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Ptosis
Vol. I l l , No. 6
sist, h o w e v e r , s u c h as t h e c o n f u s i o n b e t w e e n the l e v a t o r h o r n s a n d W h i t n a l l ' s l i g a m e n t , which seems to have found its way into nearly every book on b l e p h a r o p t o s i s . Perhaps the m o s t d i s a p p o i n t i n g c h a p t e r is t h e o n e o n c l a s s i fication. Dr. C a l l a h a n c o r r e c t l y p o i n t s o u t t h e problems with older, n o n e t i o l o g i c classifica t i o n s a n d s t r e s s e s t h e n e e d for a m e c h a n i s t i c a p p r o a c h . I n d e e d , h e r e c o g n i z e s four m a j o r categories of blepharoptosis: levator maldevelopment (myogenic), aponeurotic, neurogenic, a n d m e c h a n i c a l / a p p a r e n t . Yet h e g o e s o n t o propose several seemingly nondescriptive a n d nonetiologic groups, such as "simple levator m a l d e v e l o p m e n t " for congenital developmen tal d y s t r o p h i c b l e p h a r o p t o s i s . U n d e r a p o n e u rotic blepharoptosis are included such confus ing categories as " s e n i l e p t o s i s , " " f o l l o w i n g cataract surgery," "following local t r a u m a , " and " b l e p h a r o c h a l a s i s . " Such groupings add little t o o u r u n d e r s t a n d i n g o f o r i g i n , s i n c e a l l o f t h e m r e l a t e to a p o n e u r o t i c r e d u n d a n c y o r d e hiscence. Rather than being types of blepharop tosis, these, among many others n o t listed, are actually causes of aponeurotic blepharoptosis. Despite these few critical c o m m e n t s , M i c h a e l C a l l a h a n h a s a c h i e v e d m o r e in t h i s n e w e d i t i o n t h a n j u s t t h e r e s u r r e c t i o n o f a c l a s s i c b o o k . In m a n y ways it r e p r e s e n t s a n e w v o l u m e , o n e t h a t will i t s e l f b e c o m e a s t a n d a r d i n t h e field o f blepharoptosis surgery. Dr. Callahan's stated goal was to bring this b o o k abreast o f m o d e r n t i m e s a n d t o m a k e it useful t o t h o s e w h o p e r form t h e s e p r o c e d u r e s . H e h a s a c h i e v e d t h e s e goals admirably. This book should certainly b e on t h e s h e l f o f a n y s u r g e o n w h o e x a m i n e s a n d treats patients with blepharoptosis.
Color Atlas of Ophthalmic Surgery. Strabismus. By Kenneth W. Wright. Philadelphia, J . B. Lippincott, 1990. 261 pages. Index, Illustrated. $125 Reviewed by R O N A L D V. K E E C H
Iowa
City,
Iowa
T h i s is t h e first v o l u m e in a s e r i e s o n o p h t h a l mic surgery, which illustrates surgical proce d u r e s with d r a w i n g s a n d c o l o r p h o t o g r a p h s . T h e i n t e n t o f t h e b o o k is t o p r o v i d e a " p r a c t i c a l text to t e a c h s t r a b i s m u s s u r g i c a l t e c h n i q u e " t o the novice and as well as e x p a n d the "surgical repertoire o f the experienced surgeon." B e g i n n i n g s u r g e o n s will a p p r e c i a t e t h e c h a p
779
Book Reviews
ters on anatomy a n d basic surgical technique. T h e y w i l l a l s o b e n e f i t from t h e c o n c i s e s u m m a ry o f s u r g i c a l i n d i c a t i o n s f o u n d i n m a n y o f t h e chapters and the recommended surgical a m o u n t s f o r r e s e c t i o n s a n d r e c e s s i o n s l i s t e d in the appendices. A note o f caution to the novice: some procedures, such as the silicone expander operation used for weakening the superior oblique muscle, may b e misinterpreted as a p r o c e d u r e p r e f e r r e d b y m o s t s t r a b i s m u s sur g e o n s , w h e n i n r e a l i t y it is a n i n t r i g u i n g b u t n o t well-established technique. V e t e r a n s t r a b i s m u s s u r g e o n s m a y profit from the c h a p t e r s o n a d j u s t a b l e s u t u r e s , p o s t e r i o r fixation s u t u r e s , a n d c h e m o d e n e r v a t i o n ( b o t u lininum) surgery. T h e drawings and color pho tographs clearly demonstrate the techniques, and the references, while n o t exhaustive, are current. T h e six c o n t r i b u t o r s d o a g o o d j o b o f d e s c r i b ing a n d i l l u s t r a t i n g s t r a b i s m u s s u r g i c a l t e c h niques. A s a result, this b o o k should b e valu a b l e in t r a i n i n g r e s i d e n t s a n d f e l l o w s .
