Book Reviews

Section 3 is devoted to chapters including the OpticNerve, Clinical Evaluation of the Optic Nerve Head,Glaucomatous Optic Neuropathy, Quantitative Imagingof the Optic Disc, Evaluating the Nerve Fiber Layer, andPerimetry. Excellent diagrams, photos, and scanningelectromicrographs are skillfully intertwined in order togive the reader a truly crisp understanding of these top-ics. The chapter entitled Glaucomatous Optic Neuropa-thy was, personally, fascinating to read.

Section 4 describes the various forms of glaucomas.This ranges from chapters 14 through 30. In these chap-ters, the authors discuss the various classifications ofglaucoma, such as Primary Open-Angle Glaucoma,Angle Closure Glaucoma, Childhood Glaucoma,Steroid-Induced Glaucoma, Pigmentary Dispersion Syn-drome, etc. It is a well-outlined list of the various formsof glaucoma, and breaks glaucoma down into anextremely logical listing. It discusses such issues as thepathophysiology and microanatomy of the glaucomas,as well as clinical presentation and therapy. As in priorsections, the images and diagrams are exquisitely inte-grated into the text in order to make it more understand-able and more memorable for the long-term. Forexample, there is an exquisite image of a goniotomyprocedure. Likewise, there is an excellent photo of a sur-gical trabeculotomy. These are just examples of some ofthe teaching aides that are used in this text. Throughoutthe section, there are highlighted “pearls,” as well ashighlighted issues of “controversy.” This is very helpfulin understanding the latest state-of-the-art in the field ofglaucoma considering that the numerous authors in thistext are some of the world’s leading experts in the fieldof glaucoma.

Section 5 is entitled “Medical Therapy of Glaucoma.”This is separated into eight chapters. The breakdown islogical and classical. It begins with a chapter calledPrinciples of Ocular Medications, and then proceeds tolist the different classifications of medications in indi-vidual chapters, such as Adrenergic Agonists, Adrener-gic Antagonists, and Cholinergic Agents, etc. Again,the degree of scientific information brought into the

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Glaucoma: Science and Practice. Editors: John C. Morrison and Irvin P. Pollack. 2003.Thieme New York, 333 Seventh Avenue, NY, NY 10001. 530 pages. ISBN: 0-86577-915-5

This is a 530-page text printed on high-quality papersuch that the photos are excellent in quality. The twoeditors of this textbook are complimented by 60 con-tributors. The book is broken into seven sections,including “Epidemiology and Genetics of Glaucoma,”“Determinants of Intraocular Pressure,” “The OpticNerve,” “The Glaucomas,” “Medical Therapy of Glau-coma,” “Laser Therapy of Glaucoma,” and “SurgicalTherapy of Glaucoma.” This is a very logical break-down of this extensive material.

The section entitled “Epidemiology and Genetics ofGlaucoma” is extremely important and is covered com-prehensively. We all know that there are various propen-sities of different ethic groups to develop glaucoma.This should certainly be taken into consideration whenapproaching and diagnosing glaucoma. Chapter 2 onglaucoma genetics is a short description of the geneticsof glaucoma. It is certainly not a researcher’s approachto glaucoma; however, this chapter presents an excellentdescription for the clinician in the field. Although pre-sented in a highly graphic fashion, the chapter is basedon the latest research facts and data.

Section 2 is the “Determinants of Intraocular Pres-sure.” This section is broken down into five chapters,including Anatomy and Physiology of Aqueous HumorFormation, Anatomy and Physiology of Aqueous HumorOutflow, Gonioscopy, Intraocular Pressure and Tonome-try, and finally, Aqueous Humor Dynamics. This is areally interesting handling of this material. The imagesthat are presented are exquisite and the diagrams are veryhelpful in retaining this somewhat complicated material.The microanatomy is complimented by graphic scanningelectronmicroscopy. I particularly enjoyed the chapter ongonioscopy with its discussion of various modalities ofgonioscopy, including some history of gonioscopy, whichoutlines how the technique has evolved.

Richard Fugo, MD, PhD

discussion is more than satisfactory for a clinically oriented text. They present salient issues and discussthem in various subsections, such as “pearls” and “pit-fall” sections.

“Laser Therapy of Glaucoma” is the title of Section 6,which is divided into four chapters. The four chaptersprovide a nice outline for reading in a logical fashion andincludes Basics of Lasers, Laser Trabeculoplasty, LaserIridotomy, and Cyclodestruction. All of these chaptersare reader-friendly and discuss these approaches in arather enjoyable fashion for the reader. Not only do wecome away with significant understanding of the mate-rial, but we do so without struggling to read the text.

