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Br J Ophthalmol 2001;85:249–251 249

Br J Ophthalmol: first published as 10.1136/bjo.85.2.249d on 1 February 2001. Downloaded from http://bjo.bmj.com/ on November 22, 2019 by guest. Protected by copyright.
The authors have no proprietary or commercial knowledge. There are subtle tips on, for
interest in the findings presented. example, positioning of the hands or drape,
MAILBOX ANDREW RILEY
CHRISTINA GRUPCHEVA
which will be invaluable. Chapters describing
complications from the microkeratome, exci-
CHARLES McGHEE mer laser, errors in refractive result, and indi-
Discipline of Ophthalmology, Faculty of Medicine and
Health Sciences, University of Auckland, Private Bag vidual patient’s biological response are all
92019, Auckland, New Zealand classified and dealt with logically. The condi-
Cataract lens extraction and posterior tions “sands of the Sahara” is dealt with twice,
Correspondence to: Professor C N J McGhee
chamber lens implantation in Korean if slightly diVerently, by “guest” contributors
c.mcghee@auckland.ac.nz and highlighted in special boxes. While the
subjects
information was most interesting, their pasted
EDITOR,—We read with interest the article 1 Kee C, Moon S-H. EVect of cataract lens extrac-
position within the main text was distracting
by Kee and Moon1 who provided interesting tion and posterior chamber lens implantation on and I had to flick back a number of pages to
data on the eVect of cataract removal outflow facility and its response to pilocarpine in find what I had been interrupted reading
on outflow facility and intraocular pressure Korean subjects. Br J Ophthalmol 2000;84:987– about in the first place!
9.
(IOP). We have been interested for some 2 McGhee CN, Bryce IG, Anastas CA. Consoli- Another team of guest contributors dis-
time in the eVect of ocular surgery dating the association between Goldmann cusses the photoablative treatment of LASIK
upon measured IOP.2 Previous studies have applanation IOP undermeasurement and pho- complications, which will be of more interest
torefractive surgery. J Cataract Refract Surg
shown a reduction in IOP after cataract 1999;25:158–9. to the advanced LASIK surgeon. Topics
surgery3 4 and have suggested implications 3 Tennen DG, Masket S. Short and long-term include techniques to deal with ablation
for combined cataract and filtering eVect of clear corneal incisions on intraocular microirregularities, errors caused by patient
surgery. pressure. J Cataract Refract Surg 1996;22:568–
70. head movement, and narrow transition zone.
To assess change in outflow facility 4 Jahn CE. Reduced intraocular pressure after The penultimate chapter of section 1 dis-
Kee and Moon utilised pneumotonometry. phacoemulsification and posterior chamber in- cusses LASIK retreatment and special clinical
However, this technique has been shown traocular lens implantation. J Cataract Refract scenarios—for example, after penetrating
Surg 1997;23:1260–4.
to give low reproducibility5 as a tono- 5 Wheeler NC, Lee DA, Cheng Q, et al. Reproduc- keratoplasty (PK), photorefractive keratec-
graphy method. Indeed, Shiotz tonography ibility of intraocular pressure and outflow tomy (PRK), and radial keratotomy (RK).
may have been more accurate.5 The investiga- facility measured by pneumatic tonography and While the experience presented is not vast,
tors may have had technical reasons for Schiotz tonography. J Ocular Pharm Therapeutics
1998;14:5–13. useful information is provided for anyone
their choice of instrument; however, no 6 Meyer MA, Savitt ML, Kopitas E. The eVect of contemplating these newer indications. The
justification was provided, nor was diurnal phacoemulsification on aqueous outflow facility. last chapter draws it all together with a run
variation in IOP accounted for in this Ophthalmology 1997;104:1221–7.
through of a typical procedure, perhaps acting
study. as a “dress rehearsal” for the reader.
