The Fine Art of Prescribing Glasses Without Making a Spectacle of Yourself

Abstract

Benjamin Milder and Melvin Rubin The Fine Art of Prescribing Glasses Without Making a Spectacle of Yourself3rd edition512 pagesTriad Publishing Company, Gainesville, Florida, 2004ISBN 0 937404 66 7Price: $88.00 When the first edition of this book was published in 1978 it was awarded an ‘Ammy’ by the American Medical Writers Association as ‘The Best Medical Book of the Year’. It was also listed among the 100 most important ophthalmology books of the 20th century by the Archives of Ophthalmology in 2001. Because the second edition of 1991 has been sold out for many years, the authors have now published a new, third edition, the content of which has been updated and supplemented with new material. Refraction and the prescribing of glasses are the most commonly performed procedures in outpatient departments and ophthalmologists' clinics. The results are judged by the patient, whose level of satisfaction gives an estimate of the doctor's ability as an ophthalmologist. The first edition of the book suggested using these well known, simple and general guidelines: get the facts and use ‘rules of thumb’ cautiously, and supplemented them with Milder's Law No. 1: Primum non necere− above all, do no harm − and Milder's Law No. 2: Do not rock the boat. These apply equally well to all forms of medical practice. The authors still emphasize the use of a streak retinoscope, not just for achieving an exact objective refraction, but because close observation of the retinoscopy reflex will provide important clues as to the optical quality of the media, the cornea, lens, posterior capsule in pseudophakia and the vitreous. The refractive findings are expressed with plus cylinders because neutralizing the ‘with’ motion of the streak retinoscope with a plus cylinder is faster and easier than neutralizing the ‘against’ motion with a minus cylinder. On the subject of autorefractors, the authors state that they are certainly useful but they do not replace simple retinoscopy and a careful, ‘old-fashioned’, subjective refraction. The material is organized into 22 chapters on the following topics: spectacles, past, present, future; hyperopia; accommodation; cycloplegia; myopia; astigmatism; presbyopia; progressive power lenses; muscle imbalances; anisometropia; cataract; aphakia; pseudophakia; refractive surgery; contact lenses; absorptive lenses; medical problems and refractive errors; occupational lenses; the partially sighted patient; the psychodynamics of wearing spectacles; the art of dispensing, and the dissatisfied refraction patient. In particular, the chapters on pseudophakia, refractive surgery, progressive power lenses and the partially sighted patient contain a great deal of new material. Each chapter starts with a humorous poem on the subject. These verses by Dr Milder are well known to us from Survey of Ophthalmology. The number of clinical cases drawn from the authors' practice has been expanded. In fact, the authors had thought of titling the first edition ‘A Comedy of Errors’. Because progressive power lenses are gaining popularity, this chapter runs for 20 pages. These lenses do not provide comfort to every patient, but following the indications and contraindications given in the book may save one from making costly errors. The chapter on pseudophakia includes many helpful hints. The discrepancy between keratometry and refraction can be explained by irregular corneal astigmatism induced by surgery. Another less common cause is a tilted or decentred intraocular lens. Only a significant tilt, more than 10 degrees about the horizontal meridian, induces a cylinder axis of + 180. The correcting lens is then a cylinder axis of + 90. Because of the increasing incidence of age-related macular degeneration, the chapter on partially sighted people includes information on electronic visual aids and computer aids. It all ends with a discussion on the misery of the dissatisfied refraction patient. The preceding chapter on the psychodynamics of wearing spectacles is also important. For years this book has been included in the syllabi for national specialist board examinations in many countries, including Finland. It is a unique book and is a must for every ophthalmology resident. The new, updated and upgraded material makes this third edition equally stimulating for experienced clinicians. Prescribing is not an exact science because even the psychodynamics of wearing glasses must be taken into account. However, studying this book may help the clinician to qualify as a fine artist.