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Laser Photocoagulation of the Retina and Choroid
  1. MARK COSTEN

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    Laser Photocoagulation of the Retina and Choroid. By Folk JC, Pulido JS. Pp 292; £75. San Francisco: American Academy of Ophthalmology, 1997. ISBN 1-56055-045-7.

    In the preface to this book, the authors state their aim to make this book both practical and useful—a “how to” on laser treatment. They have managed to achieve this goal as well as include considerable detail and suggestions for further reading.

    The book begins with an overview of the physics of lasers and the optics of laser delivery systems. It is possible to cover the material quite quickly, as the layout is uncluttered and interspersed with clear diagrams and tables, which aid memorisation of the important points. The complications of laser photocoagulation are covered in some detail, together with a description of the different wavelengths of lasers available and their different indications.

    With the exception of a chapter devoted to a selection of miscellaneous conditions at the end of the book, each major chorioretinal condition is allocated a separate chapter. There are chapters on diabetic macular oedema, proliferative diabetic retinopathy, retinal vein occlusion, peripheral retinal neovascularisation, including retinopathy of prematurity and choroidal neovascularisation.

    Each chapter begins with a section on clinical evaluation including presenting symptoms, signs, and guidelines on investigations. Considerable emphasis is placed on pretreatment planning and the preparation of patients, not only in deciding which course of treatment to take, but also what the patient should be told for the purposes of informed consent. This information is often presented in handy checklists, which stand out in the text. The authors take the reader through all the steps in planning a treatment session from the choice of laser, delivery system and lens, to the location and spot characteristics of the laser burn. For each condition, an impressive array of fundus photographs and fluorescein angiograms, both pre- and post-treatment are presented. Suggestions are made concerning the frequency and nature of post-treatment follow up and this is often illustrated with the inclusion of real clinical examples.

    The chapters on diabetic retinopathy are well referenced and treatment guidelines closely follow the ETDRS and DRS protocols. An extensive reading list is provided at the end of the chapters. One possible criticism is the lack of indexing of references within the text, which could make accessing a particular reference difficult.

    The authors add their own well reasoned suggestions for managing more complicated clinical situations and a section on “special cases”, where there are other coexistent ocular conditions, is included.

    An superb set of stereo fundus photographs and angiograms in slide form complement the chapter on choroidal neovascularisation. A stereo viewer is provided, which is very easy to use. At the start of the chapter, the reader is guided through the interpretation of both fluorescein and indocyanine green angiography.

    Advice is given on the management of recurrent choroidal neovascularisation post-treatment, and this is illustrated with clinical examples. The authors give their own guidelines for treating lesions near the fovea. There is an extensive presentation of the Macular Photocoagulation Studies’ findings in summary form, with references. This is a very useful feature and will no doubt be helpful to those preparing for clinical exams.

    Guidelines on the management of retinal tears and a variety of other retinal vascular and chorioretinal conditions are presented in a separate chapter. The book concludes with a number of self assessment MCQs. These are chapter based and broadly cover the information presented. Detailed explanations are provided with the answers.

    In summary, the book is compact, succinct, and easy to read with the essential information readily accessible through a well designed “contents” section. The treatment guidelines that are suggested are evidence based and follow the major multicentre trial findings. Important practical points are often included in highlighted checklists for easy reference. For those wishing to read further about a particular subject the reading lists are very comprehensive. With its practical emphasis, it would be a welcome addition to any eye department library.

    I think individuals preparing for clinical examinations would also find this book helpful, as would anyone wanting to learn how to perform laser treatment safely and effectively.

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