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Physiology and Biophysics
BOOK REVIEWS
362
BOOK
REVIEWS
MANAGEMENT OF THE PATIENT WITH SUB NORMAL VISION. By Gerald Fonda, M.D. St. Louis, C. V. Mosby Company, 1965. 161 pages, 88 illustrations, 8 tables, bib liography,. index. Price: $11.00.
The revival of interest in optical aids for subnormal vision, sparked by the 1954 In ternational Congress of Ophthalmology in New York, is no longer evident in current ophthalmic literature. Fonda's monograph, based on an intensive study of 3,500 pa tients, should generate renewed animation in this ever-important phase of ophthalmology. Those who were dismayed by the vast ar ray of equipment often displayed and the prolonged training proposed by some will happily learn that neither is usually neces sary. Fonda utilized telescopic corrections from 1942 to 1954 but in 1955 he shifted one such patient to bifocals with high-plus adds and, since then, he has made this grati fying switch in more than 50 patients. Com pared to telescopic spectacles, high-plus adds are less conspicuous, less expensive, more comfortable and provide a larger field of vision. According to the older textbooks, a binocular add of more than 3.25D cannot be tolerated. Fonda has shown that "it ain't necessarily so." When both eyes have some vision, bifocals are advantageous and Fonda has successfully prescribed them with adds as high as 10D. The strong reading correc tions required are lighter and less conspicu ous in bifocal form.. He aids convergence by displacing each segment in one mm for each diopter of add. If reading glasses only are prescribed, he incorporates in each lens 1Δ base-in for each diopter of add. The magnification needed by the semisighted can be supplied by large-sized print (18 pt or more) practically by adequate plus lenses that permit small type to be held close to the eye. If the patient has difficulty in reading street or bus signs, a commercially available clip-on monocular telescope is rec ommended for intermittent use. Telescopic
spectacles for near vision are only necessary when a maximum reading or working dis tance is essential. When subnormal vision is associated with aphakia or high hyperopia, contact glasses are contraindicated because of the greater magnifying effect of a spec tacle correction in these cases. Fonda covers every phase and facet of his subject, con cluding with a brilliant summary in question and answer form. Every procedure that Fonda describes has been used and evalua ted personally. The clear, simple straight forward presentation reveals his dedication to this subspecialty and his eagerness to gain disciples. James E. Lebensohn. PHYSIOLOGY AND BIOPHYSICS.
Edited
by
Theodore C. Ruch, Ph.D., and Harry D. Patton, Ph.D. Philadelphia, W. B. Saunders Company, 1965. Nineteenth edition, clothbound, 1,242 pages, 851 figures in black and white, 3 color figures, 70 tables, chapter references, index. Price : $17.00. Howell's American Text-Book of Phys iology was first published in 1896 and has remained a standard undergraduate text book. The appearance of the 19th edition is thus a major event most important to oph thalmologists in reflecting current under graduate teaching material. Such is the growth and complexity of the topic that 33 contributors are required to present the ma terial. The biophysics of the title is defined as the "physics and physical chemistry of the organism or physical or quantitative biolo gy." In a number of chapters the use of models and mathematical expression is stressed but biophysics is by no means ex tended to all portions of the book. Ophthal mologists concerned that their topic is too complicated for undergraduates may be im pressed by the physical chemistry, physics and calculus the undergraduate must use with facility if he is to understand the mem brane transport, action potentials, regulation of pH and the like.
BOOK REVIEWS The chapter on the eye as an optical in strument is in the main unchanged from previous editions and is likely the weakest chapter of the book. The bibliography is not current, the text is obscure and errors are common. Regrettably, another generation of medical students will thus believe ophthal mology to be incredibly complex. Fancy dis cussing strabismus with the student who has been taught, "In conjugate deviations the eyes move in a way to keep the visual axes of the two eyes parallel or else to converge them upon a common point, the medial rectus of one eye acting with the lateral rectus of the other. In movements of convergence, the medial recti of the two eyes are associ ated. Normally, it is impossible to diverge the visual axes beyond the parallel. A move ment of this kind would produce useless double vision (diplopia)." The chapter on vision is better but nonetheless presents many confusing state ments such as: "The hyperope does not see better than the emmétrope at a distance, but sees with less need for accommodation when objects are at a distance." The chapter on binocular vision and the central visual pathways begins, "By the visual field of an eye is meant the entire ex tent of the external world which can be seen without a change in the fixation of the eye. Because of the lens, the visual field is in verted upon the retina, so that objects in the upper visual field fall upon the lower half of the retina and objects in the right half of the visual field fall upon the left half of the retina. The retina is sensitive out to the ora serrata and, if the eye protruded sufficiently from its orbit, its visual field projected upon a flat surface would be a circle, the center of which would correspond to the fovea centralis. However, the nose, eyebrows and cheek bones cut off a considerable part of this field, giving it an irregular outline. The normal field of vision is therefore of little interest, but testing of the visual fields is an important clinical maneuver, especially in cases of suspected brain tumor."
