Glaucoma – Science and practice
Edited by John C Morrison and Irvin P Pollack
Published by Thieme.
New York & Stuttgart, 2003
ISBN: 0865779155
270 colour illustrations, 507 pages
Price: USD $159.00

THIS book has not only one foreword, but two — unusual for a book which is not an update of a previous edition, but a new one with a copyright dated 2003. There’s also a long publisher’s blurb at the back but its usual biased blend of greatness makes it unhelpful in imparting the book’s true value or interest.

In today’s competitive publishing world, we expect an expensive text book like this one to contain up-to-date, comprehensive information on its subject matter, and to be written by top specialists in the field.

And although these promises are not always fulfilled, this one delivers the goods. It is heavy, well produced, with glossy paper and many colour pictures. It also feels academic, without the dryness of a peer-reviewed paper but with enough graphs and references to look as if science rather than hype will be found inside.

‘Glaucoma - Science and Practice’ is, nevertheless, heavier on practice than on basic science; perhaps this reflects the fact that the majority of the book’s contributing authors are clinicians rather than scientists. That is also appropriate, because their intended audience are clinicians.

The book’s stated aims are “to provide the resident and the general clinician with a single-volume, clinically oriented source which covers the full spectrum of glaucoma problems”, and the specialist with “information provided by the international group of contributors ... authoritative, well documented and clearly presented”.
But that ‘international’ group of experts is somewhat misguided; the list of contributors includes 56 Americans, one Australian and three Europeans. That’s about 6.8% ‘international’ and the rest dominated by US practice.

Heading — and selecting — this team of experts are two editors. John C Morrison MD is a Professor of Ophthalmology at the Oregon Health and Science University, US. He is also director of the Glaucoma Service at the Fred P Thompson Glaucoma Clinic and Casey Eye Institute, also in Portland, Oregon.

Irvin P Pollack MD is Professor of Ophthalmology at the Johns Hopkins University and Chairman Emeritus of the Department of Ophthalmology, Krieger Eye Institute, Sinai Hospital, Baltimore, Maryland, US.

Although the result is an excellent tome, and no doubt the contributors have been selected wisely, the editors should have put their foot down on the publisher’s assertion on the back cover that “it is written by a who’s who of international experts in glaucoma”.

That implies that most glaucoma experts live and work in the US and that most glaucoma experts are contributors to this book. I know of a lot of exceptions to both counts.

The book’s first two chapters present the epidemiology and genetics of glaucoma. The genetics one is interesting, and although basic, well done. There is not much practical information in there, but the explanations and diagrams about the use of vectors, liposomes and artificial chromosomes for future genetic therapies are clear and interesting.

All through the book the references are peer-reviewed at publication level. They constitute a good source of related reading for any particular sub-subject.
The use of photographs is good in general, but I particularly like the comprehensive use of histological and electron micrographs, both transmission and scanning.
Also to be found throughout the book are small (one sentence maximum) highlighted boxes. The title line labels these as: pearls, special considerations, pitfalls, and controversies. The content of these boxes and their headings do not necessarily match, but the selection is great.

I bet an enthusiast of Trivial Pursuit created them for the book. Actually, if anybody puts the lot of them together in an ophthalmic trivial pursuit game, it could be the star freebie of the next conference!
Back to the book’s main contents. The obligatory anatomy and physiology chapters open the second section, with special chapters dedicated to aqueous humour production and outflow. Gonioscopy, tomonetry and aqueous humour dynamics all have their chapters.

The optic nerve is examined closely in section three. You will find chapters covering its anatomy, physiology, clinical evaluation, optic neuropathy, imaging, evaluation, and finally, perimetry.

One third through the book, we finally arrive at the first chapter on glaucoma proper: classification. From here, tables with clinical trial results and long lists of clinical papers in the reference lists are the norm. Each of the main types of glaucoma has their chapter (POAG, angle-closure, paediatric, steroid-induced, pigmentary, pseudoexfoliation, neovascular, and iridocorneal).

Other, less common but related situations also have their space. Elevated episcleral venous pressure, and its connection with glaucoma, enjoys a full chapter, as do the lens-induced glaucomas. Trauma, inflammation, retinal disorders, intraocular tumours and systemic diseases also receive careful examination.

Towards the end of this third section you will also find a chapter on glaucoma following anterior segment surgery. This chapter not only explores the connections between surgery and glaucoma and their significance, but also presents guidance in their management, from prophylactic to salvage procedures.

The final third of the book is dedicated to glaucoma therapy, divided into the three traditional sections: medical, laser and surgical therapy.
The medical therapy section contains chapters on all the usual suspects. The novelty item is a chapter on neuroprotection. I found the most interesting section in it to be a set of guidelines for evaluating neuroprotection studies.

The laser section covers the basics: trabeculectomy, iridotomy and cyclodestruction. The surgical section has a chapter on filtration surgery and then moves on to cataract surgery and glaucoma, aqueous shunts and ocular hypotony.
The contents pages are very clear and the index comprehensive. The language does not attempt to make concessions for the non-specialist and it is clear and precise.

As a whole, the book achieves the stated aim of the editors to present “readily accessible information that is essential for clinical recognition and treatment”. It is most useful for residents and general ophthalmologists with an interest in glaucoma. Specialists will probably not bother to look at the first half, but will find a very clear exposition of current issues in the second half of the book.

As a wide-ranging look at current clinical management of glaucoma, this is one is reliable and comprehensive. I have quite a few glaucoma books on my shelf — next time I have a technical question to check, I will reach for this one.

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