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Show BOOK REVIEWS Section Editor: Barrett Katz, MD, MBA Clinical Decisions in Neuro- Ophthalmology, 3rd Edition Ronald M. Burde, Peter J. Savino, and Jonathan D. Trobe. Mosby, St. Louis, Missouri, 2002. ISBN: 0- 3230- 1707- X. $ 99.00 Scope: This is a third edition of the first medical textbook composed as a problem- based, decision- tree analysis of clinical practice. Formulated by the three musketeers of neuro- ophthalmology, Drs. Burde, Savino, and Trobe, this edition emphasizes a stylized organization of signs and symptoms that allows the reader a clear view of the authors' thought processes. One can appreciate the lines of logic that define the journey from clinical declarations of dysfunction to a specific pathophysiology that triggers such dysfunction. This new edition has been significantly rewritten, with timely references and additional Tables and Figures. Its text is a seasoned treatise on clinical neuro- ophthalmology that is evidence- based, and the product of perhaps a combined 75 years of clinical practice by its authors. Content: The book is divided into 15 chapters, each organized around a sign, a symptom, or a clinical theme. Chapters include unexplained visual loss, optic neuropathy, chiasmal disorders, transient visual loss, ocular oscillations, anisocoria, eyelid disturbances, and neuro- ophthalmic disorders of psychogenic origin. There is ample text and illustration ( both color and black and white), and decision trees within each chapter. Indeed, chapters begin with a helicopter- view decision tree that orients the reader to where the clinician begins, and ends, and how one gets from here to there. Dispersed within each section are management boxes- cogent highlighted summaries that emphasize key points of clinical care. There are frequent and helpful tables and a healthy, although not overwhelming, bibliography for each section. The index is both complete and usefully organized. Strengths: A strength of this third edition, equally true for earlier editions, is that the book can be read and processed on many levels. One can use the decision trees themselves to guide a clinical path that begins with signs or symptoms and ends with a narrowed differential diagnosis. Alternatively, the management boxes can be scanned and used as review. The text itself reads well and easily- it is succinct, nicely written, and compelling. Appendixes at the end of several chapters provide extended details on clinically relevant examination procedures and can be used independently. A great strength of the book is that while the classic party line of knowledge is presented for the readership, the authors go on to complement formal dogma in helping clinicians through the practicalities of taking care of patients and answering clinical questions. For example, in discussing the pharmacology of pupillary function testing, the authors admit that they are guided by associated clinical signs and symptoms in making their decisions, and not driven by results of such testing. They are comfortable allowing their clinical acumen to trump results of testing. This type of honesty places classic dogma in it proper perspective and allows one to balance the theory and practice of neuro- ophthalmology. The approach is wonderfully illustrated in the chapter on anisocoria, a chapter that most powerfully lends itself to a true decision tree. This chapter alone is worth the price of the book. Weaknesses: Weaknesses are few and far between. One might argue that the authors need to differentiate probability from possibility more. The reader would benefit by relative prevalence data of different entities. For example, within the section of ischemic optic neuropathies, the rarity of a true posterior ischemic optic neuropathy is not emphasized, nor is the reader cautioned that PION might best be thought of as a diagnosis of exclusion and one that is best left to others to make. Also, one might question whether serologic studies for Lyme disease really should be included in the evaluation of patients who present with progressive symmetric binocular visual loss characterized by central or centrocecal scotomas. One has to wonder how many cases of Lyme disease have been uncovered in the Bronx, Ann Arbor, and inner- city Philadelphia. Recommended Audience: One of the most compelling things about this text is there is something to be learned within it no matter what you bring to the table. That is, this book is for beginners, intermediates, and advanced clinicians. Every time I look through it, I pick up something useful and easily incorporated into my clinical world. The text is appropriate and relevant for students, residents of ophthalmology and neurology, fellows in neuro-ophthalmology, and neuro- ophthalmologists. Critical Appraisal: This book is like a fine wine; it improves with age. It is wonderfully organized, innovative in its presentation, practical in its information, and overwhelmingly useful in its paradigms. The list of texts worth owning in neuro- ophthalmology is short; this text