Section 7 is the called “Surgical Treatment of Glau-coma” and is divided into four chapters, including Fil-tration Surgery, Cataract Surgery and Glaucoma,Aqueous Shunts, and Ocular Hypotony. The section isfilled with descriptive diagrams outlining a step-by-stepapproach to performing the surgical procedures. Thissection, however, has very limited coverage on the topicof subconjunctiable lymphatics because this is a fairlyrecent finding in ophthalmology and was presented in anoriginal article in a 2004 issue of the Annals of Ophthal-mology. I suspect that future revisions of this book willprovide an in-depth review and provide adequate atten-tion to this very important new system. Likewise, a lackof understanding of the importance of the lymphatic sys-tem places a crimp in the discussion on filtering blebs.With a subconjunctiable lymphatic system, we now havea renewed understanding of why some blebs becomelarge, whereas others are flat. We also have a much bet-ter understanding of why a large bleb is not necessarily agood bleb and could well be an indicator that the sub-conjunctiable lymphatic system in the area of the bleb isdamaged or insufficient. Nonetheless, the sectionpresents some rather interesting material. The section onaqueous shunts is quite comprehensive and I enjoyedreading the section, along with the views of the authorsregarding this topic. I personally am not a big fan ofaqueous shunts, and I do believe that filtration directlyfrom the posterior chamber in difficult cases as per-formed in transcillary filtration is a much healthier andsafer approach to aqueous drainage than the more com-plicated aqueous shunts that are currently implanted.Nonetheless, the chapters fail to address the posteriorchamber filter drainage mechanism of transciliary filtra-tion mainly because the material is so new, with Foodand Drug Administration clearance for transciliary filtra-tion coming as recently as October 2004.

In conclusion, I found this to be a truly fascinatingbook on the topic of glaucoma. This is a wonderful textfor any level of reader anywhere from a physician’s

assistant to a general practitioner, a neurologist, and cer-tainly to an ophthalmologist at any level of training.Even specialist in areas such as neuroophthalmology orretina would be well served to read this text because itso nicely outlines the various aspects of glaucoma in anenjoyable fashion. The text is not only enjoyable to read,but it is a very instructive text in the sense that it allowsone to retain the material because it is so well illustratedand logically outlined. For these reasons, I give this a 3-out-of-4-star rating and would recommend this as a “tobe purchased” text in the field of glaucoma.

Richard J. Fugo, MD, PhD

Clinical Pathways in Neuro-Ophthalmology:An Evidence-Based Approach.Written by Andrew G. Lee and Paul W. Brazis.2003. Thieme New York, 333 Seventh Avenue, NY, NY 10001. 486 Pages. ISBN: 1-58890-136-X.$DDD.CC.

This is a 486-page text that approaches neuro-ophthalmology from a rather unique point of view;namely, an evidence-based approach. This approach isquite different than most texts, and this will becomeevident as I discuss this book in further depth. The fore-word of Clinical Pathways in Neuro-Ophthalmology: AnEvidence-Based Approach is written by the renowned Dr. Neil R. Miller, who praises this extremely fine work.

Chapter 1 discusses the diagnosis of optic neu-ropathies. It poses questions such as: can the appearanceof the optic nerve differentiate pathological etiology? Isthe clinical presentation typical for anterior ischemicoptic neuropathy? Is the clinical presentation typical foroptic neuritis? Key questions are posed concerning thepathology in question and then followed by a very luciddiscussion to help unravel pertinent information. Thereare diagrammatic flow charts that are very helpfulthroughout this text, and the clinical features tablesstrategically placed throughout the text are also veryhelpful. For example, on page 7, the clinical features ofan optic glioma are listed in an outline format. Thisprovides a wonderful method of distilling an immenseamount of data in a simple and easy-to-remember format.

The other interesting point of this book is that it is soheavily laden with pertinent references. You would expectthis amount of references in a major comprehensive stan-dard textbook on the subject. The discussion on diagnosisof optic neuropathies is absolutely enchanting. They’vedistilled a great deal of information and presented it as aneasy to ready and very enjoyable format. Again, the end ofeach chapter provides a wealth of pertinent, excellent ref-erences to key in on and discuss the topic in further depth.

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Chapter 2 deals with optic neuritis, which is brokendown into anterior optic neuritis and retrobulbar opticneuritis. The questions that are asked include: what arethe features of typical optic neuritis? What visual fielddefects are noted with optic neuritis? Again, the textprovides excellent table outlines and in this case, there isan outline listing the clinical profile of the optic neuritistreatment trial. This is very helpful and, at a glance,provides a wealth of information. The number of ques-tions that are posed and then answered is impressive.

Chapter 3 deals with optic disc edema with a macularstar (ODEMS) and neuroretinitis. A short summarybegins the chapter after which they ask imposing ques-tions, such as: what are the clinical features of ODEMSand optic neuritis? What is the etiology and differentialdiagnosis of ODEMS and neuroretinitis? They have anexcellent table on infectious etiologies of ODEMS andneuroretinitis. This is an excellent synopsis of this topic.The authors then proceed with a delightful analysisregarding the prognosis of cases of ODEMS.