The authors’ extrapolated ciliary muscle Section 2 comprises 31 cases in which there
response to pilocarpine from measurements of were complicating factors or unusual patient
the outflow facility before and 1 hour after 2%
pilocarpine instillation. To specifically investi- BOOK REVIEWS characteristics—for example, the eVects of
pupil size, occult preoperative keratoconus,
gate the eVect of the lens on ciliary muscle and other unmasked corneal topographical
contractility the authors repeated the anomalies. The authors advise on other
measurement 2 months after phacoemulsifi- modalities of refractive surgery which may be
cation surgery. Interestingly, these latter as- more appropriate. Surgical complications
sessments may not have allowed suYcient LASIK Complications: Prevention and such as free caps, thin flaps, incomplete passes
time for IOP and outflow facility to stabilise Management. Howard V Gimbel, Ellen E of the microkeratome, etc are included.
and the hypertensive eVect of topical cortico- Anderson Penno. £79.95. New Jersey: Slack Individual case reports of LASIK in patients
steroids to wane. In general, published 1 year Incorporated, 2000. ISBN 1556424736. who previously underwent epikeratophakia
follow up studies demonstrate mixed results in and penetrating keratoplasty are included as
relation to IOP reduction and altered outflow LASIK requires meticulous planning and rig- worked examples. I felt the cases were most
facility.3 4 6 orous attention to detail in preparation as the helpful, but the layout of the refractive/visual
We have carried out a prospective technology is very precise and there is little
data might have been more readable if
observational study of phacoemusification room for improvisation within the practice of
tabulated—there is plenty of space.
(phaco) surgery performed at a major the procedure. To learn such a technique can
In summary, I think this is a most valuable
teaching hospital. In 393 consecutive small be challenging, especially when it is to be per-
book for both the aspiring and experienced
incision (3.2 mm) phaco procedures per- formed upon a group of patients demanding
LASIK surgeon, and will help in the early
formed over a 5 month period we also perfection, and also under the pressure of a
demonstrated a significant (Student’s t test time limit. It is, therefore, most gratifying to learning curve and “getting up to speed”.
p<0.001) drop of measured IOP comparing see a book published by authors who have a Advice is well directed so that the reader may
preoperative and 4 weeks post-phaco IOP strong track record in LASIK and refractive make correct patient selection, counsel patients
(1.28 (SD 3.10) mm Hg). Furthermore, surgery, and who have published their own realistically, acquire a slick technique, and
analysis of the data revealed the drop in IOP learning curves in peer reviewed journals. deliver thoughtful aftercare. It is the intention
was significant for both clear corneal incision The book is presented in two sections. The to put the surgeon and, thus, the patient at ease.
(n=318) and scleral tunnel incision (n=75) first deals with the machinery, patient selec- The text addresses the surgical minutiae
phaco techniques, being 1.5 (3.16) mm Hg tion, performance of the surgery, and peri- that are most important to success. The tech-
(p<0.001) and 0.9 (2.9) mm Hg (p=0.015), operative management. The second is the niques and tips are apposite, and expectations
respectively. However, when those with a his- authors’ selection of case reports of patients realistic given the limitations of the technique
tory of glaucoma (n=39) were analysed sepa- who were less than straightforward and in its current form. The avoidance of potential
rately, a non-significant (p=0.28) reduction provides an instant practical experience. diYculties is particularly strongly stressed but,
of IOP (0.69 (3.47) mm Hg) was demon- Section 1 begins with a brief history of exci- in the event, the management is dealt with
strated. We believe to adequately define the mer lasers and microkeratome technology, simply and without embarrassment—after all
eVects of cataract surgery on IOP in a glauco- including the individual foibles of each instru- every one has a learning curve. The book
matous population, a larger group prospec- ment. Patient selection (who is suitable and, therefore acts as a reliable tutor during this
tively studied over a period longer than 2 importantly, who is not), examination, and period. Nevertheless, there is no true substi-
months and preferably more than 1 year is documentation are well covered, and exam- tute for hands-on experience, although it can
required and a reproducible accurate assess- ples of appropriate data collection forms, to be reassuring that the book provides support
ment of outflow facility would be of added permit the essential audit of one’s own data, and knowledge that someone has been there
value. are presented. before and can provide sensible, accessible,
The authors of this recent article elegantly The individual parts of the LASIK proce- and evidence based advice in adversity.
address the important issue of IOP changes dure are well documented with clear and I did not think that this book was especially
after intraocular surgery but standard investi- helpful colour photographic illustrations. Ad- directed at the advanced surgeon, although
gative techniques that are practical, accurate, vice is presented in a style that is direct and they will find useful material and techniques
and reproducible in the clinical setting need to reasoned. You, the reader, are in the hands of within, particularly addressing the more com-
be developed. an experienced supervisor keen to impart plex conditions and retreatment options.

