- Email: [email protected]
Ophthalmic Micro-Surgery Instrumentation, Microscopes, Techniques
BOOK REVIEWS Edited by H. Stanley Thompson, M.D.
hand, we will not forget how to test such patients. I recommended the first edition to residents, technicians, and ophthalmologists. I likewise recommend this second edition, especially to those who have recently converted (physically but not intellectually) to automated perimetry.
Perimetry With and Without Automation, 2nd ed. By Douglas R. Anderson. St. Louis, The C. V. Mosby Company, 1987. 496 pages, index, illus trated. $60 Reviewed by RICHARD MILLS
Olympia, Washington The first edition of this book was prized by physicians and technicians alike because it was a readable, understandable, practical guide to the secrets of Goldmann kinetic perimetry. As those experienced in Goldmann perimetry confront the new automated perimeters, they find themselves in need of education in the new methodology. This second edition provides just that. The initial chapters consider the principles of kinetic manual and automated static perimetry together. Descriptions of the strategies used by automated perimeters to explore the visual field seem less formidable and more reasonable. The nature of scotomas and visual field depressions as defined by both perimetric methods are illustrated. This parallel treatment is especially useful in the chapter on visual field loss in glaucoma.
Ophthalmic Micro-Surgery Instrumentation, Mi croscopes, Techniques. Edited by J. Draeger. Basel, Switzerland, S. Karger, AG, 1987. $95.75 Reviewed by HANSJOERG E. Iowa City, Iowa
KOLDER
This visually and graphically appealing book contains ten chapters on technical, physical, and logistical aspects of microsurgery. Twenty years of development are summarized, mostly originating from West Germany. The late Professor Sautter contributed a brief chapter on the history of ophthalmic microsurgery. Draeger and Klein deal with anthropometric considerations for the design of the perioperative field. They advocate a rigid plate on which the patient is placed for transfer from the moving cart to the stationary operating table. The operating table is connected to an X-Y mechanism, thereby minimizing position changes for the surgeon. The ceiling mount incorporates the anesthesia unit together with other ancillary equipment. The exposition is pragmatic and contains no details for construction. Draeger and Reiner describe, somewhat circuitously, the optical characteristics of operating microscopes and their attachments. This topic is rarely found in other publications; the treatment here is neither rigorous nor comprehensive, and is somewhat difficult to read. Machemer discusses the pathophysiology of proliferative retinopathy and treatment modalities without giving the details of his instrumentation. Spitznas describes his motorized, teleguided, stereotactic, microsurgical unit and compares its performance with free-hand vitreous surgery. Hutz and Ullerich provide information about suture characteristics and materials. Binkhorst, Burk, and Draeger describe the
The next section deals with more practical matters, for example, how the intelligent choice of a visual field testing strategy should vary with the suspected diagnosis, the mechanics of testing a patient at the perimeter, and the interpretation of the resulting chart, whether drawn by a technician or a computer. The pitfall of overinterpretation of the progression of a visual field defect because of intratest variability is properly stressed. A short but pithy chapter about the psychophysical basis for perimetry follows for those who wish to know the " w h y s " underlying the rote instructions we are told to follow to obtain meaningful visual fields. The sections on manual perimetric technique have been relegated to the final nine chapters. It is almost as though the author senses the passing of the old ways but wishes to continue to convey the ancient skills of the perimetric art to anyone who wishes to read on. There are patients who cannot cooperate for automated perimetry yet who still can be tested by using manual techniques. With these chapters in 197
198
AMERICAN JOURNAL OF OPHTHALMOLOGY
physical features and optical abberations of intraocular lenses, and discuss sterilization methods. All but two chapters of the book have been translated by that premier interpreter of German language ophthalmic literature—F.C. Blodi. He has the perspective for the task and holds the reins lightly. Occasionally terms are used which impede understanding, particularly in Chapter 3. Errors occur throughout the book. This book addresses the reader who would like a deeper understanding of ophthalmic microsurgical instrumentation. The level of exposition is adequate for those who wish to be informed at the basic level and the experienced reader is frequently rewarded with moments of profound insight.
Biostatistics in Clinical Medicine, 2nd ed. By Joseph A. Ingelfinger, Frederick Mosteller, Lawrence A. Thibodeau, and James H. Ware. New York, Macmillan Publishing Company, Inc., 1987. Softcover, 339 pages, index, illustrated. $28.50
Reviewed by TERRY A. Cox
Vancouver, British Columbia Whether we realize it or not, statistical concepts are an integral part of our clinical work. In our years of practice, we accrue a database that we call "clinical experience," and we use this database to diagnose and treat patients. But applying this experience without using
August, 1987
good statistical principles is like using a computer spreadsheet program without the manual: we may eventually figure out the best way to do things, but we will make a lot of mistakes along the way. We often attempt to improve this learning process by reading the medical literature; even so, we need some defense against improper conclusions and poorly designed studies. The authors of this book have set out to prepare physicians "to use and understand applications of probability and statistics for the care of the individual patient," and they have made an outstanding effort. I find it difficult to think of a way that this book could be made better, except perhaps to include a few ophthalmic examples. The book discusses most of the statistical topics that clinicians need to function in daily practice as well as read the medical literature, and each discussion is based on clinical situations. For example, one chapter, entitled "Blood pressure and hypertension: Distribution and variability," covers the normal distribution, confidence limits, standard deviation, and f-tests. This discussion would certainly be applicable to intraocular pressures and ocular hypertension. Some of the other chapters cover the chi-square test, regression analysis, life tables, decision analysis, and reading and using clinical trials. Each chapter begins with a list of objectives and ends with a summary, problems, and a short list of references. Some standard statistical tables are included as appendices, so that the book can serve as a reference for those who need to make simple statistical calculations. Ophthalmologists at all levels could benefit from reading this book. For clinical researchers, it should be required reading.
hand, we will not forget how to test such patients. I recommended the first edition to residents, technicians, and ophthalmologists. I likewise recommend this second edition, especially to those who have recently converted (physically but not intellectually) to automated perimetry.
