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Xerophthalmia and Measles in Kenya
656
AMERICAN JOURNAL OF OPHTHALMOLOGY
ment encountered in the various struc tures of the eye. Next there was a general description of the retinal changes encountered in hyper tensive cardiovascular disease. No at tempt was made to separate the findings in primary hypertension from those that occur in chronic nephritis, nephrosis, tox emia of pregnancy, pheochromocytoma, coarctation of the aorta, and so on. Except for demonstration of a sclerotic choroidal artery, the paper ignored the role of the choroid in the production of retinal de tachment or of Elschnig pigment spots. David Cogan's fine paper was about occlusive phenomena in the retinal vessels. Two papers were concerned with the hématologie and reticuloendothelial dis ease, followed by a paper on Crohn's disease, Whipple's disease, intestinal par asites, and peptic ulcer. Harold O. Perry and Giambattista Bietti discussed the association of derma tologie conditions with ocular disease. Both papers, the highlight of this excel lent book, are profusely and beautifully illustrated. The summary of the symposium, writ ten by Frank W. Newell, is a thoughtful and valuable evaluation of each paper, with implications for research and clini cal diagnosis. The extensive references in each sec tion are a helpful resource for the student. The index is complete and meticulously compiled. All in all, a superb book which should be in every physician's library. R O B E R T W.
OCTOBER, 1976
The proceedings of the International Glaucoma Symposium held in Albi, France in May 1974, reflect the current thinking of almost all of the world's glau coma authorities. The papers are impressive but reveal, more than any other recent summary of glaucoma, that the same problems are with us. We still don't understand the basic mechanism of the pressure eleva tion in open-angle glaucoma, medical treatment has improved little over the past decade, and the new "microsurgical" methods are probably no better than the older techniques for glaucoma surgery. An optimistic note struck in this book, however, is the tremendous effort being expended in glaucoma research to discov er better ways to help victims of the disease. Introductory chapters on the anatomy of the optic disk demonstrate the many methods of examination of the cup. The corticosteroid response of patients with open-angle glaucoma is discussed along with the use of catecholamines in the medical treatment of glaucoma. The authors seemed enthusiastic about trabeculectomy but it is obvious that the best patient care consists of tonometry, ophthalmoscopy, visual field examination, and good clinical judgment. This test represents the latest and most modern thinking in glaucoma and is a must for physicians caring for patients afflicted with a disease that remains a major cause of blindness. J. T E R R Y E R N E S T
HOLLENHORST
International Glaucoma Symposium— Albi 1974. Edited by Raymond Etienne and Gillian D. Paterson. Marseille, Dif fusion Generale de Librairie, 1975. Clothbound, 501 pages, table of con tents, index, 160 black and white fig ures, 103 color figures.
Xerophthalmia and Measles in Kenya. By J. J. M. Sauter. Groningen, The Nether lands, Drukkerij van Denderen B. V., 1976. Paperbound, 235 pages, table of contents, 5 color plates, 48 black and white figures. $10 Xerophthalmia was thought to have re treated to the impoverished rice-eating
VOL. 82, NO. 4
BOOK REVIEWS
regions of South Asia recently, although it had been discovered worldwide at the turn of the century. It was never clear why Africa, another developing land mass, remained unaffected. Dr. Sauter's thesis suggests instead that the disease went unrecognized. In the course of these investigations the author introduced "vi tal staining" as a new and potentially useful clinical test for xerophthalmia, and provided additional evidence that malnu trition is important in the etiology of measles-related corneal destruction. Over 28,000 individuals were examined at 118 sites. This search for hospitals and clinics is an efficient means of case find ing, and establishes that xerophthalmia exists in Kenya and is likely an important cause of pédiatrie blindness. Randomized prevalence surveys will be required, how ever, to determine the precise magnitude and distribution of the problem. On the assumption that keratinized epi thelium stains specifically with vital dyes, Dr. Sauter applied 1% rose bengal (and later lissamine green) topically to the eyes of many of these children. Stains simplified the diagnosis of minimal conjunctival xerosis and helped distinguish xerosis from various forms of keratoconjunctivitis. Although this method may not be as practical in large-scale surveys as the author suggests, it may be useful in specialized clinical investigations of early stages of the disease. The author made interesting observa tions on the clinical course of measles in well nourished and malnourished Kenyan children. Frank corneal destruction oc curred only in the malnourished group. This is consistent with its disappearance from industrialized countries, although the precise mechanism remains unclear. Generalized malnutrition interferes with wound healing, resistance to infection, and the like. Vital staining and selected conjunctival biopsy specimens from these Kenyan children suggest vitamin A defi
