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The Glaucomas

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    The Glaucomas, 2nd ed. Ritch R, Shields MB, Krupin T. Pp 1783; £229. London: Mosby, 1996. ISBN 0-8016-77025.

    There have been major changes in the basic conception of glaucoma since the first edition seven years ago, particularly with the understanding that factors other than intraocular pressure are important. This has resulted in a new definition of glaucoma as “a characteristic optic neuropathy” and a proposed new classification of the glaucomas based on five stages of the disease process. This edition has grown by 17 chapters and there are now 1783 well illustrated pages contained in three volumes with 130 contributors, all but a handful from North America.

    The first volume covers the basic sciences with sections on anatomy, pathophysiology, and clinical measurement. Several additional chapters have been added in relation to the new concepts of optic nerve damage including those on genetics, animal models, growth factors, vascular regulation, and optic nerve regeneration The relevance of these in relation to future potential treatments is highlighted. In the second part, particularly, there is a constant emphasis on clinical applications, examples being excellent chapters on gonioscopy, ultrasound biomicroscopy, and visual field assessment.

    The second volume deals with the various clinical entities. The common and less common glaucomas are covered in depth . A lot of space is devoted to an unhurried discussion of the problems of diagnosis and management of the more difficult areas such as angle closure glaucoma, malignant glaucoma and normal tension glaucoma.

    The final volume is devoted to glaucoma therapy. There are sections on medical, laser, and surgical treatments with summary overview chapters on the management of chronic open angle and angle closure glaucomas.

    This is a large textbook and is a distillate of the present body of knowledge of the glaucomas. It is exhaustively referenced and therefore is an excellent tool for those involved in or embarking on research. There is a strong emphasis throughout the book, even in the basic science chapters, on the clinical aspects of glaucoma and the practical problems in management.

    The Glaucomas has the hallmarks of a classic textbook. The content is comprehensive and each topic is introduced with its historical background. The vast experience of so many experts is brought together in a way that reads coherently and easily, even with the occasional touch of humour, owing to the skilful editing.

    This is a splendid textbook that will prove indispensable not only for the glaucoma specialist but perhaps more pertinently for the general ophthalmologist whose practice will inevitably contain a large proportion of glaucoma patients.