In recent years, probably because of all of the recent advances in the diagnosis and management of glaucoma, there have been numerous new and updated editions of books addressing this subject. Out of curiosity, I searched Amazon.com for glaucoma related books and found 198 listings (both technical and lay). Considering the competition, the editors faced a monumental challenge in trying to compile a text that would have a place on the shelves of clinicians. In general, I think they have met this challenge and have fulfilled their goal of providing “…the resident and general clinician with a single volume, clinically-oriented source that covers the full spectrum of glaucoma problems, including the pathophysiology epidemiology, and genetics of the many specific types of glaucoma.” Glaucoma: Science and Practice is divided into 7 sections consisting of 46 well-referenced chapters that were written by 60 contributors. It contains numerous illustrations, tables, and photographs (color and black and white). Interspersed throughout the text are boxes with the titles of PEARLS, CONTROVERSY, SPECIAL CONSIDERATION or PITFALL, which highlight key points. In section one, Epidemiology and Genetics of Glaucoma, the reader will find details addressing the risk factors for and prevalence of glaucoma based on a review of several major population-based studies. I generally find the discussions of the genetic basis of glaucoma to be overly academic but the information provided is very readable. The authors' inclusion of the potential impact these discoveries may have on the future of diagnosing and managing this disease gives us the clinical relevance that is often lacking. A thorough review of the formation, outflow, and dynamics of aqueous humor is presented in section two. This section also contains a chapter on gonioscopy with illustrations and high-quality photographs of the anterior chamber angle that should be particularly beneficial to students and residents. Section three provides a nice review of the anatomy and physiology of the optic nerve. It also has a concise yet thorough discussion of the pathophysiology of glaucomatous optic neuropathy and its clinical features. The chapter on the clinical evaluation of the optic nerve head is somewhat scant and deserved more attention considering the editors' intent to make the book especially useful to the less-experienced clinician. The chapters on imaging of the optic disc and nerve fiber layer analysis provide an adequate summary of current technology. On the other hand, the chapter on perimetry limited its discussion of automated perimetry to the Humphrey Field Analyzer without mention of the other automated perimeters currently available, including the Octopus and Dicon instruments. Understandably, because the Humphrey Field Analyzer is considered by many to be the “gold standard,” a detailed description of this instrument is appropriate; however, some mention of and/or comparison with other products would be desirable especially for residents. In section four, the editors have dedicated individual chapters to the various categories of glaucomas. In each, the authors discuss the background, pathogenesis, diagnosis, differential diagnosis, and management of each category. When reading the book from cover to cover, one encounters several specific conditions that are identified in more than one chapter. However, the editors have done a nice job of cross-referencing to minimize redundancy. The medical management of glaucoma is addressed in section five. The chapter on the Principles of Ocular Medications offers a valuable review for the experienced clinician and, for the inexperienced, it presents a concise and practical discussion of important considerations for prescribing ocular medications. There is a chapter dedicated to each class of glaucoma medication in which the authors provide a basic review of both historical and current products. Laser Therapy of Glaucoma is covered in section six and begins with a concise review of laser basics. The various methods of laser trabeculoplasty, laser iridotomy, and cyclodestruction are covered, and the background, mechanism, technique, indications, postoperative management, and complications of each procedure are presented. The background, preoperative considerations, surgical technique, postoperative management, and complications of the various surgical techniques for the treatment of glaucoma are covered in section seven. From a nonsurgeon's perspective, the descriptions of the surgical technique appear to be fairly detailed; however, a surgical resident may find it insufficient. The final section addresses the causes and management of hypotony. The frequency of this postoperative complication has greatly increased with the intraoperative use of antimetabolites, and its impact on the visual outcome of these procedures can be devastating. Dedicating a separate section to the recognition of the causes and their management is certainly appropriate. Although information from major clinical trials is appropriately interspersed throughout the text, a summary of the results and commentary on their impact on clinical practice would have been a nice addition. Writing a book on the topic of glaucoma during a time when the understanding, diagnosis, and treatment of this condition is rapidly changing, poses a tremendous challenge. The editors of Glaucoma: Science and Practice are to be commended for their efforts towards meeting this challenge.
Gregory A. Kiracofe (Sat,) studied this question.
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