Diabetic retinopathy

Diabetic retinopathy

334 Surv Ophtholmol 23 (5) March-April 1979 statistical analysis of numerous parameters of the 247 fluorescein angiographies in glaucoma patients, ...

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334

Surv Ophtholmol

23 (5) March-April 1979

statistical analysis of numerous parameters of the 247 fluorescein angiographies in glaucoma patients, pre-glaucoma patients and controls, he chooses to show the usefulness of the technique in three members of one family and one additional case. Even in these four prime cases, it is not clear whether fluorescein angiography was really of any diagnostic value. Considering specifically the question of the pathogenesis of nerve head damage, not one case is shown in which hypovascularity of an otherwise normal nerve head was found preceding the onset of cupping or the onset of glaucomatous visual field defect. On the other hand, there are several examples of the development of glaucomatous visual field defect without any concomitant angiographic change. The author does present some cases in which lowering intraocular pressure is purported to result in improved vascularity of the disc. It appears well established from the author’s data that fluorescein transit times are delayed when intraocular pressure is elevated in both gluacoma patients and ocular hypertensives, and that this effect is reversible when intraocular pressure is decreased. If it could be shown that this decrease in transit time is of prognostic value in the ocular hypertensive, it would lend weight to the vascular hypothesis. Finally, the author refers to ophthalmodynamometry values as retinal artery pressure. Ophthalmodynamometry does not measure retinal artery pressure: rather, it reflects ophthalmic artery pressure. Therefore, “retinal artery pressure” is misleading. In conclusion, this is an interesting monograph because of the author’s vast experience with a new technique; however. it answers few basic scientific questions. MICHAEL E. YABLONSKI

Diabetic Retinopathy, by Albert0 Urrets-Zavalia. New York, Masson Publishing U.S.A., 1977, 125 pp., 1 17 illus. Price: $19.50 Dr. Urrets-Zavalia has written an excellent monograph on diabetic retinopathy which provides the salient clinical features in eleven chapters. The book begins with a brief chapter covering the prevalence and importance of diabetic retinopathy. Chapters are subsequently presented concerning the clinical features and natural course of diabetic retinopathy, clinical methods of examination, and treatment approaches. The effects of diabetic control, medical therapy, photocoagulation, pituitary ablation and vitreo-retinal surgery are discussed in separate chapters. The coverage of the subject is completed with a chapter on pregnancy and its effects on retinopathy.

BOOK REVIEWS

The author reviews past thinking and brings the reader up to the present day with a well-written, succinct book. He clearly presents the large variety of constantly changing ideas concerning this highly controversial topic by citing the results and conclusions of various authors in a remarkably narrative fashion. Each major section contains many pearls which are frequently documented by references. Numerous black-and-white photographs and figures enhance the text by illustrating the clinical features, fluorescein angiographic findings and pre- and post-treatment results. The author periodically assesses conflicting findings in the literature and interjects his personal clinical results and present beliefs. Diabetic Retinopathy is a very readable monograph chocked full of good information which is conveniently referenced for more in-depth study. I thoroughly enjoyed this compact little volume. MURRAYA. WOLKSTEIN

Principles of Quantitative Perimetry: Testing and Interpreting the Visual Field, by G. W. Tate, Jr., and J. R. Lynn. New York, Grune & Stratton, 1977, 336 pp., illus. Price: $22.50 In first looking at this book, I thought immediately of having to compare it to Harrington, which has become the classic text on visual fields. After reading it, however, it is happily evident that the overlap in the stressed subject matter contained in the two books is not as large as one would have thought. Fully 75% of this book is concerned with the principles and mechanics of perimetry. What one would think of as an essentially dry subject is converted into quite an interesting one through clear writing, good organization, and profuse and lucid illustrations. The excellent introductory chapter wends its way through a discussion of isopters, the physical relationships of the stimuli on the Goldmann perimeter, the concept of Traquair’s island of vision, and conceptual and practical differences between Goldmann perimetry and tangent screen campimetry and between static and kinetic testing. The second chapter, the longest in the book, is a sweep through biophysics, retinal synaptic ultrastructure and physiology, electrophysiology, and psychophysics, and their relation to visual field testing. There is a chapter on the types and limitations of various perimeters and a meticulously detailed chapter on the use of the Goldmann perimeter, including the use of the onedot-four-dot test, central scotoma device, and static perimetry device. There is a wealth of pearls dealing with pitfalls and fine points of examination and interpretation