363
These chapters of course constitute but 54 pages of a textbook of nearly 1,250 pages but they cause uneasiness about the book as a whole. The wide acceptance by teachers of physiology suggests that the book must be considered an authoritative, useful textbook. An ophthalmologist cannot help wishing, though, that current knowledge concerning the physiology of the eye was presented. The first 522 pages are separately pub lished in a hard-cover edition selling for $11.00 Frank W. Newell L'OEIL
ET
LES
RADIATIONS
IONISANTES
(The Eye and Ionizing Radiation). By C. Haye, H. Tammet, and M.-A. Dollfus. Paris, Masson et Cie, 1965. In two vol umes, paperbound, 1444 pages, 441 figures, and 7 color plates. Author and subject indexes. Price : not listed. Another of the exhaustive and definitive annual "rapports" of the French Society of Ophthalmology is at hand. An idea of the level of excellence and completeness of these monographs can be obtained by naming just two or three that have appeared in recent years : "The Chorioretinal Heredodegenerations," by Franceschetti, François, and Babel; "Congenital Cataracts," by J. Fran çois ; and "Biology of the Lens," by Nordmann. The present volume (or volumes, since it appears in two parts) is on a par with these. The senior author, Dr. Dollfus, has for years been in charge of a clinic on ocular tumors, and his work on the X-ray therapy of such lesions is world-famous. His stu dent and colleague, Dr. Haye, has taken over much of the load from his "patron" and is now ophthalmologist to the Curie Foundation as well as ophthalmologist to the Hospital of Paris, a position of great honor and eminence. The third author, H. Jammet, is both chief of the radioisotope and radiopathology service of the Curie Foundation and chief of the health protection service of the French Atomic Energy Commission.
362
BOOK
REVIEWS
MANAGEMENT OF THE PATIENT WITH SUB NORMAL VISION. By Gerald Fonda, M.D. St. Louis, C. V. Mosby Company, 1965. 161 pages, 88 illustrations, 8 tables, bib liography,. index. Price: $11.00.
The revival of interest in optical aids for subnormal vision, sparked by the 1954 In ternational Congress of Ophthalmology in New York, is no longer evident in current ophthalmic literature. Fonda's monograph, based on an intensive study of 3,500 pa tients, should generate renewed animation in this ever-important phase of ophthalmology. Those who were dismayed by the vast ar ray of equipment often displayed and the prolonged training proposed by some will happily learn that neither is usually neces sary. Fonda utilized telescopic corrections from 1942 to 1954 but in 1955 he shifted one such patient to bifocals with high-plus adds and, since then, he has made this grati fying switch in more than 50 patients. Com pared to telescopic spectacles, high-plus adds are less conspicuous, less expensive, more comfortable and provide a larger field of vision. According to the older textbooks, a binocular add of more than 3.25D cannot be tolerated. Fonda has shown that "it ain't necessarily so." When both eyes have some vision, bifocals are advantageous and Fonda has successfully prescribed them with adds as high as 10D. The strong reading correc tions required are lighter and less conspicu ous in bifocal form.. He aids convergence by displacing each segment in one mm for each diopter of add. If reading glasses only are prescribed, he incorporates in each lens 1Δ base-in for each diopter of add. The magnification needed by the semisighted can be supplied by large-sized print (18 pt or more) practically by adequate plus lenses that permit small type to be held close to the eye. If the patient has difficulty in reading street or bus signs, a commercially available clip-on monocular telescope is rec ommended for intermittent use. Telescopic
spectacles for near vision are only necessary when a maximum reading or working dis tance is essential. When subnormal vision is associated with aphakia or high hyperopia, contact glasses are contraindicated because of the greater magnifying effect of a spec tacle correction in these cases. Fonda covers every phase and facet of his subject, con cluding with a brilliant summary in question and answer form. Every procedure that Fonda describes has been used and evalua ted personally. The clear, simple straight forward presentation reveals his dedication to this subspecialty and his eagerness to gain disciples. James E. Lebensohn. PHYSIOLOGY AND BIOPHYSICS.
