Attending Ophthalmologist Research Articles

Topiramate induced bilateral angle closure with anterior uveitis – A masquerade in a migraine patient

Topiramate (TPM), a sulphonamide derivative, is a commonly used medication by physicians and psychiatrists. Topiramate-induced angle closure glaucoma (ACG) and TPM-induced myopic shift are reported ocular adverse reactions of this drug. We report here a case of TPM-induced ciliochoroidal effusion presenting as bilateral acute angle closure with anterior uveitis and myopic shift in a patient with migraine. The acute and often bilateral severe visual deterioration in patients on TPM therapy cannot only be disturbing to the patient but can also be a challenge to the attending ophthalmologist to manage. We highlight the confusing presentation leading to the initial misdiagnosis of bilateral ACG and challenges in the management of this potentially sight-threatening condition.

Screening for ocular toxicities of immunotherapy in a real-world population.

e24125 Background: Nivolumab, Pembrolizumab, and Ipilimumab have revolutionized the treatment of melanoma. However, patients receiving these treatments risk immunotherapy-related adverse events (IRAEs). IRAEs can occur in any organ system, are treated with steroids or immunosuppressive medications, and may require treatment delay or discontinuation. Ocular IRAEs, which are caused by off-target reactions with ocular immune mechanisms, are often identified after significant damage to the eye. Ocular IRAEs are rare in the literature with an approximate prevalence of 3.3%. After observing intraocular inflammation (uveitis) with uveal depigmentation (pigment release) in some patients receiving immunotherapy, we hypothesized that the rate of such events in a real-world population may be higher than previously reported. We predict ophthalmic screening and early intervention may prevent severe and potentially permanent ocular IRAEs. Methods: Patients starting immunotherapy for melanoma were referred to an ocular screening clinic at the Cancer Centre of Southeastern Ontario (Queen’s University, Kingston, Canada) for baseline ocular assessments. Repeat assessments occurred every three months (single agent) or at every cycle (dual immunotherapy). Intake visits included examination by an attending ophthalmologist, including examination for uveitis and anterior chamber free pigment under high-powered field. Intraocular inflammation (IOI) was defined as the presence of endothelial deposits and/or anterior chamber cell and/or pigment that was not present at baseline. Ocular findings were monitored alongside other IRAEs during treatment. Results: 28 patients (17 male, 11 female) receiving adjuvant (46.4%) or palliative (53.6%) immunotherapy for melanoma were evaluated. 9 of these patients received dual immunotherapy (Ipilimumab/Nivolumab) and 19 received single agent immunotherapy. IOI was identified in 11 patients (39.2%), while only 4 presented with symptoms. None of the patients had overt signs of anterior segment inflammation such as erythema, conjunctival injection, and chemosis. IOI developed in 54.5% of dual immunotherapy-treated patients. Patients with ocular IRAEs were treated with topical/systemic steroids or other immunosuppressive medications. None required discontinuation of immunotherapy. The development of IOI was more common in metastatic patients whose cancer was responding to immunotherapy, and many of these patients sustained IRAEs in other organ systems. Conclusions: Our findings suggest IOI related to ocular IRAEs are quite common and develop in a third of patients receiving immunotherapy for melanoma. Ocular screening for IOI identified early, often asymptomatic toxicities that could progress to permanent visual disability. Further evaluation of dedicated ocular screening is indicated in patients receiving immunotherapy.

Clinical Outcomes of Topical Bevacizumab for the Treatment of Corneal Neovascularization.

Background and objective In corneal neovascularization, the peri-corneal vascular structure grows into a normally avascular cornea. This is due to an imbalance between the angiogenic and anti-angiogenic factors that sustain corneal transparency. There are various etiologies of this condition, and they can be divided into infective or non-infective causes, such as inflammation, trauma, or surgical causes. Corneal neovascularization has been shown to improve with the current treatments using steroids and anti-vascular endothelial growth factors. This study aimed to evaluate the effectiveness of topical bevacizumab as an anti-angiogenic agent in patients with corneal neovascularization. Methods This retrospective study included patients who suffered corneal neovascularization of various etiologies and completed six months of topical bevacizumabtherapy between 2020 and 2022 at the Universiti Kebangsaan Malaysia Medical Centre. Results A total of 16 patients received treatment with topical bevacizumab over the three-yearstudy period. Based on specified inclusion and exclusion criteria, 12 patients were eligible for inclusion in this study. Eight patients (66%) showed improvement in terms of either 'clock hours' of improvement, morphology, or regression of corneal neovascularization. All infective causes of corneal neovascularization showed improvement on completion of bevacizumab compared to other causes. Conclusion Topical bevacizumab can be one of the treatment choices for corneal neovascularization. As the outcome varies depending on the severity and chronicity of the condition, the attending ophthalmologist should treat each case differently. Although topical bevacizumab is more effective in mild and moderate cases, the indications for its use in chronic cases remain debatable as the results are unfavorable in such cases.

Perspectives of Resident and Attending Ophthalmologists on Common Ethical Dilemmas in Research.

