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Practical Ophthalmology—a Manual for Beginning Residents
  1. J A SCOTT

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    Practical Ophthalmology—a Manual for Beginning Residents. By Fred M Wilson II. Pp 415. £27 (Members of BMA and AAO £25.) San Francisco: American Academy of Ophthalmology, 1996. ISBN 15 605 50341.

    This book is aimed at the trainee ophthalmologist starting his first post in ophthalmology who has a steep learning curve with much new information and new skills to acquire. The intention is that the reader should learn good clinical practice from the start. The reader may wish to use the book as reading before clinical contact, but also as a reference manual to allow the correct performance of simple tasks.

    The introduction expounds not only the virtues of ophthalmology itself, but also the virtues expected of the trainee during his apprenticeship and later in his career, and the responsibilities, stresses, and ethics incumbent upon this. The duty of the trainee for continuing education is also underlined.

    The process of history taking and clinical assessment is then elaborated upon. The more common methods of examination are described with explicit instructions in a clear manner, with explanation of the process and logic behind them. The assessment of visual function (acuity and refraction, binocularity) is dealt with in detail for both adults and children, as is the ocular motility examination with useful end of chapter summaries for the reader. Visual field testing is also dealt with in a separate chapter with explanation and interpretation of the automated perimeter output. A useful chapter on the slit lamp is included with hands on tips and pertinent illustrations. External, anterior segment, and posterior segment examinations are dealt with in depth with explanation of normal (and normal ranges) as well as abnormal findings which the tyro will find useful. Advice regarding use of the indirect ophthalmoscopic methods with “hands on” tips is clear and well illustrated. The posterior segment chapter deals at length with the visualisation of the fundus and recording this by drawings. Likewise the external examination shows not only how to examine, but also to record lid and ptosis findings. I would have been pleased to have seen greater emphasis on similar schemes for the recording of anterior segment and corneal changes (for example, Waring and Laibson) and diagrammatic recording of strabismus (for example, Vivian and Morris, Kaye et al)—systems gaining wider popularity which allow quantitative evaluation over long periods for different observers.

    The book ends with management of emergencies and trauma and finally appendices with pharmacological information regarding diagnostic and therapeutic agents.

    This book is written in a very readable style with good illustrations, tables, summaries, and practice instructions for the performance of specific tasks. The British trained reader will have to adjust to the US terminology for therapeutics, units of measurement, and some aspects of practice. This book does, however, provide an excellent source of the information and material that is often not easily accessible in written form to the novice ophthalmologist, and crystallises that which is usually passed on by word of mouth from his immediate seniors, and some of which may have lost or gained its authenticity in the mists of time like much passed down in the oral tradition! Reading this book before encountering the patient will enhance the practice of the trainee. He will not, however, find it easy to carry in his pocket, nor is it encyclopaedic or exhaustive in its coverage. I was surprised at the omission of biometry technique, Frisby test, temporal artery biopsy, and only fleeting reference to the use of Bagolini glasses and Ishihara plates, while the text devoted to the Schiotz tonometer may be superfluous in contemporary UK practice. The index was clear, but I found this book to better if read in chapters rather than dipped into as a reference text. I would recommend ophthalmologists starting out on their careers to read it, and at the very beginningof their training.