is at the top of that list. Barrett Katz, MD, MBA The George Washington University School of Medicine Washington, DC 178 JNeuro- Ophthalmol, Vol. 24, No. 2, 2004 Book Reviews JNeuro- Ophthalmol, Vol. 24, No. 2, 2004 Multiple Sclerosis: Current Status and Strategies for the Future Janet E. Joy and Richard B. Johnson, Jr, Editors. National Academy Press, Washington, DC, 2001. ISBN: 0- 309- 07285- 9. $ 57.95 Scope: This is a multi- authored and multidisciplinary textbook by the Committee on Multiple Sclerosis ( MS), intended to review current knowledge so that future research dollars can be best directed and allocated. The effort included input from patients with MS. This approach allows for appeal to educated MS patients, neurology residents, primary care physicians, or general ophthalmologists. Contents: The Committee reviews the clinical manifestations of the disease in short synopses. Drugs in current use and research strategies are discussed with detailed recommendations for future studies. Strengths: Each section contains a gray shaded box with a simple, succinct summary of its contents. Various clinical symptoms and signs are reviewed with detailed medication alternatives, each with attendant side effects. The characterization and treatment of some of the symptoms ( cognitive impairment, spasticity, bladder dysfunction, pain, and fatigue) are very good. The chapters discussing future strategies for understanding disease mechanisms and potential therapies are also excellent. I especially valued the neurobiology section, with its discussion of purported roles of astrocytes and oligodendrocytes, the mechanisms of recovery of demyelinated axons and neuronal plasticity, and the interplay of immunology and gene expression. The validity of magnetic resonance imaging ( MRI) as a surrogate outcome measure is clearly and fairly presented. Weaknesses: The review of some of the symptoms and signs is superficial. Each of the current disease- modifying therapies and clinical options could be discussed in more detail. Modification of the pseudoexacerbation response is not discussed. The discussion of potassium and sodium channels and 4- aminopyridine is hidden in an appendix undergoing ongoing clinical trials. A better index, too, might also help this opus. Recommended Audience: This book has been well-designed to accomplish its task of helping to focus and direct research funding by presenting a simple overview of a very complicated field. The style of the chapters allows the text to appeal to people with varied backgrounds. Critical Appraisal: Why do we need another book on MS? Because this is a burgeoning research field with very complicated and ambiguous immune process contributions, and multiple therapeutic options. It is difficult to digest the whole " MS story" with the myriad of published papers, each presenting only a piece of the puzzle. This applies to the novice with a new interest in MS and to the clinician experienced in the field. Every health care worker who encounters MS patients would benefit from reading the compelling chapter on " disease management and measurement." Guidelines for how we deliver the diagnosis are practical and reassuring. The text reminds us that many patients do not want to know about demyelination, but rather about how to live. Although we sense this reality as physicians, we often revert to a more intellectual posture in our conversations with patients. The writing style of the book remains pleasantly clear, simple, and instructional, which is quite an accomplishment for a book with so many contributors. Pamela S. Chavis, MD Medical College of Virginia Richmond, Virginia Introduction to Functional Magnetic Resonance Imaging Richard B. Buxton. Cambridge University Press, Cambridge UK, 2002. ISBN: 5- 5215- 8113- 3. $ 160.00 Scope: A textbook that examines the subject of functional MRI. It provides a guide to the principles and application of functional MRI rather than a detailed mathematical treatment of the fundamentals and underlying physics. Contents: The book is organized into three parts, each of which has two sections. Part I is an introduction to functional neuroimaging in general. All the essential concepts are introduced and there is an overview of how functional MRI works and how it fits into the broader field of neuroimaging. Part IA describes energy metabolism of the brain, the nature of cerebral blood flow and oxygen metabolism, and basic nuclear medicine approaches to measuring these quantities. Part IB describes the basics of nuclear magnetic resonance, how an MR image is made, and how an MR signal can be related to functional activity. Part II focuses on the principles of MRI. Part IIA describes the nature of the nuclear magnetic resonance signal, sources of image contrast in MRI, and the sensitivity of the MR signal to local diffusion characteristics of tissue. Part IIB describes how the local MR signal is imaged, including the basic Fourier transform relationship ( the core of MRI), as well as the techniques for image acquisition, and noise and artifact analysis. Part