www.bjophthalmol.com
250 Mailbox, Book reviews, Notices

Br J Ophthalmol: first published as 10.1136/bjo.85.2.249d on 1 February 2001. Downloaded from http://bjo.bmj.com/ on November 22, 2019 by guest. Protected by copyright.
It is clearly presented and readable with The question of course is who is the target The Wisdom of the Eye. By David Miller.
plenty of relevant information without being audience for this book. While it’s nicely put Pp 169; £29.95. San Diego: Academic Press,
too dry. There are good illustrations and together and well illustrated, one would think 2000. ISBN 0-12-496860-0.
references. The extended characters set proof- that the average registrar (or resident) after a
ing errors (“£” for “<” substitutions) within year or so of training will have already This relatively short single authored book
the guest contributor section are not too con- accumulated most of the information pro- states that its aim is to “survey the major con-
fusing. I would recommend this book to those vided in this book. Is the book therefore really cepts underlying many of the findings of the
wishing to take up LASIK, and for the general meant to be used by students rather than oph- basic sciences relating to the human eye and
reader who wants to know what this surgery thalmologists in training? If so, more intro- visual brain”. The justification for this is
involves. Would it, however, be a substitute for given that the explosion of information in the
ductory information at the beginning of each
a supervisor/trainer during your first few field of basic eye and vision research prevents
chapter would certainly be helpful. Finally,
cases? I am not sure. Anyway, for your own eye clinicians, students, and scientists from
confidence, read it before you start and you while it’s clear that this is meant to be a short
approach to the diVerential diagnosis of other fields being aware of them. The author
will not go far wrong. is quite clear that he intends to use everyday
ophthalmic disorders a few references at the
J A SCOTT end of each chapter would be useful, particu- language to describe theoretical and labora-
tory concepts. The book is divided into two
larly for students who might use this book.
major parts, the first is entitled “The Eye”, in
Ocular Tumours. Diagnosis and Treat- Nevertheless, this is a relatively inexpensive,
which the subchapters are The Young Eye,
ment. Bertil Damato. £75; Pp 288. Oxford: well illustrated presentation of the diVerential
The Image Of The Adult Human Eye, Eyes
diagnosis of common ophthalmic disorders. Of DiVerent Animals, The Healing Eye,
Oxford: Butterworth-Heinemann, 2000.
ISBN 0750622202. CREIG HOYT Refractive Errors Of The Human Eye: A
Sociologic Viewpoint, and Eye Communica-
To a non-ophthalmic oncologist this book was tion. The second section is devoted to the
a delight to read. The script, illustrations, and Visual Fields. 2nd ed. By David B Henson. visual brain with chapters entitled Creating
format made for light work, without losing Pp 176; £30. Oxford: Butterworth- Visual Stories and Illusions Around The
emphasis, on referencing statements made Heinemann, 2000. ISBN 0-7506-4173-8. Retinal Image, Brain Sharpening Of The
and incorporating correlative imaging (par- Retinal Image, Coloring The Retinal Image
ticularly enjoyable the emphasis on echogra- Visual field assessment is an essential part of And Awareness Of The Retinal Image. Does
phy) and histology. The book begins with everyday clinical practice and has evolved con- this book succeed in its stated goal? Without
basic examination techniques, and then covers any question I believe it does not. First and
siderably over the past decade. It is therefore
each tissue from conjunctiva to retina with the foremost, no book that fails to discuss
highly appropriate that Dr Henson has chosen
array of tumours that occur at these sites molecular biology and the current state of
(starting logically with the most common to update his superb textbook on the subject.