The History of Ophthalmology, vol. 9. The First and Second Half of the Nineteenth Century. By Julius Hirschberg. Translated by Frederick C. Blodl. Germany, Verlag, 1 9 9 0 . 3 3 2 pages. In dex, illustrated. $ 1 8 0 Reviewed by FRANK W . NEWELL
Chicago,
Illinois
After d e l a y o f a l i t t l e m o r e t h a n t w o y e a r s , publication of Frederick Blodi's translation into English o f Julius Hirschberg's " T h e History of O p h t h a l m o l o g y " h a s resumed with the appear a n c e o f v o l u m e 9 , " T h e First a n d S e c o n d H a l f of the N i n e t e e n t h Century, United States o f America, Switzerland, and Belgium." The original of the section on the United S t a t e s w a s p u b l i s h e d i n L e i p z i g in 1 9 1 5 a s a continuation of the Graefe-Saemisch-Hess Handbuch der Gesamten Augenheilkunde un der the editorial direction of Professors Saemisch and Elschnig. Blodi's translation of " O p h t h a l m o l o g y in t h e U n i t e d S t a t e s " o m i t s o n l y t h e d e d i c a t i o n o f t h e o r i g i n a l to t h e O p h thalmological Society of Colorado, which was founded by Edward Jackson. Julius Hirschberg v i s i t e d t h e U n i t e d S t a t e s t h r e e t i m e s a n d in this volume described an incident o f his horse rear ing w h i l e touring Yellowstone National Park with Hermann Knapp.
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AMERICAN JOURNAL OF OPHTHALMOLOGY
The History extends beyond the end of the 1 9 t h c e n t u r y a n d d e s c r i b e s e v e n t s as l a t e as 1914. Hirschberg concluded the United States his tory w i t h the s t a t e m e n t , " T h e s i z e o f t h e c o u n try a n d the n u m b e r of i n h a b i t a n t s , t h e r e sources and the industrial richness, the intelligence and ambition of the citizens and e s p e c i a l l y the l i b e r a l i n s t i t u t i o n s o f t h e U n i t e d S t a t e s g o v e r n m e n t m a k e a d v a n c e s in c i v i l i z a t i o n , i n c l u d i n g our s p e c i a l t y , for t h i s c o u n t r y n o t o n l y j u s t i f i e d , b u t n e c e s s a r y . " In s o m e ways, w e h a v e fulfilled t h i s h o p e , b u t m o r e is still n e c e s s a r y . T h e s e c t i o n s on S w i t z e r l a n d a n d B e l g i u m are l i m i t e d ; e a c h fills a b o u t 5 0 p a g e s ( t h e n u m b e r of p a g e s in t h e v o l u m e is a p p r o x i m a t e l y e q u a l to the o r i g i n a l b u t t h e n e w v o l u m e s are far m o r e attractive). T h e s e c t i o n on S w i t z e r l a n d is d i v i d e d a b o u t e q u a l l y b e t w e e n the U n i v e r s i t y o f B a s e l , a n d the cities of Zurich and G e n e v a . The study of o p h t h a l m o l o g y in B e l g i u m w a s i n i t i a t e d , as in E n g l a n d , b y the r a v a g e s o f m i l i t a r y o p h t h a l m i a ( t r a c h o m a ) after N a p o l e o n ' s E g y p t i a n c a m paign. Hirschberg d o c u m e n t e d the founding of t h e A n n a l e s d ' O c u l i s t i q u e b y F l o r e n t C u n i e r in 1 8 3 8 . T h e j o u r n a l ' s n a m e d i s a p p e a r e d in 1 9 7 8 w h e n it m e r g e d w i t h t h e A r c h i v e s d ' O p h t a l m o l o g i e , f o u n d e d in 1 8 5 3 , to f o r m t h e J o u r n a l Frangais O p h t a l m o l o g i e . H i r s c h b e r g com plained of the lack of representative G e r m a n o p h t h a l m o l o g