III deals with the techniques used in functional MR. Part IIIA covers tracer kinetic studies, bolus tracking experiments with MR contrast agents, and arterial spin labeling techniques for direct measurement of cerebral blood flow. Part IIIB focuses on the blood oxygen level dependent ( BOLD) effects used in functional MR. 179 JNeuro- Ophthalmol, Vol. 24, No. 2, 2004 Book Reviews The appendix contains a thorough discussion of the physics behind nuclear magnetic resonance reflective of the author's expertise in this field. A CD- ROM is included with the figures used in the book. Strengths: This text is well- written and readable. It balances theory with clinical application. For those readers wishing greater detail in mathematical theory, the author provides gray, highlighted areas that can be read in addition to the basic text. The CD- ROM is easily downloadable and contains images of figures used throughout the book. Weaknesses: A welcome addition would have been a section dealing with future directions of research and applications of functional MRI, including BOLD effect. Recommended Audience: Active neuroscience investigators using functional MRI in their research as well as new investigators or clinicians without previous knowledge of the field will find this text easily readable and thorough. It has much to offer the neuro- ophthalmology community. Critical Appraisal: The author provides an excellent manual on an ever- expanding field. His expertise rings solidly throughout this work. It will no doubt be a great resource for both researcher and clinician alike. Ron Braswell, MD University of Mississippi School of Medicine Jackson, Mississippi Magnetic Resonance in the Diagnosis of CNS Disorders Vaso Antunovic, Zvonimir Levic, Gradamir Dragutinovic, andMiroslav Samardzic. Thieme, Stuttgart, 2001. ISBN: 88- 7141^ 444- 6. $ 129.00 Scope: This is a multiauthored hard- cover text that surveys MRI findings in a broad range of disorders commonly seen in neurologic and neurosurgical practice. The monograph does not cover such newer techniques as FLAIR, diffusion and perfusion- weighted imaging, MR spectroscopy, or functional MRI. Orbital imaging is not included. Contents: The book begins with a short chapter encompassing the basic physics of MRI, definitions of the various imaging sequences, uses of paramagnetic contrast media, and some features of normal MR anatomy. The remaining chapters are arranged logically according to disease processes, with chapters on cerebrovascular disease, trauma, intracranial infection, degenerative diseases, and tumors. Another chapter is devoted to MR angiography. An additional chapter is devoted to MRI in children. Strengths: The book contains dramatic representative images illustrating common MRI findings of the more common neurologic disorders, accompanied by one or more representative images illustrating disorders in their very advanced stages. Weaknesses: The illustrations are not of the highest resolution, although generally sufficient to illustrate pathology. The book omits many of the newer imaging techniques that have extended the usefulness of MRI. The chapter on pediatric disorders contains no text, with but nine illustrations and captions. The radiologic features of illustrations are not detailed, and no differential diagnosis is given. A brief discussion is included in the section on most disease entities, but the depth of clinical information is inconsistent and at times dogmatic and lacking in subtlety. Recommended Audience: This text might be of value to medical students rotating through neurology, neurosurgery, or neuro- ophthalmology services. They would appreciate the radiologic images demonstrating gross pathology. Having mastered these images, they could graduate to more advanced neuroradiologic material. The book cannot be recommended for specialty trainees or practitioners in any of the neurologic disciplines. Critical Appraisal: The radiologic images do not offer the breath and depth of MRI findings for most disorders, and little attention is given to subtle and early findings in either rare or common conditions. Thorough differential diagnoses are rarely offered. The text seems destined for a secondary role in the more sophisticated medical libraries and likely will not command much loyalty or success. Joel M. Weinstein, MD University of Wisconsin School of Medicine Madison, Wisconsin Cerebrovascular Disease Pak H. Chan, Editor. Cambridge University Press, Cambridge, 2002. ISBN 0- 521- 80254- 7. $ 130.00 Scope: This is a multi- authored collection of conference proceedings assembled and collected for scientists and clinicians interested in stroke. Contents: The text is the memorialization of the Proceedings of the 22nd Princeton Conference on Cerebrovascular Disease of March 2000, in 10 sections, 36 chapters, and 460 pages. It illustrates the immense understanding of the fine 180 © 2004 Lippincott Williams & Wilkins Book Reviews JNeuro- Ophthalmol, Vol. 24, No. 2, 2004 natural balance of central nervous system function and the interwoven reactions to ischemia. The