657
ciency may plan an important role. Serum vitamin A levels in selected children were extremely low. Unfortunately it is a labile test, and comparative values on healthy and malnourished children with measles, but without xerosis, are not provided. In contrast with these prospective stud ies, the retrospective analysis of children in schools for the blind is of doubtful significance. It is hard to appreciate how children blinded between the ages of 2 and 5 years can provide "more or less detailed histories" on the nature and course of their disease, various modes of therapy employed, general underlying nutritional state, accompanying systemic illnesses, and the social situation in their home at the time. Despite these reservations, the book contains interesting data, vivid photo graphs and illustrations, and a considered synthesis of new and exciting material. I recommend it highly to all interested in xerophthalmia, measles, malnutrition, and pédiatrie blindness in the developing world. A L F R E D SOMMER
The Ophthalmic Assistant. By Harold A. Stein and Bernard J. Slatt. St. Louis, C. V. Mosby Co., 1976. Paperbound, 594 pages, table of contents, index, 853 black and white figures. $23.75 The third edition of "The Ophthalmic Assistant" has been completely revised and considerably expanded while still retaining the easy-to-read style of the original text. The chapters are well organ ized and complete with considerable de tail of many definitive ophthalmologic procedures. A new feature is the expansion of the area of contact lenses, particularly soft contact lenses, and the application of therapeutic lenses. The emphasis on con tact lenses is most welcome as this is an
AMERICAN JOURNAL OF OPHTHALMOLOGY
ment encountered in the various struc tures of the eye. Next there was a general description of the retinal changes encountered in hyper tensive cardiovascular disease. No at tempt was made to separate the findings in primary hypertension from those that occur in chronic nephritis, nephrosis, tox emia of pregnancy, pheochromocytoma, coarctation of the aorta, and so on. Except for demonstration of a sclerotic choroidal artery, the paper ignored the role of the choroid in the production of retinal de tachment or of Elschnig pigment spots. David Cogan's fine paper was about occlusive phenomena in the retinal vessels. Two papers were concerned with the hématologie and reticuloendothelial dis ease, followed by a paper on Crohn's disease, Whipple's disease, intestinal par asites, and peptic ulcer. Harold O. Perry and Giambattista Bietti discussed the association of derma tologie conditions with ocular disease. Both papers, the highlight of this excel lent book, are profusely and beautifully illustrated. The summary of the symposium, writ ten by Frank W. Newell, is a thoughtful and valuable evaluation of each paper, with implications for research and clini cal diagnosis. The extensive references in each sec tion are a helpful resource for the student. The index is complete and meticulously compiled. All in all, a superb book which should be in every physician's library. R O B E R T W.
OCTOBER, 1976
The proceedings of the International Glaucoma Symposium held in Albi, France in May 1974, reflect the current thinking of almost all of the world's glau coma authorities. The papers are impressive but reveal, more than any other recent summary of glaucoma, that the same problems are with us. We still don't understand the basic mechanism of the pressure eleva tion in open-angle glaucoma, medical treatment has improved little over the past decade, and the new "microsurgical" methods are probably no better than the older techniques for glaucoma surgery. An optimistic note struck in this book, however, is the tremendous effort being expended in glaucoma research to discov er better ways to help victims of the disease. Introductory chapters on the anatomy of the optic disk demonstrate the many methods of examination of the cup. The corticosteroid response of patients with open-angle glaucoma is discussed along with the use of catecholamines in the medical treatment of glaucoma. The authors seemed enthusiastic about trabeculectomy but it is obvious that the best patient care consists of tonometry, ophthalmoscopy, visual field examination, and good clinical judgment. This test represents the latest and most modern thinking in glaucoma and is a must for physicians caring for patients afflicted with a disease that remains a major cause of blindness. J. T E R R Y E R N E S T
HOLLENHORST
International Glaucoma Symposium— Albi 1974. Edited by Raymond Etienne and Gillian D. Paterson. Marseille, Dif fusion Generale de Librairie, 1975. Clothbound, 501 pages, table of con tents, index, 160 black and white fig ures, 103 color figures.