i s t s on t h e E d i t o r i a l B o a r d . H e described Evariste Warlomont, founder of the A n n a l e s d ' O c u l i s t i q u e , w h o i n i t i a t e d t h e First I n t e r n a t i o n a l C o n g r e s s o f O p h t h a l m o l o g y in B r u s s e l s in 1 8 5 7 . It is e x c i t i n g to have b o t h t h i s n i n t h v o l u m e appear and the promise of the remaining vol u m e s in t h e n e a r future. E n g l i s h - s p e a k i n g o p h t h a l m o l o g i s t s are i n d e b t e d to t h e s c h o l a r s h i p o f Professor Blodi.
EndNote Plus. Berkeley, Niles & Associates, 1990. Computer disk and 216-page manual, index. $249 R e v i e w e d b y W . L. M . A L W A R D Iowa City, Iowa E n d N o t e P l u s is a c o m p u t e r s o f t w a r e p a c k a g e that g i v e s p h y s i c i a n s a n d s c i e n t i s t s a way to h a n d l e t h e vast q u a n t i t y of i n f o r m a t i o n o b
June, 1991
t a i n e d from r e a d i n g s c i e n t i f i c l i t e r a t u r e . It is a v a i l a b l e in b o t h I B M a n d M a c i n t o s h f o r m a t s . I have worked only with the Macintosh version on a M a c S E - 3 0 c o m p u t e r . E n d N o t e P l u s h a s two p u r p o s e s a n d fulfills b o t h b e a u t i f u l l y . First, it is a data b a s e m a n a g e r d e s i g n e d s p e c i f i c a l l y for s t o r i n g a n d r e t r i e v i n g references. References are easily entered into a t e m p l a t e that h a s fields for a u t h o r s ' n a m e s , t i t l e , j o u r n a l , a n d the l i k e . T h e r e are a l s o fields for a b s t r a c t s a n d n o t e s , e a c h o f w h i c h will h o l d u p to 3 2 , 0 0 0 c h a r a c t e r s . E n t r y o f data i n t o E n d N o t e P l u s is e a s y a n d s e l f - e x p l a n a t o r y . T h e m o s t useful feature o f t h e E n d N o t e P l u s data b a s e is its a b i l i t y to s e a r c h for i n f o r m a t i o n . W h e n a s k e d to find a w o r d or w o r d f r a g m e n t , it will s e a r c h all fields u n l e s s o t h e r w i s e i n s t r u c t e d . It w i l l find all r e f e r e n c e s o n t h e s u b j e c t w h e t h e r t h e w o r d a p p e a r s in t h e t i t l e , a b s t r a c t , t h e n o t e s , or any o t h e r l o c a t i o n . You m a y l i m i t t h e s e a r c h to a u t h o r , y e a r , a n d t h e l i k e , b u t the s e a r c h is s o fast t h a t t h i s is n o t u s u a l l y n e c e s s a r y . A B o o l e a n l o g i c is u s e d for c o m p l e x searches. An unlimited number of search terms can b e j o i n e d b y " a n d , " " o r , " a n d " n o t . " For e x a m p l e , a s e a r c h t h r o u g h a 6 0 0 - r e f e r e n c e data b a s e for a r t i c l e s on t r a b e c u l e c t o m y " o r " i r i d o t omy " a n d " apraclonidine " a n d " 1 9 8 9 yielded one article and took about two seconds. The s p e e d at w h i c h t h e p r o g r a m s e a r c h e s is a s t o u n d i n g . T h e data b a s e is d e s i g n e d to h o l d 32,000 references. T h e s e c o n d f e a t u r e o f E n d N o t e P l u s is its a b i l i t y to c r e a t e b i b l i o g r a p h i e s . W h e n w o r k i n g on a m a n u s c r i p t , E n d N o t e c a n b e k e p t o p e n a n d r u n n i n g in the c o r n e r o f t h e s c r e e n . O n the M a c i n t o s h t h i s c a n b e d o n e as a d e s k a c c e s s o r y or as a s e p a r a t e a p p l i c