likely to receive honors or an A grade on core basic and clinical science courses. There was no difference in failure rates of core courses. Regular admission students had higher scores on Parts I and II of the National Board of Medical Examiners examination, and special consideration students were more likely to repeat the examination to receive a passing grade. Following graduation, the experience of the special consideration admission students was very similar to that of regular admission students. There was no difference in completion of residency training or evaluation of performance by residency directors. Both populations selected primary care disciplines at the same rate. The practice characteristics of the 2 populations were remarkably similar. Criteria other than undergraduate grade point average and Medical College Admission Test scores can be used in predicting success in medical school. An admissions process that allows for ethnicity and other special characteristics to be used heavily in admission decisions yields powerful effects on the diversity of the student population and shows no evidence of diluting the quality of the graduates.

History of the Secretariats of the American Academy of Ophthalmology

The American Academy of Ophthalmology and Otolaryngology grew steadily during its 82-year existence, and since 1979, the American Academy of Ophthalmology has had an accelerated increase in membership and activity. In 1995, as the Academy approached its centennial, the AAO had more than 20,000 members and an annual budget of more than +26 million. Total registration for the 1994 Annual meeting was slightly more than 27,000, an all-time high. Instruction Courses numbered 450,300 scientific papers were presented, and 130 posters were displayed. The original postgraduate course in 1921 served as the predecessor to the more than 700 hours of instruction presented at the 1994 Annual Meeting. The original committee of four was the predecessor of what has become the Secretariats of the Academy. The popular Home Study Courses were the forerunners of the Academy's programs, formulated and supervised by the Education Secretaries. The Clinical Education Programs include the Basic and Clinical Science Courses, Focal Points, Continuing Ophthalmic Video Education, Manuels, Regional Update Courses, Special Focus/Skills Courses, Monographs, PROvision, slide scripts, and other programs produced for allied health personnel, medical students, and other physicians. The Secretaries originate, produce, and oversee all the important functions of the Academy. The individuals who have served the Academy as Secretaries through the years have been dedicated volunteers. Their contributions have been incalculable. In recent years, the various Secretaries have been ably assisted by Associate Secretaries, Advisory Committees, and Subcommittees, spreading the workload of each Secretary. Credit for the success of the Academy's endeavors, while under the guidance of the Secretaries, also must be given to the Academy's many committee chairs and committee members who have diligently worked to achieve their goals and objectives. In 1995, the Executive Vice President, the 11 Secretaries, and the Editor were aided and assisted by 46 committees. The Secretaries, through the years, and the Academy are further indebted to a wonderful, dedicated staff who willingly and conscientiously contribute to the many Academy programs. When you stand back and look at this history of active, participating Academy members who have contributed so many hours in travel, meeting, and homework within the Secretariats, you marvel at the dedication and forces at work in the American Academy of Ophthalmology. Is it any wonder that, through the years, so many Secretaries, because of their proven ability, talents, and contributions to ophthalmology, have been selected by the membership to serve as President of the American Academy of Ophthalmology.

External Disease and Cornea: A Slide-Script Program

External Disease and Cornea has been revised and updated by the American Academy of Ophthalmology from its excellent 1981 version. new program is even The new program is even better. slide-script program is intended to supplement section 7 of the academy's Basic and Clinical Science Course dealing with external disease and cornea. program consists of fifty-two 35-mm slides, each of excellent quality, representing common or clinically important conditions. slides include graphics and composites demonstrating several key features of one condition on the same slide. Many of the slides are from the first edition. major improvement in the program is the accompanying guide in which a black-and-white photograph of each slide is printed above the descriptive text. This feature makes the program extremely user friendly when scanning the slides for pattern recognition or teaching. slide program is organized in an anatomic fashion moving from

Pathobiology of Ocular Disease: A Dynamic Approach

Ophthalmology: Basic and Clinical Science Course , section 11: Ophthalmic Pathology 1985-1986 , by J. Douglas Cameron, Marilyn Kincaid, Robert Folberg, et al, 236 pp, with illus, San Francisco, American Academy of Ophthalmology, 1986, $35. Ocular Pathology: A Text and Atlas , ed 2, by Myron Yanoff and Ben Fine, 916 pp, with illus, New York, Harper & Row Publishers Inc, 1982. Ocular Pathology: Clinical Applications and Self-Assessment , ed 3, by David J. Apple and Maurice F. Rabb, 560 pp, with illus, St Louis, CV Mosby Co, 1985. Ophthalmic Pathology: An Atlas and Textbook , ed 3, edited by William H. Spencer, 1392 pp, 2894 illus, Philadelphia, WB Saunders Co, 1985 and 1986, 3 vols, $275. Pathobiology of Ocular Disease: A Dynamic Approach is oriented differently from the traditional anatomical approach. A glance at the table of contents of part B exemplifies this: Lysosomal Storage Diseases, Glycogen Storage Diseases, Disorders of Glycosaminoglycans and Proteoglycans,

A graphic three-step test.

A graphic technique is used to analyze cyclovertical muscle palsies. This technique is similar to that presented in the Ophthalmology Basic and Clinical Science Course, but has the following advantages: only one diagram is required to apply the method, and knowledge of the actions of the cyclovertical muscles, when analyzing the Bielschowsky head tilt test, is not required.