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Fundamentals of Clinical Ophthalmology: Glaucoma
  1. SHAN LIN

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    Fundamentals of Clinical Ophthalmology: Glaucoma. Ed Roger A Hitchings. Pp 232; £60. London: BMJ Books, 2000. ISBN 0727914480.

    This excellent, concise text covering the field of glaucoma is the latest in the Fundamentals of Clinical Ophthalmology series of monographs written for ophthalmologists in training and comprehensive practitioners. The stated goal of this collection is to provide updated, practical clinical information on each subject. Dr Hitchings has successfully fulfilled this aim by drawing upon the clinical expertise of notable glaucomatologists in the UK and around the world.

    A majority of the text has been dedicated to the diagnosis and management of primary open angle glaucomas. In the first chapter, “What is primary open angle glaucoma?,” Dr Hitchings gives the history of how POAG came to be understood by its current concepts. He also sets the philosophical tone for much of the remainder of the book by describing the present imperfections in determining progression and treatment needs. Subsequent chapters on epidemiology, clinical screening, and genetic screening are concise and well researched. The chapters describing the clinical features of glaucoma—optic disc features, glaucoma perimetry, and intraocular pressure—are well written and provide useful guidelines for assessing each aspect's role in glaucoma. Medical and surgical treatment options are covered in chapters 8–11. A must read for ophthalmologists in training is Dr George Spaeth's chapter on “Principles of treatment of glaucoma.” The uncertainties in determining the best course of treatment are addressed with a perspective towards the patient's overall health and needs. The identification of glaucoma progression is discussed in two chapters, one on visual fields and the other on optic disc cupping. Both describe standard methods and more recent techniques such as scanning laser polarimetry and confocal scanning laser ophthalmoscopy.

    Primary angle closure, the childhood glaucomas, and secondary glaucomas are covered in the last six chapters. All are excellently written with very good illustrations and photographs. Primary angle closure is often poorly understood among residents and general ophthalmologists. Classification, clinical features, epidemiology, mechanism, and management are presented in appropriate detail. Good quality ultrasound biomicroscopy (UBM) images effectively illustrate the various mechanisms of angle closure. The two chapters on paediatric glaucomas expertly cover the various types of glaucoma encountered in children and the many treatment options available. The final chapter is on secondary glaucomas and their treatments. Given the constraints of a single chapter, Dr Barton has done a splendid job of presenting this large and varied group of disease entities. In future editions, consideration may be given to expanding coverage of this section to two chapters.

    In summary, this primer on glaucoma from theFundamentals series is an excellent resource for those in ophthalmology training as well as general ophthalmology practice.

    Narrative Based Medicine, An Interdisciplinary Conference Research, Narrative, and Practice A two day conference—Monday 3rd and Tuesday 4th September 2001 Homerton College, Cambridge, UK

    BMJ Publishing Group

    For full details contact: BMA/BMJ Conference Unit, Tavistock Square, London, WC1H 9JP Tel: +44 (0)20 7383 6819; fax: +44 (0)20 7383 6663; email: clyders{at}bma.org.uk. www.quality.bmjpg.com

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