The eyes have it

Primary care ophthalmology. 2nd ed.

David A Palay, Jay H Krachmer. Philadelphia: Elsevier Mosby, 2005 (xvi + 395 pp). ISBN 0 323 03316 4.

I was pleasantly surprised at the balanced approach achieved in this book by its American ophthalmologist authors. As a reference book, it delivers as much detail as most primary care practitioners would seek, without getting bogged down in minutiae.

At about 400 pages, lightened by abundant photographs, Primary care ophthalmology goes a bit beyond being just a primer. Many of the segments invite browsing, whereas others would only be consulted for a specific topic. There is an emphasis on management at a general practice level, together with clear guidelines on when specialist referral is needed. The urgency of timing of referrals and the frequency of specialist reviews often seems a bit excessive, but this may reflect the American environment. Similarly, the range of medications reflects availability there, especially in antibiotics.

The initial sections on examination, differential diagnosis, and the acute red eye are well presented and would also be useful to medical students. Skills varying from as mundane as everting eyelids up to applanation tonometry are clearly described. Much of the rest of the book is anatomically arranged, with brief anatomy refreshers and then succinct disease descriptions, each with differential diagnoses, investigation, treatment and follow-up recommendations.

Ophthalmology has not completely seceded from the rest of medicine, and the excellent section on systemic disease reflects this. The systemic drug toxicity segment is clearer than I’ve seen anywhere else. Another highlight is the chapter on the manifestations of ocular trauma and its management.

Overall, this is a very useable, good-value and readable reference with good photographic illustrations. Its main role would be in general practice, but emergency departments would also find it useful. The limitations of the American pharmacopoeia don’t really take away from the book, and I don’t think it will date quickly.

Malcolm J BurvillOphthalmologist, Mount Lawley, WA