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Contact Lens Complications

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    Contact Lens Complications. By Nathan Efron. Pp 193 plus CD-Rom; £55. Oxford: Butterworth-Heinemann, 1999. ISBN 0-7506-0582-0.

    This book is of very attractive design. The generous format, matt paper, and uncrowded layout immediately invite attention.

    It has copious illustrations of generally excellent quality. Detail in a few of the photographs is a little unclear, but that is a reflection of the difficulty of imaging subtle ocular pathology.

    The book opens with a “Tabular summary of contact lens complications” Some of the “conditions” listed sit rather uncomfortably in the first column because they are not caused by, although they may be relevant to, lens wear. They deserve their place because of their potential influence on lens wear, but a more appropriate description might have been better.

    Also, anterior segment specialists have been trying to replace the earlier descriptions of eyelid margin disease because they are ambiguous. The simplified classification of “anterior lid margin disease” (ALMD), “posterior lid margin disease” (PLMD), and “mixed anterior and posterior lid margin disease” (ALMD/PLMD) has been introduced to ease the confusion. It would have been good to see this terminology perpetuated here.

    Aside from these points there is nothing much to criticise. The content is accurate, well researched, well referenced, and is presented in a way that draws attention.

    Coverage of medical matters is limited, but then it would be unreasonable to expect the book to excel in this domain too. Readers can embrace the work for its excellent handling of aetiology, pathogenesis, and contact lens related care.

    The last chapter, and the appendices, are devoted to the author's grading system for contact lens related disorders. Grading systems can be useful to achieve consistency in description, particularly between observers, if used conscientiously, but they can be too time consuming to apply in routine clinical practice.

    The author's scheme follows a fairly universal format of four levels of severity of signs from “0” (minimal) to “4” (most severe). His novel contributions are to define the grades using a set of splendid paintings rendered by Terry Tarrant and to include a dual format compact disk carrying morphs of the illustrations. Morphs are computer generated animations that flow from one end of the descriptive scale to the other. Viewed side by side with the patient they could assist greatly in the making of consistent records.

    Professor Efron has given us a rare work—a fine and comprehensive production with several unique features. It deserves to be studied by any clinician with an interest in contact lens work.

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