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This is a beautiful book. In keeping with the title Atlas of Glaucoma, the most striking feature is the universally excellent quality of the illustrations. The authors' aim is to "illustrate what we know about glaucoma" and in this they have certainly succeeded. The 300 pages of this book are divided into 3 parts: The Basics of Glaucoma, encompassing glaucoma classification, aqueous humour dynamics, intraocular pressure measurement, gonioscopy, optic nerve head examination and psychophysical and electrophysiological testing; Clinical Entities, detailing primary and secondary open-angle glaucoma, angle-closure glaucoma, normal-tension glaucoma, developmental glaucomas and a section on ocular blood flow; and Treatment of Glaucoma, discussing medical, laser and surgical therapies, with full chapters on shunt surgery, combined glaucoma and cataract surgery and treatment of developmental glaucomas. The coverage with these chapter titles is thorough, although not comprehensive, and for a clinical book which still allocates significant space to Schiotz tonometry and measurement of aqueous outflow, the lack of a dedicated chapter on optic nerve head and retinal nerve fibre layer imaging - which is covered in only 2 pages - is at least curious. The full chapter on ocular blood flow is, by comparison, entirely appropriate. Chapters are written by contributors who are recognized experts in their field, and who are, with the exception of Carlo Traverso from Italy, all US-based. The editors allude to the difficulties in harnessing contributions from a wide range of sources and styles into a coherent whole, and this difficulty remains evident in the variation in format between the chapters. The sections on angle-closure glaucoma, visual fields and to some extent developmental glaucomas have kept to an atlas format, and are largely illustrative with detailed footnotes, while the bulk of the other chapters contain a considerable text supplemented with illustrative material. As such, this is, therefore, really a textbook rather than an atlas. The format variation does result in some unevenness, and while, for example, the angle-closure chapter photographs are superb, making particular use of the relatively new technique of high frequency ultrasound biomicroscopy (UBM), the lack of a framework text in this chapter results in a patchy feel, and the coverage of malignant glaucoma is somewhat inadequate. The chapters are, on the whole however, concise and well-rounded, with a level of detail appropriate to a single volume work. The editors do not state a target audience for their book, but the coverage is such that it would find wide use among general ophthalmologists and trainees as a handbook of glaucoma. The medical therapy chapter is a very helpful summation of drug formulations, dosage regimens and potential side effects, and would be a handy ready-reference, while the sections on laser and surgical therapy contain sufficient practical minutiae for the book to be useful as a stand-alone source on technique (although one might be excused for believing that complications are not seen following these interventions); the chapter on gonioscopy is highly recommended. The American bias of the book is slight and seldom a real problem, and although the epidemiology is largely US data, Paul Lee's references to the American Academy of Ophthalmology's Preferred Practice Patterns are in keeping with similar moves by The Royal Australian and New Zealand College of Ophthalmologists. Drop therapies are plainly recognizable despite the illustrations carrying US proprietary names and the standard deployment of the Humphrey Field Analyzer will be a comfort to most Australian readers, at least among ophthalmologists. The only serious defect in emphasis for the local reader is in the filtering surgery chapter with the dangerous notion (extensively implied across the American literature) that Mitomycin C (MMC) may be considered the usual antifibrosis adjuvant therapy in trabeculectomy. All statements regarding MMC should be prefaced with a knowledge of the increased prevalence and aggressiveness of glaucoma in the black American population, and the heightened healing response that they demonstrate, the combination of which may justify MMC use on a wide scale. Mitomycin use in an Australian context should generally be approached with extreme caution and, if antifibrosis treatment is to be used, 5-fluorouracil as an onlay is generally preferred. Half a page in this chapter is given to MMC, while 5-fluorouracil is accorded only 4 lines, and then largely as the now dated postoperative course of injections. In addition, advocacy of the use of antifibrosis therapy should always be accompanied by a discussion of potential complications and their management, which is here notably lacking, and covered only fleetingly in the combined glaucoma and cataract surgery chapter. A niggling deficiency in this book is the system of bibliography. Each chapter concludes with a set of recommended Further Reading, which is frequently large and contains many essential keynote papers. In addition, several contributors make specific reference by name throughout their texts to investigators' work, and admittedly, these named investigators are usually included in the Further Reading, but it would have been so much more useful - having gone to the trouble of assembling such a formidable list of source and related works - to formally reference these in the text. This is particularly so when an investigator is not named: all but a reader totally lacking in curiosity will pursue the origin of a statement such as "(p166)...betaxolol may improve blood flow and may, therefore, be of benefit in low-tension glaucoma", but will search the Further Reading section in vain for the reference. Similarly, "(p216).....patients treated with betaxolol showed a slight increase in mean sensitivity (on visual field testing)", and a graph is provided, but with no mention of the authors or source, only the cognoscenti will know to seek the paper by Collignon-Brach from more than 3 pages of Further Reading. Despite functioning as a handbook, the material in the text is sufficiently detailed that formal referencing is certainly justified, and its absence is a source of recurring frustration, which detracts somewhat from the book's wider usefulness so that it is, therefore, not adequate for those pursuing an interest, or for medal candidates for the RACO Fellowship Examination. The market is already well-served with comprehensive multi-volume textbooks of glaucoma and this book does not claim to be a pretender to that niche. Atlas of Glaucoma is a superbly illustrated handbook of glaucoma, which should be of practical use to all trainees and general ophthalmologists. It contains a wealth of information and illustration and its few areas of deficiency outlined above do not, on the whole, negate the value of the book as a more affordable and accessible alternative to the definitive textbooks. Mark J Walland This is available for purchase through the Library's Bookshop Service, or available for loan through the library. Contact the library for more details.
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