The Retinal Circulation

The Retinal Circulation

796 AMERICAN JOURNAL OF OPHTHALMOLOGY and the health and welfare of our patients. Frank W. Newell REQUEST FOR CONTRIBUTIONS Editor, American Journa...

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796

AMERICAN JOURNAL OF OPHTHALMOLOGY

and the health and welfare of our patients. Frank W. Newell REQUEST FOR CONTRIBUTIONS

Editor, American Journal of Ophthalmology : I am editing a book on the role of faith or religion in healing from a physician's stand­ point. Any physician interested in contribut­ ing to this book, please write me. Claude A. Frazier, M.D. 4-C Doctors Park, Asheville, North Carolina 28801. CORRECTION

The Gifford lecture of Professor Dr. H. Goldmann (Am. J. Ophth. 73: 309, 1972) should be entitled, "The examination of the function of the cataractous eye." BOOK R E V I E W S By George N. Wise, Colin T. Dollery, and Paul Henkind. New York, Harper and Row, 1971. Clothbound, 574 pages, table of contents, index, 876 black and white figures. $35.00 The past decade has been as exciting in ophthalmology as must have been the 10 years following Helmholtz' description of the ophthalmoscope. Thanks to the contribu­ tion of fluorescein angiography, we are able to diagnose fundus abnormalities and to un­ derstand their pathogenesis in a manner that was not previously possible. Thanks to the genius of photocoagulation some diseases, which were previously considered unbeat­ able are now amenable to arrest or correction. Indeed, in some instances, effective therapy is available for conditions regarded as de­ generative but a short time ago, with ameli­ oration awaiting a discovery of a fountain of youth.

T H E RETINAL CIRCULATION.

Ophthalmologists all over the world are making new and original observations of ret­ inal disease at an unprecedented rate. What an exciting moment it is to be seated at a flu­

MAY, 1972

orescein angiography conference and hear "This finding has not been previously de­ scribed." This new text, written by three pi­ oneers of the modern age of ophthalmoscopy, reflects these advances. Fluorescein angiography, light ophthalmoscopy, electron microscopathy, and histopathology are com­ bined in a remarkable sequence. The opening chapters are devoted to em­ bryology, gross and fine anatomy of the reti­ nal and choroidal blood vessels, phylogeny of the retinal blood vessels, physiologic princi­ ples underlying blood flow, and pharmacol­ ogy. These chapters bring together material that is widely scattered in the literature. It is richly annotated with the authors' own ex­ perimental and clinical observations. The final chapters are devoted to diagnos­ tic methods and treatment of vascular dis­ ease. The most original material in the book deals with vascular lesions of the retina. Not everyone will agree that the capillaries in the nerve fiber layer of the retina belong pre­ dominantly to the arterial side of the circula­ tion, and deeper capillaries belong to the ve­ nous side. Nonetheless, this division pro­ vides a logical framework in which to dis­ cuss disease. Moreover, clinical evidence ap­ pears to favor this approach and to gather from injection specimens the retinal capillary circulation is laminated, having at least three layers. This book reflects the revolution in our thinking concerning vascular disease of the retina, although the revolution is still in progress. The authors provide a superb back­ ground for appreciation of disease. The section of disciform macular disease will cause much discussion. Fluorescein angiographers, of course, devote much of their time to such discussion and often times dis­ agree. That is why the whole field is so stim­ ulating and appealing. However, the sections on choroidal sclerosis, fundus flavimaculatus, vitelliform macular degenerations, and related lesions are not based on extended personal observations, and are less tidy than they might be. These, however, are but mi­ nor points.

VOL. 73, NO. 5

BOOK REVIEWS

The design is a masterpiece of the book­ maker's art. How often one has thumbed through a textbook designed for grade or highschool and envied the beautiful exposi­ tion and the combination of illustrations and text. This volume is the first in ophthalmol­ ogy to reflect a similar skill. It should be on the shelf of every internist and every oph­ thalmologist and indeed anyone who uses the ophthalmoscope. It is highly recommended. Frank W. Newell T H E HEREDITARY DYSTROPHIES OF THE POS­ TERIOR POLE OF THE EYE. By A. F. Deut-

man. Amsterdam, Von Gorcum and Com­ pany, 1971, Clothbound. 484 pages, table of contents, subject and author indexes, 250 black and white figures and 12 color plates. 146 Hfl As an ophthalmologist, if you are inter­ ested in dystrophies of the macular area, and you should be, then this book is a requisite assignment. Dr. Deutman has prodigiously performed a masterful job of meticulously delineating the major diagnostic features of only 13 dys­ trophies affecting the posterior pole of the eye. Most are commonplace, but perhaps lesser known are : ( 1) reticular dystrophy of the retinal pigment epithelium, and (2) but­ terfly-shaped pigment dystrophy. He has placed documented emphasis on the heredi­ tary nature and genetic causation of these entities which appeals to my own bias. Note­ worthy is his attempt to present an orderly and clinically useful classification of macular dystrophies based on "an extensive clinical and genetic investigation" of an amazing number of patients and their families. His classification will stand as a solid foundation upon which future investigation can proceed, awaiting of course expansion of our investi­ gative armamentarium. Dr. Deutman strongly supports the opin­ ion that the several dystrophies of the retina and choroid are determined by several differ­ ent genes. Thus, according to him, there are several specific entities that are of genetic

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origin among the macular dystrophies and not different manifestations of a single en­ tity, as so many authorities insist. Dr. Deutman succeeds admirably in metic­ ulously applying recent clinical and labora­ tory methods to the patient, including electroretinography, electro-oculography, pho­ tography, and fluorescein angiography. Us­ ing these methods, he undertakes an "edu­ cated guess" as to the specific location of the primary defect of a number of the dystro­ phies described. The book is written much in the style and manner of the continental monograph or treatise. It is superbly illustrated with black and white photographs of excellent quality; I regret that there is not more color. There are errors—idiomatic, reference, misnumbered figures, etc., but these do not detract from the value of the book. My one concern and shock is its price. Harold F. Falls TRANSPLANTATION TODAY. PROCEEDINGS OF THE T H I R D INTERNATIONAL CONGRESS OF THE TRANSPLANTATION SOCIETY. Ed­

ited by Hans Balner, D. W. von Bekkum, and Felix Τ. Rapaport. New York, Grune & Stratton, 1971. Clothbound, 978 pages, table of contents, index, 268 black and white figures, $25.00 This volume contains the Proceedings of the Third International Congress of the Transplantation Society, held September 711, 1970, in the Hague, the Netherlands. The topics discussed were: transplantation anti­ gens, their hereditable nature, their relation to organ transplantation ; the basic chemistry of transplantation antigen ; results in trans­ plantation ; tissue and organ preservation ; clinical and experimental studies of immunosuppressive agents and mechanisms ; and im­ munologie tolerance. In all, 247 contributions were made at this major global meeting. The participants con­ cluded that clinical prospects for organ transplantation are improved. With respect to clinical transplantation, considerable fur-