Description

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Reviews

Shields Textbook of Glaucoma returns for its sixth edition–and its second in the capable hands of R. Rand Allingham as senior author. Some decades back, this was a mainstay reference for all glaucoma topics, possibly overshadowed only by Chandler and Grant. Readers with a working knowledge of the earlier editions were on solid ground at both the slit lamp and the operating microscope. This edition continues that honorable tradition, and the authors have provided a solid, well-referenced, easy-to-use resource covering the myriad complexities of the management of intraocular pressure in children and adults.

The approach differs in a significant way from that of most medical textbooks. Claudius Galenus presumably authored his work on circulation single-handedly; more recently, however, textbooks of medicine are generally produced by committee. Too often, the result is not ideal. Most ophthalmic texts have a plethora of authors, each responsible for a chapter in his or her particular niche. Although this approach is successful in many cases, it can mask significant bias on the author’s part. Occasionally, chapters are authored by a medical student, resident, or fellow. However, that is not the case here. Each of the 5 authors has personally authored a substantial portion, presenting a balanced view of a rapidly changing field. Although this does not necessarily allow the putative expert in each subtopic to showcase his or her own work, it can–and does–allow for a more even-handed result.

The education of a nascent ophthalmologist or glaucoma specialist mandates understanding a broad spectrum of diseases, generally with elevated intraocular pressure as a common finding. However, future advances likewise depend on grasping areas in which progress is presently limited to the laboratory and has not yet reached the clinic. The clinician needs a working familiarity with upcoming advances if he or she expects to be able to intelligently translate these advances to patient management as they become clinically relevant. On both levels–the tried and true and the cutting edge–this book does an excellent job. When discussing current diagnostic approaches and therapies for glaucoma, the authors provide historical context. This makes the reading both more enjoyable and more informative, so the student can appreciate the background behind current management. An example is perimetry. Although much space is (as it should be) devoted to automated static perimetry, the tangent screen and Goldmann perimeters are described as well. Short wavelength and frequency-doubling approaches are described, and the benefits and shortcomings of these approaches are reviewed.

Another strong point is that each of the more obscure glaucomas is discussed and illustrated. Even the glaucomologist will rarely encounter these, but the discussions of them are clear and easily followed. The clinical photographs are of excellent caliber. This is an excellent reference for the physician caring for patients with rare forms of glaucoma. In considering some of the newer aspects of the study of glaucoma, the authors have done an excellent job of reviewing the state of the art. For example, as the tools of genetic analysis continue to become clinically relevant, a prudent practitioner will need to be positioned to use these developments. The included information provides a clear snapshot of this rapidly evolving field. The tables and illustrations add greatly. Another strength is the extensive references provided for each chapter. The interested student has all the data necessary to review the primary literature for almost every statement in the text.

The discussion on surgical management could have been expanded. The last decade has seen the limited adoption of canaloplasty, the Ex-PRESS mini shunt, and other variations on intraocular surgery to lower intraocular pressure. The book discusses these newer options briefly, but to make an informed clinical decision, the practitioner needs to go beyond the material available here.

On balance, however, Shields Textbook of Glaucoma is a strong, easy-to-use resource. In his foreword, Shields notes that sales of the fifth edition topped 9000; astonishing, since the American Academy of Ophthalmology has but 30 000 members. This edition should do at least as well.