breath of material covered is impressive. We are reminded that " a strong case can be made for molecular oxygen in the air we breathe being the most dangerous toxin and carcinogen in the environment" and appraised of the dangers of peroxynitrite anions ( derived from nitric oxide and superoxide anions). There is a concise review of drags that prevent excessive activation of NMD A receptor- operated ion channels, a discussion of apoptosis and other possible programs of cell death, and explanation of the potential role of astrocytes in ischemic brain injury. The importance of the vast difference in glial cell numbers between the rodent brain, which is the most commonly used experimental model, and the human brain, is highlighted. In the rodent brain there are approximately equal numbers of glial cells and neurons, whereas in the human brain, more that 90% of all cells are glia. Despite this immense knowledge, no effective therapies are available. The book's closing chapters ask, what have we learned? Justin A. Zivin attempts to answer and outlines the reasons why clinical trials of neuroprotective agents have yet to produce significant improvements in outcome after stroke. Strengths: The symposium offers a comprehensive and accessible review of current theories of cellular and molecular mechanisms of damage, methods of assessment of ischemic damage by MRI, and potential therapeutic pathways in cerebral ischemia. Weaknesses: This is not your basic primer on cerebrovascular disease. Indeed, this is not for the faint of heart. There is an overwhelming and potentially bewildering amount of information for readers without thorough background knowledge or the time to fully assimilate all the papers presented. Recommended Audience: The clinician with a general interest in neuro- ophthalmology may enjoy browsing though the book to acquire an understanding of the complexity of the molecular and cellular processes initiated by cerebral ischemia. Anyone with a specific clinical or research interest in ameliorating the consequences of cerebrovascular disease will appreciate the availability of such a comprehensive review. Critical Appraisal: To some this book will be full of hope, to others it will be full of despair. As noted by Kennedy R. Lees in chapter 35 (" Prospects for Improved Neuroprotection Trials in Stroke"), the experimental basis for neuroprotection is well- founded. Many drags acting by a variety of mechanisms can be administered up to several hours after the ischemic insult and reductions in infarct volume can be demonstrated. Numerous strategies have been sufficiently convincing to encourage such clinical development; unfortunately, the range of drags and mechanisms that have been tested in the clinic exactly parallels the list of those that have failed. And so the paradox becomes obvious. Paul Riordan- Eva, FRCOphth King's College Hospital London, United Kingdom The Aging Brain Lawrence Whalley. Columbia University Press, New York, 2001. ISBN: 0- 2311- 2024- 9. $ 58.00 Scope: This eighth volume of the Maps of the Mind series continues the presentation of mind- brain issues targeting a lay population while remaining mindful of a medical audience. Contents: The book's 10 chapters define aging in terms of its physical, social, and psychologic impacts. The author clearly presents research and discussions on the spectrum of life cycle changes of the human brain. This includes a spectrum from normal aging to dementia and its possible modulation. Included are general reference and a bibliography of primary sources. Strengths: The author thoughtfully covers a surprising range of contemporary brain and mind research and concepts. The succinct style and casual presentations make it a painless perusal. An unusual feature of this book is the incorporation of social and environmental issues. Their integration reflects the author's expertise and experience as a professor of mental health at the University of Aberdeen, Scotland. Weaknesses: Paradoxically, the book's strengths are also its weaknesses. References are not annotated and the tone is too colloquial, weakening its scientific rigor. Only one page, for example, targets an ophthalmologic audience and relates predominantly to visual sensory loss with age and its consequences. Recommended Audience: The text is particularly useful for the physician interested in the effects of aging or for those not familiar with modern concepts of brain- mind issues, aging, and dementia. Much in the text will also be of interest to the lay public and to patients looking for more information about geriatric neurobiology. Critical Appraisal: This is a succinct book incorporating a surprising breadth of contemporary neuroscience, easily digestible, with many thoughtful and innovative concepts about aging and the brain. Although it is a pleasurable read for anyone, it is unlikely to further educate those currently active in the medical specialties of brain or mind. Roy J. Meckler, MD The University of Louisville School of Medicine Louisville, Kentucky 181 JNeuro- Ophthalmol, Vol. 24, No. 2, 2004 