a t i o n . As i n f o r m a t i o n is t y p e d i n t o the w o r d p r o c e s s o r , o n e s i m p l y c o p ies a n d p a s t e s t h e r e f e r e n c e s from E n d N o t e P l u s i n t o the w o r d p r o c e s s i n g d o c u m e n t . T h i s places a bracketed reference statement with the a u t h o r ' s last n a m e , t h e y e a r , a n d a r e f e r e n c e n u m b e r at t h e l o c a t i o n o f t h e c i t a t i o n . U p o n c o m p l e t i o n of a m a n u s c r i p t , a j o u r n a l s t y l e is s e l e c t e d , a n d E n d N o t e P l u s is i n s t r u c t e d to format the paper. Within m o m e n t s a version of the paper appears with each reference typed out in t h e b i b l i o g r a p h y a n d c i t e d in t h e t e x t j u s t t h e way t h e j o u r n a l w a n t s it. O n e d o e s n e e d to c u s t o m i z e E n d N o t e P l u s for the m a j o r o p h t h a l m i c j o u r n a l s , b u t t h i s is n o t c h a l l e n g i n g . A separate add-on program. End Link, makes it p o s s i b l e t o t r a n s f e r d a t a f r o m o n - l i n e b i b l i o g r a p h i c d a t a b a s e s s u c h as B R S i n t o E n d N o t e Plus.
sist, h o w e v e r , s u c h as t h e c o n f u s i o n b e t w e e n the l e v a t o r h o r n s a n d W h i t n a l l ' s l i g a m e n t , which seems to have found its way into nearly every book on b l e p h a r o p t o s i s . Perhaps the m o s t d i s a p p o i n t i n g c h a p t e r is t h e o n e o n c l a s s i fication. Dr. C a l l a h a n c o r r e c t l y p o i n t s o u t t h e problems with older, n o n e t i o l o g i c classifica t i o n s a n d s t r e s s e s t h e n e e d for a m e c h a n i s t i c a p p r o a c h . I n d e e d , h e r e c o g n i z e s four m a j o r categories of blepharoptosis: levator maldevelopment (myogenic), aponeurotic, neurogenic, a n d m e c h a n i c a l / a p p a r e n t . Yet h e g o e s o n t o propose several seemingly nondescriptive a n d nonetiologic groups, such as "simple levator m a l d e v e l o p m e n t " for congenital developmen tal d y s t r o p h i c b l e p h a r o p t o s i s . U n d e r a p o n e u rotic blepharoptosis are included such confus ing categories as " s e n i l e p t o s i s , " " f o l l o w i n g cataract surgery," "following local t r a u m a , " and " b l e p h a r o c h a l a s i s . " Such groupings add little t o o u r u n d e r s t a n d i n g o f o r i g i n , s i n c e a l l o f t h e m r e l a t e to a p o n e u r o t i c r e d u n d a n c y o r d e hiscence. Rather than being types of blepharop tosis, these, among many others n o t listed, are actually causes of aponeurotic blepharoptosis. Despite these few critical c o m m e n t s , M i c h a e l C a l l a h a n h a s a c h i e v e d m o r e in t h i s n e w e d i t i o n t h a n j u s t t h e r e s u r r e c t i o n o f a c l a s s i c b o o k . In m a n y ways it r e p r e s e n t s a n e w v o l u m e , o n e t h a t will i t s e l f b e c o m e a s t a n d a r d i n t h e field o f blepharoptosis surgery. Dr. Callahan's stated goal was to bring this b o o k abreast o f m o d e r n t i m e s a n d t o m a k e it useful t o t h o s e w h o p e r form t h e s e p r o c e d u r e s . H e h a s a c h i e v e d t h e s e goals admirably. This book should certainly b e on t h e s h e l f o f a n y s u r g e o n w h o e x a m i n e s a n d treats patients with blepharoptosis.
