Irregular Astigmatism: Diagnosis and Treatment

Irregular Astigmatism: Diagnosis and Treatment Ming Wang, ed., Thorofare, NJ: Slack Inc.; 2007. $174.95. I have to confess, my first thought before cracking the binding on this one was that it was probably not going to take the place of my summer poolside paperback. I even asked myself if this is a topic that deserves its own dedicated textbook. After all, how much is there to say about irregular astigmatism that has not already been said? I was skeptical that the authors and editors could excite me about this topic. In short, I was pleased to find myself grabbing for this book even at the end of a long day; it is interesting and well done. Do not get me wrong, I am not saying it will trump a good geo-political spy story or a steamy romance novel, but add a couple of interesting characters, a few plot twists and who knows … What the Editors have accomplished is the compilation of a highly useful text that uses the unifying theme of irregular astigmatism to span a wide range of topics including wavefront optics, corneal imaging, tissue biomechanics, refractive surgery, keratoconus, lamellar and penetrating keratoplasty, vector mathematics, corneal cross-linking, and much more. This thematic unification is a clever approach that works well to bring a wide range of topics together. What the editors have done is that they have addressed irregular astigmatism from almost every conceivable angle, providing depth and perspective that is both timely and timeless. In the Preface of this book Dr. Wang makes a compelling case for the importance of this topic. He prepares the table for the reader by highlighting the common causes of this condition and defines the boundaries of current research related to the diagnosis and treatment of irregular astigmatism. In addition, he challenges the validity of a purely wavefront-guided approach to the treatment of irregular astigmatism, arguing effectively that corneal structure, geometry, biological, and biomechanical responses to treatment cannot be ignored. The first section of this book, titled Optics, Etiology, and Clinical Presentation of the Irregular Cornea delivers nicely on Dr. Wang’s promise to address the origin, diagnosis, and clinical evaluation of irregular astigmatism. I found one of the best chapters in this section was Etiology and Clinical Presentation of Irregular Astigmatism in Other Surgical Settings by Wuqaas M. Munir and Jeremy Kieval. Although these authors may not be familiar names to most readers, their contribution was one of the best examples of good writing found throughout this book—thorough consideration of the specific topic and thoughtful review and interpretation of current and relevant research. The focus of the second section is management of the irregular cornea and includes an excellent chapter on non-surgical treatments as well as topography- guided ablation, implantable devices, and an excellent summary of possible future innovations. This section addresses the second facet of the Editor’s stated objectives: current and future directions for the treatment of irregular astigmatism. In summary, I found this textbook was a nice surprise that surpassed my initial expectations. Although authors Patterson, Clancy, King, and others probably have little to fear with their own publications, clinicians interested in this topic are likely to find this text a useful reference and an excellent guide to the current art and clinical science diagnosing and treating irregular astigmatism. Michael Twa University of Houston College of Optometry Houston, TexasFigure