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Eye Examination and Refraction.
  1. J A SCOTT

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    Eye Examination and Refraction. 2nd ed. By R J Fletcher, D C Still. Pp 288, £29.95. Oxford: Blackwell Science, 1998. ISBN 0-632-05141-8.

    This paperback book is part of a series written for optometry students preparing for their final professional qualifying examination. The ophthalmologist, in preparation for optics and refraction examinations or wishing to revise issues of refraction and spectacle prescription in clinical practice, may find it useful, however, as it raises practical problems to which answers may not be easily accessible in other texts—for example, manufacturing imperfections of trial lens sets or dealing with unfamiliar equipment.

    Divided into three sections, the first concentrates on the optometric eye examination and a review of necessary equipment for setting up a practice. Basic examination techniques, courtesies, and the issues and responsibilities in the maintenance of clinical records are discussed. This material may not all be directly applicable to an ophthalmologist, but does lend insight to the perspectives of a fellow profession, from whom a large number of referrals are derived.

    Section 2 is devoted to the performance of refraction, with useful tips and advice on objective and subjective refraction, including reviews of estimation of refraction from Snellen vision testing, near addition prescribing, and the use of cross cylinders. Included is a chapter on the needs of special or more challenging patients.

    The final section, and probably most useful for the ophthalmologist, consists of 100 case histories of patients with proposed solutions presented for self assessment, or as a useful basis for discussion in a teaching group. These are not purely refractive cases, but include those with medical problems for whom optical correction has a role in rehabilitation.

    The appendices contain practice guidelines issued by the College of Optometrists and more self assessment.

    The book is written in a readable, chatty style with anecdotes and cautionary tales used to illustrate important clinical messages. The book is not a primer for the novice refractionist as it assumes basic knowledge and clinical method, nor is it a comprehensive manual of optics and refraction techniques, but rather an “experienced practitioner” offering a pragmatic companion to revision and refinement of technique “in the real world”. While some techniques are expounded at length, others are mentioned only in passing or merely referenced, with some references quite historical. The ophthalmologist will find some of the references unfamiliar, but will be clearly directed to the relevant material to pursue. The text emphasises the need for flexibility of approach and the importance of familiarity with more than one method of examination or approach to achieve a desirable outcome and to satisfy the foibles of colleagues (examiners!). Thus it brings together material which might be used in viva voce examinations.

    Overall, I found this an interesting read, with useful practical advice, and the case histories illuminating. I would direct the reader to peruse the introduction first so as to gauge the flavour of the text.

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