Color Atlas of Ophthalmic Surgery. Strabismus. By Kenneth W. Wright. Philadelphia, J . B. Lippincott, 1990. 261 pages. Index, Illustrated. $125 Reviewed by R O N A L D V. K E E C H
Iowa
City,
Iowa
T h i s is t h e first v o l u m e in a s e r i e s o n o p h t h a l mic surgery, which illustrates surgical proce d u r e s with d r a w i n g s a n d c o l o r p h o t o g r a p h s . T h e i n t e n t o f t h e b o o k is t o p r o v i d e a " p r a c t i c a l text to t e a c h s t r a b i s m u s s u r g i c a l t e c h n i q u e " t o the novice and as well as e x p a n d the "surgical repertoire o f the experienced surgeon." B e g i n n i n g s u r g e o n s will a p p r e c i a t e t h e c h a p
779
Book Reviews
ters on anatomy a n d basic surgical technique. T h e y w i l l a l s o b e n e f i t from t h e c o n c i s e s u m m a ry o f s u r g i c a l i n d i c a t i o n s f o u n d i n m a n y o f t h e chapters and the recommended surgical a m o u n t s f o r r e s e c t i o n s a n d r e c e s s i o n s l i s t e d in the appendices. A note o f caution to the novice: some procedures, such as the silicone expander operation used for weakening the superior oblique muscle, may b e misinterpreted as a p r o c e d u r e p r e f e r r e d b y m o s t s t r a b i s m u s sur g e o n s , w h e n i n r e a l i t y it is a n i n t r i g u i n g b u t n o t well-established technique. V e t e r a n s t r a b i s m u s s u r g e o n s m a y profit from the c h a p t e r s o n a d j u s t a b l e s u t u r e s , p o s t e r i o r fixation s u t u r e s , a n d c h e m o d e n e r v a t i o n ( b o t u lininum) surgery. T h e drawings and color pho tographs clearly demonstrate the techniques, and the references, while n o t exhaustive, are current. T h e six c o n t r i b u t o r s d o a g o o d j o b o f d e s c r i b ing a n d i l l u s t r a t i n g s t r a b i s m u s s u r g i c a l t e c h niques. A s a result, this b o o k should b e valu a b l e in t r a i n i n g r e s i d e n t s a n d f e l l o w s .
The History of Ophthalmology, vol. 9. The First and Second Half of the Nineteenth Century. By Julius Hirschberg. Translated by Frederick C. Blodl. Germany, Verlag, 1 9 9 0 . 3 3 2 pages. In dex, illustrated. $ 1 8 0 Reviewed by FRANK W . NEWELL
Chicago,
Illinois
After d e l a y o f a l i t t l e m o r e t h a n t w o y e a r s , publication of Frederick Blodi's translation into English o f Julius Hirschberg's " T h e History of O p h t h a l m o l o g y " h a s resumed with the appear a n c e o f v o l u m e 9 , " T h e First a n d S e c o n d H a l f of the N i n e t e e n t h Century, United States o f America, Switzerland, and Belgium." The original of the section on the United S t a t e s w a s p u b l i s h e d i n L e i p z i g in 1 9 1 5 a s a continuation of the Graefe-Saemisch-Hess Handbuch der Gesamten Augenheilkunde un der the editorial direction of Professors Saemisch and Elschnig. Blodi's translation of " O p h t h a l m o l o g y in t h e U n i t e d S t a t e s " o m i t s o n l y t h e d e d i c a t i o n o f t h e o r i g i n a l to t h e O p h thalmological Society of Colorado, which was founded by Edward Jackson. Julius Hirschberg v i s i t e d t h e U n i t e d S t a t e s t h r e e t i m e s a n d in this volume described an incident o f his horse rear ing w h i l e touring Yellowstone National Park with Hermann Knapp.