Xerophthalmia and Measles in Kenya. By J. J. M. Sauter. Groningen, The Nether lands, Drukkerij van Denderen B. V., 1976. Paperbound, 235 pages, table of contents, 5 color plates, 48 black and white figures. $10 Xerophthalmia was thought to have re treated to the impoverished rice-eating
VOL. 82, NO. 4
BOOK REVIEWS
regions of South Asia recently, although it had been discovered worldwide at the turn of the century. It was never clear why Africa, another developing land mass, remained unaffected. Dr. Sauter's thesis suggests instead that the disease went unrecognized. In the course of these investigations the author introduced "vi tal staining" as a new and potentially useful clinical test for xerophthalmia, and provided additional evidence that malnu trition is important in the etiology of measles-related corneal destruction. Over 28,000 individuals were examined at 118 sites. This search for hospitals and clinics is an efficient means of case find ing, and establishes that xerophthalmia exists in Kenya and is likely an important cause of pédiatrie blindness. Randomized prevalence surveys will be required, how ever, to determine the precise magnitude and distribution of the problem. On the assumption that keratinized epi thelium stains specifically with vital dyes, Dr. Sauter applied 1% rose bengal (and later lissamine green) topically to the eyes of many of these children. Stains simplified the diagnosis of minimal conjunctival xerosis and helped distinguish xerosis from various forms of keratoconjunctivitis. Although this method may not be as practical in large-scale surveys as the author suggests, it may be useful in specialized clinical investigations of early stages of the disease. The author made interesting observa tions on the clinical course of measles in well nourished and malnourished Kenyan children. Frank corneal destruction oc curred only in the malnourished group. This is consistent with its disappearance from industrialized countries, although the precise mechanism remains unclear. Generalized malnutrition interferes with wound healing, resistance to infection, and the like. Vital staining and selected conjunctival biopsy specimens from these Kenyan children suggest vitamin A defi
657
ciency may plan an important role. Serum vitamin A levels in selected children were extremely low. Unfortunately it is a labile test, and comparative values on healthy and malnourished children with measles, but without xerosis, are not provided. In contrast with these prospective stud ies, the retrospective analysis of children in schools for the blind is of doubtful significance. It is hard to appreciate how children blinded between the ages of 2 and 5 years can provide "more or less detailed histories" on the nature and course of their disease, various modes of therapy employed, general underlying nutritional state, accompanying systemic illnesses, and the social situation in their home at the time. Despite these reservations, the book contains interesting data, vivid photo graphs and illustrations, and a considered synthesis of new and exciting material. I recommend it highly to all interested in xerophthalmia, measles, malnutrition, and pédiatrie blindness in the developing world. A L F R E D SOMMER
The Ophthalmic Assistant. By Harold A. Stein and Bernard J. Slatt. St. Louis, C. V. Mosby Co., 1976. Paperbound, 594 pages, table of contents, index, 853 black and white figures. $23.75 The third edition of "The Ophthalmic Assistant" has been completely revised and considerably expanded while still retaining the easy-to-read style of the original text. The chapters are well organ ized and complete with considerable de tail of many definitive ophthalmologic procedures. A new feature is the expansion of the area of contact lenses, particularly soft contact lenses, and the application of therapeutic lenses. The emphasis on con tact lenses is most welcome as this is an