Leading expert spreads clarity and depth across just 100 pages

Strabismus
Francis A Billson
Hardback, 90 pages, colour
illustrations
BMJ Books, London, March 2003
ISBN: 0 7279 1562 2

THE immense majority of the books I review tell the readers – with reassuring conviction, and generally printed on the book’s back cover – that the book was "written by one of the world’s leading authorities". Then, sometimes, I have to struggle to find out who the hell the writer is, where he or she is working now, and what exactly he or she has done in the last 10 or 20 years that justifies such world renown.

In this case, the assertion that the author is an expert is wholly justified. Prof Francis A Billson has the research record, the years of successful clinical practice, the high calibre publication record, and the interventions in both specialist and general media to justify his status as "world expert".

Prof Billson is currently the director of the Save Sight Institute and the Lions Eye Bank and the Head of Department at Sydney Eye Hospital, Australia. Since he was appointed Foundation Professor of Ophthalmology at Sydney University in 1977, his work has been divided between clinical responsibilities at various hospitals in Sydney, teaching and research.

Also, from the 1970s, he has been closely involved in prevention of blindness programs in the Asia Pacific region, assisting with training programmes for local ophthalmologists, and serving on committees with the World Health Organisation and International Agency for Prevention of Blindness.

Among his many awards are those of Officer in the Order of Australia and "Weary" Dunlop Asia Medal for humanitarian service and leadership. He is also this year’s recipient of the International Blindness Prevention Award, presented by Eye Care America, a public service foundation of the American Academy of Ophthalmology.
After sorting out the question of who the author is, the second question that suspicious minds like mine ask is: Has he written the book? Himself? Personally, with his own fair hands on the keyboard?

It looks like it. It is a very good book, and the style and level of depth of the different areas is consistent and succinct. And credits are due to a research assistant, James Wong, who is a trainee ophthalmologists at Sydney Eye Hospital – who probably did a lot of the running around required to put together a book.

The series editor is another well known figure in the international stage for ophthalmology, Susan Lightman, from the Department of Clinical Ophthalmology and the Institute of Ophthalmology at Moorfields Eye Hospital in London.

This series consists of ophthalmic monographs written for ophthalmologists in training and general ophthalmologists wishing to update themselves or to get an introduction to specialised areas within ophthalmology. Previous titles include cataract surgery, glaucoma, paediatric ophthalmology and neuro-ophthalmology.

The succinct and ‘to the point’ approach of the book is reflected from page one. The series editor’s preface, the preface proper, the acknowledgments, the foreword, and the introduction are all remarkably short and clear. They say what they want to say and stop there.

It is a short book. It packs everything into less than 100 pages of distilled information, very tightly focused on the subject throughout. Clinical photographs and the occasional line drawing illustrate the text, and the double column layout – together with the numerous headings, sub-headings and sub-sub-headings – break the text into very easily digestible chunks.

Every chapter is referred, but I was disappointed to find that you only need the fingers of one hand to count the references with a publication date of 1999 or more recently. Contrast that against the publication date of the book itself: March 2003. On the other hand, the text contents can’t be accused of being out of date, so the scarcity of recent references is probably of academic concern only.

The occasional historical reference may be very valid, but for trainees and general ophthalmologists, current, more recent papers are easier to access and more relevant to current clinical practice.

The book’s contents are organised into seven clearly written chapters. It starts by presenting the neuropsychological bases of binocular vision. Don’t expect generic anatomical introductions: after a clear exposition of what normal binocular vision is, we are into strabismus on page one. Very soon we are into the breakdown of binocular vision and the sequel of strabismus in the immature visual system of children.

The second section starts with a useful and practical classification of strabismus by decades of life. The birth to 10 years of age period produces strabismus connected to non-progressive underlying pathology and static neurological abnormalities.
For patients aged 10 to 20 years of age – the culprit is likely to be cranial nerve dysfunction, intracranial hypertension or trauma. The next three decades sees strabismus related to trauma, MS and several other systemic alterations. And in those patients aged 50 years or older, degenerative diseases, hypertension, diabetes and others, take centre stage as causes of strabismus. Prof Billson then goes into a detailed assessment of strabismus at the different stages, with the largest section dedicated to childhood-onset strabismus.

The third and final section of the book deals with the management of strabismus – in two chapters dedicated to assessment and treatment.
The photographs are well selected for their clarity. And I was glad to see them looking current. Not many 1970s photos here.

There is also a glossary at the back. But don’t get too excited, it has only 20 words. And one of them is "strabismus", so there are only 19 really. If you were expecting help here for the technical sub-specialty terms, you’ll need to be lucky to find that the word you are looking for is one of these 19.

And you may need that help, because regarding vocabulary, this book does not take prisoners. If you are not familiar with specialist clinical ophthalmology, you may struggle a little. And if you are tired or English is not your mother tongue, you may need to read a sentence or two twice, because when the author has had a choice between the strictly correct or the more straight forward, he has gone for the first.

That said, the concepts, the problems and their treatments, are all clearly explained and rationalised. The need to concentrate has more to do with the condensation and the succinctness of the content, rather than any lack of clarity.

The best asset of this book is the way it blends clinical views with research knowledge.
It is a ready-to-use guide to strabismus management. Considering that strabismus is not an uncommon condition, this book would be a reliable information source in most ophthalmic departments.

I fully agree with the publishers that ophthalmologists in training and general ophthalmologists would find it clear and useful. I am not sure I agree with the bit that says the book is suitable "for general physicians needing to understand the associations with other diseases". For a general practitioner or other physician without ophthalmic training it will be less useful.

As for established specialists? If they have anything to do with the training of residents or treating of children on a regular or even occasional basis, they would also benefit. To me, the index of "space taken on the self-usefulness of contents" is very high indeed.

Price: st£45 for text or st£20 for an electronic version through British Medical Journal’s bookshop at www.bmjbookshop.com

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