Visual Fields is aimed at both perimetrists genetics as it applies to ophthalmology can be
first!). There are, additionally, dedicated seen as a serious eVort to communicate with
chapters on lymphoid tumours, metastasis, and “readers” of visual field test results. It
other physicians, students, and scientists with
and paraneoplastic syndromes. An enjoyable succeeds where other texts fail by providing
regard to vision research findings. Moreover,
end for the non-specialist are the chapters on relevant information for both the uninitiated
the brevity of the book does not allow the
treatments including radiotherapy, surgery, and the highly experienced. The relaxed but author to go into any great detail about many
and phototherapy. This book needs no further concise writing style makes the book a topics; indeed, some topics are described in
review except to say I think it meets its aims in delightful continual read that serves equally such short detail that they are badly misrepre-
delivering, very enjoyably, general information well for quick reference. Considerable detail is sented. For example, on page 162 the
regarding the diagnosis and management of provided that will satisfy all but the most curi- description of blind sight experiments con-
ocular tumours to the non-specialist. ous, who are provided with comprehensive sists of just a few sentences and leaves the
ANDREW DICK and well selected references. reader to believe that a significant number of
The text is intuitively divided into 11 patients with damage to the visual cortex can
digestible chapters, covering psychophysics, consistently identify objects from the so
DiVerential Diagnosis in Ophthalmology. examination strategies, alternative perimetric called blind field. This grossly misrepresents
By Stephen A Vernon. Pp 192; £19.95. tests, extraneous factors aVecting the visual an area of research that has occupied
London: Manson Publishing, 1999. ISBN field, visual pathways, diVerential diagnosis, hundreds of investigators over the past
1-874545-90-1. glaucoma, screening, defect quantification, decade or so. Similar is the statement that the
practical advice, and instrumentation. The visual cortex is plastic enough that patients
This small handbook was meant to provide “a author urges novice perimetrists to start at the who have been congenitally blind use neurons
diVerential diagnosis for those who provide eye beginning while encouraging veterans to delve in the visual cortex for the sense of touch.
care”. The book is divided into 10 chapters: This is presented as a single sentence and the
at their leisure. A short glossary is available to
Essentials of anatomy and physiology, Exami- citation to justify this point of view is not a
help interpret perimetric jargon.
nations of the visual system, The child with primary scientific publication. Finally, and in
Revisions made from the 1993 edition deal
suspected eye disease, Chronic loss of vision, my mind, most seriously, most of the
Acute painless visual disturbance, The acute with new developments that are now commer- references to be found at the end of the chap-
red eye, Abnormal looking “eyes”, Chronic cially available: newer thresholding strategies ters of this book are older than five years.
ocular unease and associated headaches, Ocu- (Swedish Interactive Thresholding Algo- Considering how short the half life is of new
lar trauma, and Ophthalmology throughout the rithms, Tendency Orientated Perimetry, information in the field of vision research no
world. All of the chapters are relatively short. FASTPAC), new instrumentation, alternative serious attempt to present an overview of
They are well illustrated with multiple colour techniques (short wavelength automated per- vision research could depend on so many ref-
photographs, which are of high quality and imetry, frequency doubling technology perim- erences that are clearly outdated.
highlight the text appropriately. The retinal etry), and well thought out information and Having stated the above, however, I want to
photographs are of particularly good quality. clinical advice on monitoring for progressive recommend that this is a book that every oph-
Because of the brevity of the book, few loss. Of particular interest are the screening thalmologist, medical student, and vision
details are given and much of the information and defect quantification sections that present scientist can thoroughly enjoy. It is an
is provided in highlighted boxes where graphs, a thorough, balanced synopsis of facts that can absolutely good read. It should be viewed not
flow charts, and other quick visual means of take years to assimilate from abundant peri- as the author views it as a review of basic eye
presenting diVerential diagnoses are available. metric literature. The only small disappoint- and vision research but as a relatively straight-
All of these chapters are eVective with perhaps ment is that the author does not comment on forward description of the phenomenology of
the exception of ophthalmology throughout the wealth of perimetric research designed to the eye, vision, and the visual brain. It is
the world. The author obviously has an inter- provide insight into mechanisms of cell death clearly written and in most cases beautifully
est in providing ophthalmic care in less well in early glaucoma. illustrated. Regrettably, some of the black and
developed nations. His commitment to this is In summary, this revised edition is a highly white illustrations, particularly those taken
apparent in this particular chapter; however, readable text that provides useful information from a secondary source, are unclear. If the
the chapter is too short to be of any use to author does revise the textbook, one hopes
for all involved with assessment of the visual
those ophthalmologists who do provide care that these illustrations will be improved in
field.