Book Reviews HIV/ AIDS and the Eye: A Global Perspective Emmett T. Cunningham, Jr, MD, PhD, MPH, and Rubens Belfort, Jr, MD, PhD, MBA. American Academy of Ophthalmology, San Francisco, 2002. ISBN: 1- 5605- 5264- 6. $ 68.00 Scope: This is one of the Academy's ophthalmology monographs, number 15 in the series, that addresses human immunodeficiency virus ( HIV) and its manifestations within the eye. It is a component of the " lifelong education for the ophthalmologist" ( LEO) series designed to provide a framework to assist members and practitioners in their continuing medical education. The series includes a vast array of clinical products and programs that form the core of self-directed, individualized, continuing medical education and re- certification for the practicing clinician. Contents: This monograph is divided into nine chapters, beginning with epidemiology, continuing through molecular mechanisms and prevention of HIV transmission, culminating in focal anatomic declaration of HIV infection. The clinical chapters include adnexal and orbital disease, anterior segment manifestations, posterior segment manifestations, neuro- ophthalmic manifestations, and manifestations in children. The closing chapter addresses ophthalmic manifestations of HIV in the developing world. The book concludes with an epilogue entitled " From Despair to Hope." The text includes generous photographs, with some in color, clearly presented tables and figures, and an extraordinarily sophisticated and straightforward writing style. Strengths: The monograph is assembled by two unusual and talented clinical scientists. The authors are sophisticated and multidimensional practitioners schooled in ocular manifestations of inflammatory disease. In addition, Dr. Cunningham holds a degree as master of public health, so that he is eminently qualified to speak to the larger world health care issues of endemic HIV infection. Dr. Belfort provides the perspective of one based in South America who has been President of the World Uveitis Symposium and the Pan American Congress of Ophthalmology. The strengths of this book are the photographs, the organization, the clarity of writing, the tables, and the cited bibliography. Weaknesses: The only thing I could think of as a deficiency is the lack of an accompanying CD- ROM to allow access electronically to the wonderful figures. Critical Appraisal: The success of this monograph is the simplicity of its presentations and the clarity of its illustrations. The text is also exemplary. If one wants a single singular summary of HIV as it affects the eye, this monograph is it. Recommended Audience: The book is a wonderful summary, quick review, and appropriate overview for anyone interested in HIV infection and its effects within the visual system. It offers the strength of an atlas and the simplicity of outline presentation. Barrett Katz MD, MBA The George Washington University School of Medicine Washington, DC The Requisites in Ophthalmology: Retina, Choroid, and Vitreous Jose S. Pulido, MD. Mosby, St. Louis, 2002. ISBN: 0- 3230- 0237- 4. $ 92.00 Scope: This book is one of the " Requisites in Ophthalmology" series edited by Jay H. Krachmer, MD, chair of the Department of Ophthalmology, University of Minnesota Medical School. The author, professor, and director of the Eye and Ear Infirmary in the Department of Ophthalmology and Visual Sciences at the University of Illinois at Chicago has written this volume to serve as an introduction for ophthalmology residents to diseases of the posterior segment. Contents: Organization nicely follows clinical paradigms of examination of the posterior segment. Also included are discussions of relevant anatomy, an overview of surgical techniques, appropriate ancillary testing, and discussions of fluorescein angiography. The text proceeds according to specific disease types. Topics include diabetic retinopathy, arterial and venous disease, retinitis pigmentosa, age-related macular degeneration, tumors, phakomatoses, peripheral retinal disease, toxicities, infectious and inflammatory disease, and trauma. Strengths: There are excellent photographs, many in color. The book is superbly organized, quite practical to read from cover to cover, and useful as a reference on a single subject. It covers very well the underlying anatomy, common causes, and current therapies. Weaknesses: The text lacks timely references. By design, the book is a distillation of many sources of knowledge not always derived directly from literature. Indeed, the intent of this book is that it be read as a general learning tool rather than as a conduit to primary sources. Recommended Audience: This fine book will provide an excellent beginning for residents in ophthalmology. Critical Appraisal: The author brings forth his formidable skills and clinical experience. I recommend adding this text to the readings of residents and as a component of every practicing ophthalmologist's library. Along with the 182 © 2004 Lippincott Williams & Wilkins Book Reviews JNeuro- Ophthalmol, Vol. 24, No. 2, 2004 American Academy