Chapter 4 deals with nonarteritic ischemic optic neu-ropathy. We are all interested in this topic because of itsimmense clinical implications. This chapter proceeds bydiscussing the clinical features of this problem, as wellas other conditions associated with this pathology. Clini-cal features of the pathology are discussed and outlinedin an excellent table format. Treatment is managed in a very interesting fashion. They look at standardlyaccepted treatments, as well as some otherwise morecontroversial potential treatments.

Chapter 5 discusses arteritic anterior ischemic opticneuropathy and giant cell arteritis. This always seems to bea popular topic in neuro-ophthalmology because of theimmense and rapid implications that this pathology bringsto the table. This book discusses the value of sedimenta-tion rates, as well as other hemotological tests in the diag-nosis of the pathology. The issue of artery biopsy is verynicely covered. They break suspicion of giant cell arteritisinto moderate clinical suspicion and low clinical suspicion,then proceed on with a preferred treatment regimen forthis pathology. One topic that was quite popular severalyears ago was the issue of giant cell arteritis and ocularblood flow. There have been several methods of ocularblood flow evaluation and measurement, which have beenutilized including Doppler and orthopantomography(OPG) machine analysis. The Gee-OPG machine wasprobably the finest OPG device to evaluate ocular bloodflow. There are several excellent Doppler devices that havebeen in use. I personally have performed OPG ocularblood flow analysis and found them to be quite accurate.The neuro-ophthalmology lab at the Wills Eye Hospital inPhiladelphia, PA wrote several papers on this modality and

were very enthusiastic in those journal articles. However,they then began to rely more heavily on Doppler bloodflow as time progressed.

Chapter 6 covers traumatic optic neuropathy. Thisaddresses a whole host of potential issues from fractureto tissue inflammation, then treats it quite sufficientlyand interestingly.

Chapter 7 covers the topic of papilledema. It definespapilledema, and then, it approaches the issue of distin-guishing real papilledema from pseudo-papilledema. Itthen evaluates the issue of optic disc drusen. Numerousdisc swelling issues are raised with excellent gradingsystems as well as charts. The topic of pseudotumorcerebri syndrome is extremely well covered.

Chapter 8 deals with transient visual loss. The textbegins with questions that should be asked of a patientwith transient visual loss. I believe that this is a reallypertinent section and is very helpful because many times,appropriately asked questions can almost secure a diag-nosis before the exam begins. A host of excellent flowcharts summarize how we should approach transientvisual loss from a diagnostic and testing point of view.

Chapter 9 deals with visual field defects. This is cer-tainly a bread and butter topic in the field of ophthalmol-ogy and must be understood by every ophthalmologist.Again, the text is filled with excellent flow charts andtables outlining information in order to simplify possiblevisual field defects. The causes of such visual defectsare quite extensive and the book provides an excellentsource of pinpointing visual field defect etiology.

Chapter 10 deals with diplopia. This is really a well-outlined chapter and gives you an excellent path to studyand interpret the issue of diplopia.

Chapters 11, 12, and 13 cover third nerve, fourthnerve, and sixth nerve disorders. These chapters areorganized in a very challenging fashion. They probe top-ics such as the importance of ptosis and pupil abnormal-ities. The material in these three chapters of course isextremely important and they handle it in a very freshfashion. There are numerous charts and graphs to helpthe reader, as well as excellent references to allow thereader to delve deeper into a given topic.

Chapter 14 is dedicated to supranuclear disorders ofgaze. Chapter 15 is focused on ocular myasthenia gravis.Chapter 16 explores thyroid eye disease, and chapter 17looks at nystagmus. The last three chapters include pto-sis, lid retraction and lid lag, and then finally anisocoriaand pupillary abnormalities.

It is hard to find something that you really don’t like aboutthis book. It certainly is not a standard comprehensivetext, but on the other hand, it presents neuro-ophthalmologyin a fresh and very interesting perspective.

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I really enjoyed this text because it does provide a uniqueview of neuro-ophthalmology. We don’t frequently see themore esoteric neuro-ophthalmological diseases in basicclinical practices. Nonetheless, as an ophthalmologist, wemust be familiar with the most important aspects ofneuro-ophthalmology. This book fits in beautifully withall ophthalmologists, as well as neurologists. In conclu-sion, I would say that this book is a “keeper.” It certainlyis a book to be read by medical students and residents, butit also is a book to be read by the resident-in-training, aswell as the ophthalmologist out on the “front lines” inophthalmic practice. It is such a delightful book to readthat this book makes neuro-ophthalmology as fun of a

subject as I think it can possibly be made. The bookdeserves a place in all ophthalmic libraries because of itsunique approach, as well as its really effective manner ofdisseminating the large volume of information, which wehave come to call neuro-ophthalmology. I give this a 3 star rating out of 4.

Richard J. Fugo, MD, PhDSenior Medical Editor

AcknowledgmentThank you for extensive technical assistance of Nicole V. Fugo.

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