in the developing world, and for those who do subsequent editions. This is a book that can be
not it adds little to the rest of the textbook. PAUL G D SPRY easily read in a single sitting and, at the end of

www.bjophthalmol.com
Mailbox, Book reviews, Notices 251

Br J Ophthalmol: first published as 10.1136/bjo.85.2.249d on 1 February 2001. Downloaded from http://bjo.bmj.com/ on November 22, 2019 by guest. Protected by copyright.
doing so, the reader is left with a renewed awe OYce of Continuing Medical Education held as a part of this international meeting.
for the visual system. The author is to be com- A symposium “Randomised trials in ophthal- Further details: Dr B Krishna Rau, President,
mended for producing a book that is just plain mology: past, present, future” will be held 2–3 14th World Congress of the International
fun to read. April 2001 at the Thomas B Turner Building, Society for Laser Surgery and Medicine,
CREIG HOYT Johns Hopkins University School of Medi- Department of Surgery, D2 Ward, Sri Ram-
cine, Baltimore, Maryland, USA. Further achandra Medical College and Research
details: Johns Hopkins University School of Institute, Porur, Chennai - 600 116, India (tel:
Medicine, OYce of Continuing Medical 91-44-4765856, 4768027-28, 8527776,
Education, Turner 20, 720 Rutland Avenue,
NOTICES Baltimore, MD 21205-2195, USA (tel: (410)
8594804; fax: 91-44-8594578, 4767008;
email: krishnar@giasmd01.vsnl.net.in and
955-2959; fax: (410) 955-0807; email: website: www.medindia.net/islsm2001).
cmenet@jhmi.edu).

XXV Detachment Course American Institute of Ultrasound in


Vision 2020: cataract outcomes Medicine—Millennium Ultrasound
The XXV Detachment course, retinal and vit-
The latest issue of Community Eye Health (35)
reous surgery, will be held in Poznan, Poland Course Series
discusses cataract surgery outcome. For fur-
on 5–6 April 2001. Further details: Professor A course entitled “Obstetrical and Gynecologi-
ther information please contact Community
Krystyna Pecold, Katedra I Klinika Oku- cal Ultrasound” will be held in New York City,
Eye Health, International Centre for Eye
listyki, ul Dluga 1/2, 61–848 Poznan, Poland NY, on 24–26 August 2001. Further details:
Health, Institute of Ophthalmology, 11–43
(tel/fax: 004861-8527619) or Professor Ingrid Stacey Bessling, Public Relations Coordinator,
Bath Street, London EC1V 9EL. (Tel: (+44)
Kreissig, Univ-Augenklinik, Schleichstrasse AIUM, 14750 Sweitzer Lane, Suite 100,
(0) 20-7608 6909/6910/6923; fax: (+44) (0)
12, D-72076 Tuebingen, Germany (fax: Laurel, MD 20707-5906, USA (tel: 301-498-
7250 3207; email: eyeresource@ucl.ac.uk)
Annual subscription £25. Free to workers in 49-7071-293746; email: ingrid.kreissig@ 4100; email: sbessling@aium.org).
developing countries. uni-tuebingen.de).

Optometry 01 31st Cambridge Ophthalmological


Second Sight
Second Sight, a UK based charity whose aims Optometry 01 will take place on 21–23 April Symposium
are to eliminate the backlog of cataract blind 2001 with more than 100 events—lectures The 31st Cambridge Ophthalmological Sym-
in India by the year 2020 and to establish and workshops—at the Atrium Gallery, NEC, posium will be held 3–5 September 2001 at St
strong links between Indian and British Birmingham, UK. Further details: tel: 0207 John’s College Cambridge. The subject is
ophthalmologists, will be sending volunteer 261 9661; email: info@Optometry01.co.uk; Retinal Detachment. Further details: COS
surgeons to India early in 2001. Details can website: www.optometry01.co.uk. Secretariat, Cambridge Conferences, The
be found at the charity website at www. Lawn, 33 Church Street, Great Shelford,
secondsight.org.uk or by contacting Dr Lucy 14th Annual Meeting of German Cambridge CB2 5EL, UK (tel: 01223
Mathen, email: lucymathen@yahoo.com. Ophthalmic Surgeons 847464; fax: 01223 847465; email:
The 14th Annual Meeting of German Oph- b.ashworth@easynet.co.uk).