780
AMERICAN JOURNAL OF OPHTHALMOLOGY
The History extends beyond the end of the 1 9 t h c e n t u r y a n d d e s c r i b e s e v e n t s as l a t e as 1914. Hirschberg concluded the United States his tory w i t h the s t a t e m e n t , " T h e s i z e o f t h e c o u n try a n d the n u m b e r of i n h a b i t a n t s , t h e r e sources and the industrial richness, the intelligence and ambition of the citizens and e s p e c i a l l y the l i b e r a l i n s t i t u t i o n s o f t h e U n i t e d S t a t e s g o v e r n m e n t m a k e a d v a n c e s in c i v i l i z a t i o n , i n c l u d i n g our s p e c i a l t y , for t h i s c o u n t r y n o t o n l y j u s t i f i e d , b u t n e c e s s a r y . " In s o m e ways, w e h a v e fulfilled t h i s h o p e , b u t m o r e is still n e c e s s a r y . T h e s e c t i o n s on S w i t z e r l a n d a n d B e l g i u m are l i m i t e d ; e a c h fills a b o u t 5 0 p a g e s ( t h e n u m b e r of p a g e s in t h e v o l u m e is a p p r o x i m a t e l y e q u a l to the o r i g i n a l b u t t h e n e w v o l u m e s are far m o r e attractive). T h e s e c t i o n on S w i t z e r l a n d is d i v i d e d a b o u t e q u a l l y b e t w e e n the U n i v e r s i t y o f B a s e l , a n d the cities of Zurich and G e n e v a . The study of o p h t h a l m o l o g y in B e l g i u m w a s i n i t i a t e d , as in E n g l a n d , b y the r a v a g e s o f m i l i t a r y o p h t h a l m i a ( t r a c h o m a ) after N a p o l e o n ' s E g y p t i a n c a m paign. Hirschberg d o c u m e n t e d the founding of t h e A n n a l e s d ' O c u l i s t i q u e b y F l o r e n t C u n i e r in 1 8 3 8 . T h e j o u r n a l ' s n a m e d i s a p p e a r e d in 1 9 7 8 w h e n it m e r g e d w i t h t h e A r c h i v e s d ' O p h t a l m o l o g i e , f o u n d e d in 1 8 5 3 , to f o r m t h e J o u r n a l Frangais O p h t a l m o l o g i e . H i r s c h b e r g com plained of the lack of representative G e r m a n o p h t h a l m o l o g i s t s on t h e E d i t o r i a l B o a r d . H e described Evariste Warlomont, founder of the A n n a l e s d ' O c u l i s t i q u e , w h o i n i t i a t e d t h e First I n t e r n a t i o n a l C o n g r e s s o f O p h t h a l m o l o g y in B r u s s e l s in 1 8 5 7 . It is e x c i t i n g to have b o t h t h i s n i n t h v o l u m e appear and the promise of the remaining vol u m e s in t h e n e a r future. E n g l i s h - s p e a k i n g o p h t h a l m o l o g i s t s are i n d e b t e d to t h e s c h o l a r s h i p o f Professor Blodi.