Edited
by
Theodore C. Ruch, Ph.D., and Harry D. Patton, Ph.D. Philadelphia, W. B. Saunders Company, 1965. Nineteenth edition, clothbound, 1,242 pages, 851 figures in black and white, 3 color figures, 70 tables, chapter references, index. Price : $17.00. Howell's American Text-Book of Phys iology was first published in 1896 and has remained a standard undergraduate text book. The appearance of the 19th edition is thus a major event most important to oph thalmologists in reflecting current under graduate teaching material. Such is the growth and complexity of the topic that 33 contributors are required to present the ma terial. The biophysics of the title is defined as the "physics and physical chemistry of the organism or physical or quantitative biolo gy." In a number of chapters the use of models and mathematical expression is stressed but biophysics is by no means ex tended to all portions of the book. Ophthal mologists concerned that their topic is too complicated for undergraduates may be im pressed by the physical chemistry, physics and calculus the undergraduate must use with facility if he is to understand the mem brane transport, action potentials, regulation of pH and the like.
BOOK REVIEWS The chapter on the eye as an optical in strument is in the main unchanged from previous editions and is likely the weakest chapter of the book. The bibliography is not current, the text is obscure and errors are common. Regrettably, another generation of medical students will thus believe ophthal mology to be incredibly complex. Fancy dis cussing strabismus with the student who has been taught, "In conjugate deviations the eyes move in a way to keep the visual axes of the two eyes parallel or else to converge them upon a common point, the medial rectus of one eye acting with the lateral rectus of the other. In movements of convergence, the medial recti of the two eyes are associ ated. Normally, it is impossible to diverge the visual axes beyond the parallel. A move ment of this kind would produce useless double vision (diplopia)." The chapter on vision is better but nonetheless presents many confusing state ments such as: "The hyperope does not see better than the emmétrope at a distance, but sees with less need for accommodation when objects are at a distance." The chapter on binocular vision and the central visual pathways begins, "By the visual field of an eye is meant the entire ex tent of the external world which can be seen without a change in the fixation of the eye. Because of the lens, the visual field is in verted upon the retina, so that objects in the upper visual field fall upon the lower half of the retina and objects in the right half of the visual field fall upon the left half of the retina. The retina is sensitive out to the ora serrata and, if the eye protruded sufficiently from its orbit, its visual field projected upon a flat surface would be a circle, the center of which would correspond to the fovea centralis. However, the nose, eyebrows and cheek bones cut off a considerable part of this field, giving it an irregular outline. The normal field of vision is therefore of little interest, but testing of the visual fields is an important clinical maneuver, especially in cases of suspected brain tumor."
363
These chapters of course constitute but 54 pages of a textbook of nearly 1,250 pages but they cause uneasiness about the book as a whole. The wide acceptance by teachers of physiology suggests that the book must be considered an authoritative, useful textbook. An ophthalmologist cannot help wishing, though, that current knowledge concerning the physiology of the eye was presented. The first 522 pages are separately pub lished in a hard-cover edition selling for $11.00 Frank W. Newell L'OEIL
ET
LES
RADIATIONS
IONISANTES
(The Eye and Ionizing Radiation). By C. Haye, H. Tammet, and M.-A. Dollfus. Paris, Masson et Cie, 1965. In two vol umes, paperbound, 1444 pages, 441 figures, and 7 color plates. Author and subject indexes. Price : not listed. Another of the exhaustive and definitive annual "rapports" of the French Society of Ophthalmology is at hand. An idea of the level of excellence and completeness of these monographs can be obtained by naming just two or three that have appeared in recent years : "The Chorioretinal Heredodegenerations," by Franceschetti, François, and Babel; "Congenital Cataracts," by J. Fran çois ; and "Biology of the Lens," by Nordmann. The present volume (or volumes, since it appears in two parts) is on a par with these. The senior author, Dr. Dollfus, has for years been in charge of a clinic on ocular tumors, and his work on the X-ray therapy of such lesions is world-famous. His stu dent and colleague, Dr. Haye, has taken over much of the load from his "patron" and is now ophthalmologist to the Curie Foundation as well as ophthalmologist to the Hospital of Paris, a position of great honor and eminence. The third author, H. Jammet, is both chief of the radioisotope and radiopathology service of the Curie Foundation and chief of the health protection service of the French Atomic Energy Commission.