Perimetry With and Without Automation, 2nd ed. By Douglas R. Anderson. St. Louis, The C. V. Mosby Company, 1987. 496 pages, index, illus trated. $60 Reviewed by RICHARD MILLS
Olympia, Washington The first edition of this book was prized by physicians and technicians alike because it was a readable, understandable, practical guide to the secrets of Goldmann kinetic perimetry. As those experienced in Goldmann perimetry confront the new automated perimeters, they find themselves in need of education in the new methodology. This second edition provides just that. The initial chapters consider the principles of kinetic manual and automated static perimetry together. Descriptions of the strategies used by automated perimeters to explore the visual field seem less formidable and more reasonable. The nature of scotomas and visual field depressions as defined by both perimetric methods are illustrated. This parallel treatment is especially useful in the chapter on visual field loss in glaucoma.
Ophthalmic Micro-Surgery Instrumentation, Mi croscopes, Techniques. Edited by J. Draeger. Basel, Switzerland, S. Karger, AG, 1987. $95.75 Reviewed by HANSJOERG E. Iowa City, Iowa
KOLDER
This visually and graphically appealing book contains ten chapters on technical, physical, and logistical aspects of microsurgery. Twenty years of development are summarized, mostly originating from West Germany. The late Professor Sautter contributed a brief chapter on the history of ophthalmic microsurgery. Draeger and Klein deal with anthropometric considerations for the design of the perioperative field. They advocate a rigid plate on which the patient is placed for transfer from the moving cart to the stationary operating table. The operating table is connected to an X-Y mechanism, thereby minimizing position changes for the surgeon. The ceiling mount incorporates the anesthesia unit together with other ancillary equipment. The exposition is pragmatic and contains no details for construction. Draeger and Reiner describe, somewhat circuitously, the optical characteristics of operating microscopes and their attachments. This topic is rarely found in other publications; the treatment here is neither rigorous nor comprehensive, and is somewhat difficult to read. Machemer discusses the pathophysiology of proliferative retinopathy and treatment modalities without giving the details of his instrumentation. Spitznas describes his motorized, teleguided, stereotactic, microsurgical unit and compares its performance with free-hand vitreous surgery. Hutz and Ullerich provide information about suture characteristics and materials. Binkhorst, Burk, and Draeger describe the
The next section deals with more practical matters, for example, how the intelligent choice of a visual field testing strategy should vary with the suspected diagnosis, the mechanics of testing a patient at the perimeter, and the interpretation of the resulting chart, whether drawn by a technician or a computer. The pitfall of overinterpretation of the progression of a visual field defect because of intratest variability is properly stressed. A short but pithy chapter about the psychophysical basis for perimetry follows for those who wish to know the " w h y s " underlying the rote instructions we are told to follow to obtain meaningful visual fields. The sections on manual perimetric technique have been relegated to the final nine chapters. It is almost as though the author senses the passing of the old ways but wishes to continue to convey the ancient skills of the perimetric art to anyone who wishes to read on. There are patients who cannot cooperate for automated perimetry yet who still can be tested by using manual techniques. With these chapters in 197
198
AMERICAN JOURNAL OF OPHTHALMOLOGY
physical features and optical abberations of intraocular lenses, and discuss sterilization methods. All but two chapters of the book have been translated by that premier interpreter of German language ophthalmic literature—F.C. Blodi. He has the perspective for the task and holds the reins lightly. Occasionally terms are used which impede understanding, particularly in Chapter 3. Errors occur throughout the book. This book addresses the reader who would like a deeper understanding of ophthalmic microsurgical instrumentation. The level of exposition is adequate for those who wish to be informed at the basic level and the experienced reader is frequently rewarded with moments of profound insight.
Biostatistics in Clinical Medicine, 2nd ed. By Joseph A. Ingelfinger, Frederick Mosteller, Lawrence A. Thibodeau, and James H. Ware. New York, Macmillan Publishing Company, Inc., 1987. Softcover, 339 pages, index, illustrated. $28.50
Reviewed by TERRY A. Cox
Vancouver, British Columbia Whether we realize it or not, statistical concepts are an integral part of our clinical work. In our years of practice, we accrue a database that we call "clinical experience," and we use this database to diagnose and treat patients. But applying this experience without using
August, 1987
good statistical principles is like using a computer spreadsheet program without the manual: we may eventually figure out the best way to do things, but we will make a lot of mistakes along the way. We often attempt to improve this learning process by reading the medical literature; even so, we need some defense against improper conclusions and poorly designed studies. The authors of this book have set out to prepare physicians "to use and understand applications of probability and statistics for the care of the individual patient," and they have made an outstanding effort. I find it difficult to think of a way that this book could be made better, except perhaps to include a few ophthalmic examples. The book discusses most of the statistical topics that clinicians need to function in daily practice as well as read the medical literature, and each discussion is based on clinical situations. For example, one chapter, entitled "Blood pressure and hypertension: Distribution and variability," covers the normal distribution, confidence limits, standard deviation, and f-tests. This discussion would certainly be applicable to intraocular pressures and ocular hypertension. Some of the other chapters cover the chi-square test, regression analysis, life tables, decision analysis, and reading and using clinical trials. Each chapter begins with a list of objectives and ends with a summary, problems, and a short list of references. Some standard statistical tables are included as appendices, so that the book can serve as a reference for those who need to make simple statistical calculations. Ophthalmologists at all levels could benefit from reading this book. For clinical researchers, it should be required reading.