BOOK REVIEWS 71

technology of optical wave guides (e.g., fiber op- On the other hand, the book suffers from the
tics). The goal of photoreceptor optics, according negative aspects of the excellent qualities described
to the editors, is “to explain the structural basis of above. It is a curious compendium of elementary
a photoreceptor’s absolute, spectral, directional operations and highly complex techniques far
and polarization sensitivities.” To achieve this, the beyond the reach of the general ophthalmologist.
contributors examine the intricate and varied Thus, a simple Z-plasty, with variations, is detailed
arrangements of membranes within invertebrate in six pages, but is followed later by two pages
and vertebrate photoreceptive structures, the devoted to the transnasal wiring fixation
geometric ordering of molecules within procedure, with the rather cavalier comment that,
photoreceptor membranes, and the consequences “It is not unusual for the transnasal wiring
of these structural arrangements for the absorption technique to be accompanied by bilateral
of light through interaction of photons with the dacryocystorhinostomy.”
ordered molecules. On balance, this is a useful and thought-
Because “each participant was invited to review provoking volume, to be absorbed with the proviso
the fundamentals of his field, in addition to pre- that the surgeon new to plastics be thoroughly
senting recent research results and perspectives,” familiar with the fully detailed classic texts before
there is much overlapping and repetition among proceeding to the knife.
the papers. Furthermore, some of the papers pre- VIRGINIALUBKIN
sent mathematical arguments that most readers, I
would guess, will not attempt to wade through
(even if they are able). Nevertheless, anyone in- Visual Optics and Refraction, A Clinical Approach,
terested in deepening her/his understanding not by David G. Michaels. St. Louis, C. V. Mosby,
only of what happens to light in a photoreceptor, 1975, 517 pp. Price: $42.50.
but also of the astonishingly varied visual David Michaels was a superb teacher of
strategies that different orders of animals have physiological optics before he entered medical
evolved, can enjoy spending some time here. school. Fortunately, on becoming an ophthal-
Papers which I found particularly stimulating dis- mologist and entering private practice, he has not
cussed physiological optics and electrophysiology lost any of his genius at pedagogy as is
of invertebrate eyes (Laughlin, Franceschini, demonstrated beautifully in this book. His
Waterman, Horridge); molecular orientation of background in physiological optics has also left its
rhodopsin in receptors (Laughlin et al); membrane mark, since the scope of the book extends far
structure of rod outer segments (Liebmen); and the beyond the limited, strictly optical purview of most
directional sensitivity of rods (Enoch). Also, I refraction texts, to include such topics as ocular
gained some new insight not only into mechanisms motility, visual perception and binocular vision.
of the Stiles-Crawford effect, but also into its im- Happily, he relates even his “offbeat” subject
plications for retinal organization and function; matter to clinical experience rather than just in-
the effect is a consequence of the light-guiding jetting it as a curiosity or unrelated distraction, as
properties of the receptors - and it became clear has been the case in some other authors’ attempts
how these properties are responsible for higher to broaden the ophthalmologic horizon. And he is
sensitivity without sacrifice of acuity (and vice ver- not averse to slipping in an anecdote or colorful
sa) than would otherwise be possible. turn of phrase on occasion, which certainly makes
ADAMATKIN the reading more pleasant.
An old problem in refraction texts is just how
much mathematics to include. Dr. Michaels comes
down on the “keep it to a minimum” side of the
Reconstructive and Plastic Surgery of the Eyelids,
fence, for the most part, but compensates well for
by Frank P. English and Warren A. Keats.
any lack this might introduce by including an ex-
Springfield, Ill., Charles C 7’homa.s, 1975, 95 pp.
tensive bibliography for further study, a practice
Price: $11 .OO.
continued throughout the book. Another potential
This brief volume (95 pages) is statedly designed problem for texts such as this is the diagrams and
as an introduction to ophthalmic plastic surgery illustrations. Michaels has successfully sur-
geared to the ophthalmologist in his novitiate. mounted the usual obstacles with illustrations not
Written with the charm and readability of the only sufficient in number but so well done in many
British mode, it is to be commended for a thought- cases, that it seems clear that many of them - par-
ful exposition of the principles underlying plastic ticularly in refraction - are going to be widely
surgical repair. Readers are thus intelligently plagiarized by lecturers on refraction!
