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The Pupil. Anatomy, Physiology and Clinical Applications.

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    The Pupil. Anatomy, Physiology and Clinical Applications. Irene E Loewenfeld. £180; Pp 2223. Oxford: Butterworth-Heinemann, 1999. ISBN 0750671432.

    This text represents a lifetime body of work for Professor Irene Loewenfeld. Perhaps more accurately, it represents a greater part of two lifetimes' work; having been commenced in the mid-1950s as a collaborative project with Professor Otto Lowenstein at the Columbia-Presbyterian Medical Center in New York. Following Otto Lowenstein's death in 1965, Irene Loewenfeld continued writing, eventually publishing through Wayne State University Press in 1993.

    Presented in two volumes, the first includes the text and runs to 1645 pages, divided into five sections, while the second volume sensibly presents a separate bibliography thereby making the text (marginally) more transportable. The first volume is a comprehensive review of the anatomy and physiology of the pupil with its associated neurology and the diseases which play a part in compromising pupil function.

    As a physiologist, Loewenfeld has written a book with a thorough foundation in basic science, with comprehensive discussion covering pupillary function across the animal kingdom, not simply restricting the project to humans.

    Having been inscribed over a near 40 year period the text has a strong historical perspective, presenting research work in chronological order over a period during which understanding of pupil function has evolved. In striving to be comprehensive Irene Loewenfeld has included papers which may subsequently have been reinterpreted or simply proved incorrect. She has willingly injected a subjective flavour to the book when giving her own interpretation of earlier work which serves to make the text readable. This is also true for the bibliography where she includes “reference manager” style comments about the value of many references.

    By its nature, such a reference tome can be difficult to “dip into”. To assist those who may want rapid access to a subject each section is presented on three levels: a “thumbnail” summary for readers in a hurry; elaboration with historical perspectives for those with more time; plus an additional level with material delving into the background for readers keen to look to the source of understanding.

    One section where clinical work may be underrepresented is the chapter on glaucoma. Here the text focuses on historical record of the pharmacological influence of drugs upon pupil function and their role in therapeutics. Recent clinical work on pupillometry in glaucomatous optic neuropathy aimed towards developing “pupil perimetry” has not been presented.

    However, with this one exception, this text represents the definitive work upon the pupil which all ophthalmologists will find valuable, either as an introduction to the field or as the last word on the subject.

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