EndNote Plus. Berkeley, Niles & Associates, 1990. Computer disk and 216-page manual, index. $249 R e v i e w e d b y W . L. M . A L W A R D Iowa City, Iowa E n d N o t e P l u s is a c o m p u t e r s o f t w a r e p a c k a g e that g i v e s p h y s i c i a n s a n d s c i e n t i s t s a way to h a n d l e t h e vast q u a n t i t y of i n f o r m a t i o n o b
June, 1991
t a i n e d from r e a d i n g s c i e n t i f i c l i t e r a t u r e . It is a v a i l a b l e in b o t h I B M a n d M a c i n t o s h f o r m a t s . I have worked only with the Macintosh version on a M a c S E - 3 0 c o m p u t e r . E n d N o t e P l u s h a s two p u r p o s e s a n d fulfills b o t h b e a u t i f u l l y . First, it is a data b a s e m a n a g e r d e s i g n e d s p e c i f i c a l l y for s t o r i n g a n d r e t r i e v i n g references. References are easily entered into a t e m p l a t e that h a s fields for a u t h o r s ' n a m e s , t i t l e , j o u r n a l , a n d the l i k e . T h e r e are a l s o fields for a b s t r a c t s a n d n o t e s , e a c h o f w h i c h will h o l d u p to 3 2 , 0 0 0 c h a r a c t e r s . E n t r y o f data i n t o E n d N o t e P l u s is e a s y a n d s e l f - e x p l a n a t o r y . T h e m o s t useful feature o f t h e E n d N o t e P l u s data b a s e is its a b i l i t y to s e a r c h for i n f o r m a t i o n . W h e n a s k e d to find a w o r d or w o r d f r a g m e n t , it will s e a r c h all fields u n l e s s o t h e r w i s e i n s t r u c t e d . It w i l l find all r e f e r e n c e s o n t h e s u b j e c t w h e t h e r t h e w o r d a p p e a r s in t h e t i t l e , a b s t r a c t , t h e n o t e s , or any o t h e r l o c a t i o n . You m a y l i m i t t h e s e a r c h to a u t h o r , y e a r , a n d t h e l i k e , b u t the s e a r c h is s o fast t h a t t h i s is n o t u s u a l l y n e c e s s a r y . A B o o l e a n l o g i c is u s e d for c o m p l e x searches. An unlimited number of search terms can b e j o i n e d b y " a n d , " " o r , " a n d " n o t . " For e x a m p l e , a s e a r c h t h r o u g h a 6 0 0 - r e f e r e n c e data b a s e for a r t i c l e s on t r a b e c u l e c t o m y " o r " i r i d o t omy " a n d " apraclonidine " a n d " 1 9 8 9 yielded one article and took about two seconds. The s p e e d at w h i c h t h e p r o g r a m s e a r c h e s is a s t o u n d i n g . T h e data b a s e is d e s i g n e d to h o l d 32,000 references. T h e s e c o n d f e a t u r e o f E n d N o t e P l u s is its a b i l i t y to c r e a t e b i b l i o g r a p h i e s . W h e n w o r k i n g on a m a n u s c r i p t , E n d N o t e c a n b e k e p t o p e n a n d r u n n i n g in the c o r n e r o f t h e s c r e e n . O n the M a c i n t o s h t h i s c a n b e d o n e as a d e s k a c c e s s o r y or as a s e p a r a t e a p p l i c a t i o n . As i n f o r m a t i o n is t y p e d i n t o the w o r d p r o c e s s o r , o n e s i m p l y c o p ies a n d p a s t e s t h e r e f e r e n c e s from E n d N o t e P l u s i n t o the w o r d p r o c e s s i n g d o c u m e n t . T h i s places a bracketed reference statement with the a u t h o r ' s last n a m e , t h e y e a r , a n d a r e f e r e n c e n u m b e r at t h e l o c a t i o n o f t h e c i t a t i o n . U p o n c o m p l e t i o n of a m a n u s c r i p t , a j o u r n a l s t y l e is s e l e c t e d , a n d E n d N o t e P l u s is i n s t r u c t e d to format the paper. Within m o m e n t s a version of the paper appears with each reference typed out in t h e b i b l i o g r a p h y a n d c i t e d in t h e t e x t j u s t t h e way t h e j o u r n a l w a n t s it. O n e d o e s n e e d to c u s t o m i z e E n d N o t e P l u s for the m a j o r o p h t h a l m i c j o u r n a l s , b u t t h i s is n o t c h a l l e n g i n g . A separate add-on program. End Link, makes it p o s s i b l e t o t r a n s f e r d a t a f r o m o n - l i n e b i b l i o g r a p h i c d a t a b a s e s s u c h as B R S i n t o E n d N o t e Plus.