of Ophthalmology's Basic and Clinical Science series, this book will provide a solid foundation for a lifetime of study. Mitchell Vincent Gossman, MD St. Cloud, Minnesota Clinical Retina David A. Quillen and Barbara A. Blodi, Editors. AMA Press, Chicago, 2002. ISBN 1- 57947- 284- 2. $ 149.00 Scope: A multiauthored textbook and atlas that presents a wide spectrum of information about both common and less usual retinal diseases. The book's goal is to provide medical students and ophthalmology residents with essential information about medical retina. Contents: The text follows the traditional classification of retinal diseases. It is structured into 15 chapters and covers all aspects of retina, from anatomy and physiology to laser photocoagulation and PDT. Each chapter is structured to have text on the left, with accompanying images or illustrations on the right. Chapters are subdivided into sections: general information, symptoms, clinical features, ancillary testing, pathology/ pathogenesis, treatment/ prognosis, and systemic evaluation. Every chapter ends with timely references. There are nice summaries of macular diseases, retinal vascular diseases, hereditary retinal disorders, drug toxicities, intraocular tumors, inflammatory diseases, trauma, peripheral retinal diseases, and diseases of the vitreous. There is a fine summary of the histopathology of retinal diseases that deserves particular mention. There is a chapter on clinical trials, including diabetic retinopathy, retinal vascular diseases, retinopathy of prematurity, and newer therapies for macular degeneration. The book itself is complemented by an accompanying CD- ROM, which contains all the photographs and illustrations displayed. Strengths: The most successful features of this book are its iconography, the high quality of images, and the cogent text. An innovative layout permits quick access for consultation, and the many tables allow the reader to assemble a useful differential diagnosis. The enclosed CD- ROM is a source of delight for the expert ophthalmologist as well as a source of new knowledge for students and residents. Weaknesses: The alphabetical order in which diseases are presented can lead to some difficulty in making appropriate clinical connections and cross- referencing information. Recommended Audience: Although this textbook- atlas is designed especially for medical students and ophthalmology residents, specialists too may also appreciate it. The neuro- ophthalmologist will be especially interested in presentations of the white dot syndromes and acute zonal occult outer retinopathy. The 800 fine photographs and many comparative tables and the summary guidelines from more recent trials make the book a useful reference tool. Critical Appraisal: I found this to be an engaging book that gave me the opportunity to see representations of rare diseases not commonly encountered. The contributing authors assembled by the editors are expert in retina disease. Antonio Caccavale, MD Magenta and Abbiategrasso General Hospital Abbiategrasso, Italy Pediatric Eye Disease: Color Atlas and Synopsis Richard W. Hertle, David B. Schaffer, and Jill A. Foster. McGraw- Hill Publishing, New York, NY, 2002. ISBN: 0071365095. $ 59.00 Scope: This short pocket text provides a brisk visual overview of common pediatric eye disease. The focus is on appearance and pattern recognition as well as the differential diagnosis of the more common ophthalmic pathologic processes in childhood. Contents: The book is a 247- page multi- authored text divided into five parts emphasizing those pediatric ophthalmic conditions seen at differing ages. Section I, neonatal eye disease, includes six chapters covering ophthalmia neonatorum, TORCH syndromes, cataracts and developmental anomalies of the lens, glaucoma and developmental abnormalities of the anterior segment, congenital anomalies of the lid and orbit, and retinopathy of prematurity. Section II, ophthalmic disease in infants, covers strabismus in infancy, systemic genetic craniofacial syndromes with ophthalmic involvement, developmental vitreoretinal disease, optic nerve anomalies, ophthalmic involvement in non- accidental trauma, and nasal lacrimal duct obstruction. Section III moves on to ophthalmic disease in toddlers, and covers amblyopia and strabismus, ophthalmic infections and inflammation, ptosis, orbital tumors, and intraocular and surface tumors. Section IV covers ophthalmic disease in school- aged children, including uveitis, nystagmus and anomalous head postures, vision development testing and visual screening, refractive errors and further orbital tumors in the young children. Section V covers accidental trauma and spectacles in infants and children. Each chapter has been designed to emphasize definition, differential diagnosis, work- up, treatment, and conclusions. Each chapter also includes up- to- date references. The most compelling contents are the pictures themselves, located at the end of each chapter. 