Diagnostic Procedures in OPHTHALMOLOGY

This book does not allow easy categorisation. It has its own way of doing things and does not apologise for it. Take the names of the editors on the front cover: HV Nema and Nitin Nema. One has only initials and the other the full first name, and I just couldn't find out what "HV" stands for. I couldn't even find if the two editors are related family-wise, although I suspect they are: the book is conjointly dedicated to ‘Ma'. Regardless, HV is very consistent.

HV has always been so – from papers dating to the late 1960s to this volume, and including another ophthalmology textbook that he – or she – recently edited. It is a hardback – of medium size and medium thickness. As the title very rightly says, it is a textbook about diagnostic procedures in ophthalmology. The preface suggests that this book can be useful to practising ophthalmologists, ophthalmology residents, optometrists and technicians. I am not sure, however, that that whole list of people would benefit from it. The list of contributors contains 35 names, but a surprisingly low number of centres are represented (four centres account for 26 of the contributors).

The authors are overwhelmingly Indian (only three contributions from outsiders: one from the USA and two from Japan ). It seems that the editors had the Indian market in mind when preparing the book for publication: it tells you that the University of Wisconsin is in Madison , USA , but assumes you know that Ahmedabad, Lucknow and Tirunelveli are Indian cities. I didn't, but I do now. I looked them up on a map. As must be expected in a multiple-author work, the quality of the writing and language proficiency varies from chapter to chapter.

Some are very well written; others tend towards the dry or the baroque end; and some are written in "international" English rather than in "idiomatic" English. The emphasis of the book in general is on "what can be done now," with no particularly state-of-the-art equipment. That does not mean that the latest technological devices for diagnosis and management of ophthalmic diseases are not discussed, but they receive various levels of depth in the different chapters. In general, the traditional, long-established diagnostic devices and investigational approaches take centre-stage here.

The main difference of this book from other available books on the same subject is that this one presents great strategies for all situations in ophthalmologic clinical practice, and not only in high tech settings. There are many valuable bits of information among the chapters. Particularly telling examples are the guidance and evaluation graphs designed to assess visual acuity in illiterate people. There are also photographs of how blood agar cultures of corneal scrapping with colonies of Pseudomonas aeruginosa look – in case you can't rely on a microbiologist's report.

I was amused to find 1970s-style photos. Considering how much time and effort is needed to complete a complex task like editing a textbook such as this one – or, to a lesser extent, contributing a chapter to it – it is surprising that the extra little effort needed to take or to get up-to-date, good quality photographs is so frequently overlooked. I know that the old ones illustrate the point as well, and that we don't need to re-invent the wheel, but a casual browser may pre-judge the book as dated, just on the grounds of a few of the chapters' photographs.

Most, but not all, of the chapters have a reference list at the back; however, the depth and currency of the references varies considerably between chapters. With the exception of a couple of well referred chapters, the rest of the reference lists rely on books and peer review papers from the 1980s and early 1990s. There is very little overlapping of contents in this book. This may be due to the clear division of contents: sometimes the chapter is dedicated to a diagnostic technique, such as perimetry; sometimes to an anatomic area, such as the optic disc; and sometimes to a specific medical condition, such as uveitis.

The contents cover most of the basic and well-established diagnostic procedures in ophthalmology. It starts with visual acuity, the use of the slit lamp, and the assessment of corneal topography – each with a full chapter dedicated to the procedure. Wavefront technology, however, is not included. Tonometry and gonioscopy follow suit. The optic disc evaluation in glaucoma and basic perimetry are dealt with individually, in separate chapters. Three chapters take very defined points of view, to cover ophthalmoscopy: ophthalmic photography, fluorescein angiography and indocyanide green angiography.

The book moves then onto the ‘graphy' group of techniques: A-scan ultrasonography, B-scan ultrasonography, ultrasound biomicroscopy and optical coherence tomography. You have the feeling that we are following a progression towards a more complex world. The electro-diagnostic tests finish the device-focused chapters. The final two are dedicated to keratitis and uveitis infections. I don't agree with the back cover blurb assertion that the authors are all "eminent experts in their respective fields." And I am concerned by the absence of some up-and-coming diagnostic approaches.

However, I realise that I am judging this book from a very starved-of-time point of view. The potential readers that I have in mind are clinicians in busy practices with limited time for textbook consultation. They would prize conciseness, clarity of language, and coverage of the latest technical advances over discursive overviews of well-established procedures and techniques. Abstracting information easily and quickly may not be a fit-all for a textbook outfit. The book's publishers are clearly aiming this book at the international, western market. You can find it at www.amazon.co.uk and at www.amazon.com; the price ($99.00) points in the same direction.

Perhaps my reservations about the book are based on circumstances. To be absolutely up-to-date may be essential in a teaching hospital in central London . Maybe it is not such an issue in many smaller centres, where practitioners with enough time to dedicate to each patient can get the best of traditional and well established devices and methods. I wouldn't be surprised if a patient's evaluation form from both settings gives a higher rating to the less mechanised consultation.

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