guided into comprehending the rationale of the The author attempts to give the reader insights
various operations, and can nurture the expecta- into many areas of refraction, including ap-
tion that they can now extrapolate into other propriate reference to the optician’s vs. the
procedures on their own. Undoubtedly, such an ap- ophthalmologist’s role and even takes the time to
proach is superior to the usual recipe book. define the ambiguous term “visual skills.” History
72 Surv Ophtholmol 21 (1) July-August 1976
is covered as it relates to refraction in a somewhat
spotty, but pleasant, manner. The history of
bifocals on page 377 is particularly good and the
author even gives us a short section on philosophy,
which is entirely appropriate in his chapter on
perception. The author frequently relates the
various facets of refraction to amblyopia; the latter
is perhaps the weakest portion of this strong book.
I enjoyed reading this book. While the book is
nominally directed at the neophyte ophthalmolo-
gist, the wealth of Michaels’ experience and reflec-
tion provide many useful nuggets of information
that the “old pro” will benefit from even more
than the beginner will. And all of us will do well to
reflect on his repeated admonition that, in refrac-
tion, it is the needs of the patient rather than the
refractive findings that should serve as your guide
to treatment.
ROBERT
D. REINECKE
Phacoemulsification and Aspiration: The Kelman
Technique of Cataract Removal, by Charles D.
Kelman. Birmingham, Ala., Aesculapius, 1975,
137 pp., 269 illus., Price: $42.50.
It is unusual in modern ophthalmology to devote
an entire book to a single specific procedure, and
even more unusual for the author to use his own
eponym. In this case both appear to be justified.
The Kelman technique of cataract extraction by
phacoemulsification and aspiration has engen-
dered considerable controversy in recent years.
Although the stated function of this brief book is
as a practical guide to performance of the tech-
nique, it also presents the arguments for its inclu-
sion in the ophthalmic surgical armamentarium.
The history, instrumentation, patient selection,
surgical technique, and complications are
presented in a profusely illustrated manner in-
tended to supplement a practical phacoemulsifica-
tion course. Additional presentations of techniques
for practice surgery are useful for the beginner.
Brief chapters on anesthesia and nursing are of less
value.
On the whole, this book succeeds admirably as a
technical manual. Some criticisms are warranted,
BOOK RRVIEWS
however. Although mention is made of the high
degree of success and the surgeon is cautioned
frequently to avoid specific errors which could lead
to various complications, no data is given. Such
documentation might bolster the author’s case.
The failure to mention permanent bullous
keratopathy as an occasional complication is
notable. Although literature is cited, full references
are never given.
This is a book which should be read by all
ophthalmologists who are considering adopting the
phacoemulsification procedure and reread several
times by all beginning to perform it.
ALAN SUGAR
Contact Lens Practice, by Montague Ruben.
Baltimore, Williams and Wilkins, 1975, 368 pp.
Price $6 1.OO.
In this complete and well-illustrated volume,
Doctor Montague Ruben presents the Moorfields
Eye Hospital approach to contact lenses. The dis-
cussion is thorough, beginning with the history and
ending with the manufacture of contact lenses.
Physiology, optics, materials, indications, and
special disease states are all well presented and
there is an especially complete discussion of
keratometry. The “meat” of any contact lens
book, though, is the fitting of lenses. This is
presented in a manner which is not likely to
simplify the task for the practitioner. There is a
strong tendency to rely on the mathematics of lens
curves without an actual how-to-do-it scheme. A
confusing system of abbreviations is used for lens
parameters, often without explanation. Many un-
usual fitting situations are well presented and there
are excellent illustrations of fluorescein patterns.
In relation to current American practice, there is a
great excess of material on scleral lenses, while the
presentation of soft lenses is incomplete.
Perhaps the greatest value of this book is as a
source of information on contact lens details for
those already well-grounded in fitting techniques.
The resident or practitioner beginning to lit lenses
is better off seeking a basic contact lens fitting
manual for less than half the price of this volume.
ALAN SUGAR