183 JNeuro- Ophthalmol, Vol. 24, No. 2, 2004 Book Reviews Strengths: With the exception of dermatology and radiology, no field in medicine is as pattern recognition- oriented as ophthalmology. It is a weakness of many extensive texts in ophthalmology that illustrations are inadequate. That is not a weakness here. Most of the pictures presented make their points well, are of high quality, and are in color. The organizational system of patient age is user- friendly. The capsule vignettes on each diagnosis are good. Without question, however, the greatest strength of this atlas is the quality of its photographs. With only rare exception ( the Peter's anomaly could be replaced and several of the pictures could be better cropped), the photographs are first-rate. They go a long way toward illustrating many of the important disease processes seen by the generalist as well as the pediatric ophthalmologist. This book would even be appropriate in a pediatrician's office, because it gives a rapid capsule summary as well as pictures to compare. Weaknesses: Although the authors have gone to great lengths to maintain uniformity of chapters, there are significant variations. It may be unnecessary to have a second chapter on orbital tumors in " young children," because there is some degree of duplication with the earlier orbital tumor chapter; the two could have easily been combined. Separating non- accidental from accidental trauma seems artificial. The final chapter on spectacles in infants and children could have been included in earlier discussions of refractive errors. Recommended Audience: This is a handy text for residents doing their pediatric ophthalmology rotation. It clearly supplements the excellent American Academy of Ophthalmology's Basic and Clinical Science Course section VI by including many more illustrations of common pediatric disease. The atlas would find a very nice home in the office of general ophthalmologists who see children and practicing pediatricians. Critical Appraisal: Although suffering from some rough spots and variability, this text accomplishes its goal quite well. The pictures are good, the text is easy to read, and a wide spectrum of pediatric pathology is concisely presented. Steven A. Newman, MD The University of Virginia School of Medicine Charlottesville, Virginia Field Guide to the Eyes Jonathan D. Trobe, MD and Richard E. Hackel, MA, CRA. Lippincott Williams & Wilkins. Philadelphia, USA, 2002. ISBN 0- 7817- 3168- 2. $ 32.95 Scope: This slim, pocket- sized, heavy- jacketed paperback, written by an ophthalmologist and an ophthalmic photographer, is intended to help the primary care physician identify eye problems in much the same way one might identify birds with binoculars by their salient visual characteristics. Contents: There are 80 eye conditions sighted, each accompanied by one or more clinical photographs. These illustrations are usually of excellent quality. Each is discussed in stylized fashion, asking six questions: what is it?, what does it look like?, what else looks like it?, how do you diagnose it?, how do you manage it?, and what is its outcome? There are several appendices that do not follow this pictorial format yet discuss diagnosis and management of common ophthalmic symptoms, such as transient visual loss and flashes and floaters. Ophthalmic screening tests and ancillary examination techniques are presented and well summarized. Strengths: The clinical photographs make compelling visual aids to the accompanying text. In general, the conditions discussed are important for the primary care physician to be able to identify and manage, or refer, if and when appropriate. For such a slim volume, which could be read completely on a one- hour airplane trip, it is a rather complete, succinct guide for common ( and even some uncommon) ophthalmic problems. Weaknesses: Some of the conditions do not easily lend themselves to " the six questions" approach. At times, the ability of the primary care physician to manage a problem seems to depend on the use of equipment that he/ she may not have available ( loupes or a slit lamp in the case of a corneal foreign body). Also, some of the clinical pictures are not as convincing as they could be ( angle closure and subconjunctival hemorrhage, both of which are important for primary care providers to recognize). Recommended Audience: Primary care physicians are the stated readers to whom the volume is directed. Emergency room physicians might also find the book helpful. A neurologist entering a neuro- ophthalmology fellowship might also find the book useful, as might allied health personnel who triage eye care. Those with more formal training in ophthalmology will value the excellence of its clinical photography. Critical Appraisal: This fine book fulfills its mission well for its target audience and can be recommended to anyone for its excellent clinical ophthalmic photography. It will not be of especial appeal to a tertiary neuro- ophthalmic audience. One of many " field guides" already published, this one should be the " National Audubon Society" equivalent for the eye. Lyn A. Sedwick, MD Orlando, Florida 184 © 2004 Lippincott Williams & Wilkins |