Residents’ Foreign Exchange thalmic Surgeons will be held in the Meister-
Programme singerhalle, Nurenberg, Germany on 17–20
May 2001. Further details: MCN 4th International Conference on the
Any resident interested in spending a period of
up to one month in departments of ophthal- Medizinische Congress-organisation Nuren- Adjuvant Therapy of Malignant
mology in the Netherlands, Finland, Ireland, berg AG, Zerzabelshofstrasse 29, 90478 Melanoma
Germany, Denmark, France, Austria, or Por- Nurenberg, Germany (tel: ++49-911- The 4th International Conference on the
tugal should apply to: Mr Robert Acheson, 3931621; fax: ++49-911-3931620; email: adjuvant therapy of malignant melanoma
European Board of Ophthalmology, Institute doerflinger@mcn-nuernberg.de). will be held at The Royal College of
of Ophthalmology, University College Dublin, Physicians, London on 15–16 March 2002.
60 Eccles Street, Dublin 7, Ireland. European Association for the Study of Further details: Conference Secretariat,
Diabetic Eye Complications (EASDEC) CCI Ltd, 2 Palmerston Court, Palmerston
First International Congress on The next meeting of the European Associ- Way, London SW8 4AJ, UK (tel: +44
Non-Penetrating Glaucoma Surgery ation for the Study of Diabetic Eye Complica- (0)20 7720 0600; fax: +44 (0)20 7720 7177;
The First International Congress on tions (EASDEC) will be held in Paris, France, email: melanoma@confcomm.co.uk: website:
Non-Penetrating Glaucoma Surgery will on 19–20 May 2001. Further details: Collo- www.confcomm.co.uk/Melanoma).
take place in Lausanne, Switzerland on quium, 12 Rue de la Croix Faubin, 75 557
1–2 February 2001. Further details: Paris Cedex 11, France (tel: +33-1-44 64 15
Dr Tarek Shaarawy, Organising Committee, 15; fax +33-1-44 64 15 10; email: International Society for Behçet’s
University of Lausanne, Hopital Ophtalmique s.mundler@colloquium.fr). Disease
Jules Gonin, Avenue de France 15, The International Society for Behçet’s Dis-
1004 Lausanne, Switzerland (tel: 41 21 626 14th World Congress of the International ease was inaugurated at the 9th International
81 11; fax: 41 21 626 88 88; website: Society for Laser Surgery and Medicine Congress on Behçet’s Disease. Professor
www.glaucoma-lausanne.org). Shigeaki Ohno represents the ophthalmology
The 14th World Congress of the International
Society for Laser Surgery and Medicine is to division (Department of Ophthalmology and
Call for papers—6th European Forum on be held on the 27–30 August 2001 at Sri Visual Sciences, Hokkaido University Gradu-
Quality Improvement in Health Care, Ramachandra Medical College and University ate School of Medicine, Sapporo, Japan: tel:
29–31 March 2001, Bologna, Italy Hospital, Chennai, India. The American +81-11-716-1161 (ext 5944); fax +81-11-
Further details: BMA/BMJ Conference Unit, Society of Lasers in Medicine and Surgery has 736-0952; email: sohno@med.hokudai.ac.jp).
BMA House, Tavistock Square, London indicated that it will designate the 14th World The 10th International Congress on Behçet’s
WC1H 9JP, UK (tel: +44 (0) 20 7383 6409; Congress of ISLSM as its society’s co- Disease will be held in Berlin 27–29 June
fax: +44 (0) 20 7383 6869; email: quality@ sponsoring meeting. A pre-conference course 2002. Further details: Professor Ch Zouboulis
bma.org.uk; website: www.quality.bmjpg.com). and separate sessions in ophthalmology will be (email: zoubbere@zedat.fu-berlin.de).

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