Purpose To assess how resident and attending ophthalmologists perceive and evaluate ethically controversial scenarios regarding mentorship, authorship, and ethics compliance that may occur during research involving residents. Methods An online survey was developed and contained 14 controversial vignettes based on common research scenarios that can occur when conducting research with trainees. The scenarios were designed to capture issues regarding three themes: mentorship, authorship, and compliance with ethical guidelines. Resident and attending ophthalmologists at eight military and civilian academic residency programs in the United States were invited to participate. Respondents used a Likert scale to assess the ethicality of the situations in addition to self-reported demographic characteristics. Results The response rate was 35.6% (77/216), consisting of 37.7% ( n = 29) residents and 62.3% ( n = 48) attendings. More attending ophthalmologists responded than residents ( p = 0.004). Many respondents identified controversies around compliance (67.3%) and authorship (57.1%) as unethical, whereas situations regarding mentorship were largely viewed as neutral to ethical (68.0%). Responses to two scenarios, one regarding mentorship and one regarding authorship, significantly differed between residents and attendings ( p = 0.001 and p = 0.022, respectively). Conclusion Academic ophthalmologists' perceptions of the ethicality of common research scenarios varied. There is a need for more prescriptive guidelines for authorship and mentorship ethics at all training levels to ensure consistency, fairness, and integrity of research.

Intra- and interobserver concordance of a new classification system for myopic maculopathy

BackgroundMyopic maculopathy (MM) is one of the major causes of visual impairment and irreversible blindness in eyes with pathologic myopia (PM). However, the classification of each type of lesion associated with MM has not been determined. Recently, a new MM classification system, known as the ATN grading and classification system, was proposed; it is based on the fundus photographs and optical coherence tomography (OCT) images and includes three variable components: atrophy (A), traction (T), and neovascularization (N). This study aimed to perform an independent evaluation of interobserver and intraobserver agreement for the recently developed ATN grading system for MM.MethodsThis was a retrospective study. Fundus photographs and OCT images of 125 patients (226 eyes) with various MMs were evaluated and classified using the ATN grading of the new MM classification system by four blinded and independent evaluators (2 attending ophthalmologists and 2 ophthalmic residents). All cases were randomly re-evaluated by the same observers after an interval of 6 weeks. The kappa coefficient (κ) and 95% confidence interval (CI) were used to determine the interobserver and intraobserver agreement.ResultsThe interobserver agreement was substantial when considering the maculopathy type (A, T, and N). The weighted Fleiss κ values for each MM type (A, T, and N) were 0.651 (95% CI: 0.602–0.700), 0.734 (95% CI: 0.689–0.779), and 0.702 (95% CI: 0.649–0.755), respectively. The interobserver agreement when considering the subtypes was good or excellent, except for stages A1, A2, and N1, in which the weighted κ value was less than 0.6, with moderate agreement. The intraobserver agreement of types and subtypes was excellent, with κ > 0.8. No significant differences were observed between the attending ophthalmologists and residents for interobserver reliability or intraobserver reproducibility.ConclusionsThe ATN classification allows an adequate agreement among ophthalmologists with different qualifications and by the same observer on separate occasions. Future prospective studies should further evaluate whether this classification can be better implemented in clinical decision-making and disease progression assessments.

High Axial Myopia in Neurofibromatosis Type 1

Background: Clinicians must be aware of phenotypic variability in neurofibromatosis type 1 (NF 1) presentations. There is perhaps a limited understanding on progression of NF 1 in prepubertal years and the subsequent threat to vision. Progressively increasing myopia may go unnoticed under a severely ptotic eyelid that gathers attention, due to a disfiguring mass in patients with NF 1. High myopia may result in recalcitrant amblyopia if not tackled early with multidisciplinary management. Clinical Description: A 12 year old girl had a history of progressively increasing left upper eyelid ptosis due to an upper eyelid mass, first noticed at the age of 1 year and eventually resulted in severe ptosis by the age of 5 years. However, this went unnoticed until she was diagnosed with NF 1 at the age of 12 years. Best corrected visual acuity was 6/6 (Plano) in the right eye (OD) and counting finger 2 m with − 15.0 diopter spheres in the left eye (OS). Peripheral fundus examination was normal in both eyes. Levo elevation and abduction were limited OS. Hypotropia, pulsatile proptosis, and depression of the globe were clinically attributable to enlargement of orbital tissues and lid problems. Contrast enhanced computed tomography scan revealed plexiform NF with extraconal extensions. Axial length was 21.94 mm OD and 28.92 mm OS. B scan ultrasound revealed a posterior staphyloma OS. Management: The patient underwent a debulking surgery of the eyelid mass which on histopathological examination confirmed plexiform NF. Surgery resulted in a cosmetic reduction in ptosis; however, any intervention was relatively too late to rehabilitate the left eye. Conclusions: Eye care certainly has its regional differences. High axial myopia may result in low VA and recalcitrant amblyopia that may go unrecognized and comes with management challenges to the attending ophthalmologist and allied specialties dealing with these cases of NF 1.

Characteristics Associated With New Patient Appointment No-Shows at an Academic Ophthalmology Department in the United States

This study aimed to identify patient and appointment characteristics associated with no-shows to new patient appointments at a US academic ophthalmology department. Cross-sectional study. This was a study of all adult patients with new patient appointments scheduled with an attending ophthalmologist at Penn State Eye Center between January 1st and December 31st of 2019. A multiple logistic regression model was used to assess the association between characteristics and no-show status. Of 4,628 patients, 759 (16.4%) were no-shows. From the multiple logistic regression model, characteristics associated with no-shows were age (Odds Ratio (OR) for 18-40 years vs. >60 years: 3.41, 95% Confidence Interval (CI) 2.57, 4.51, p <0.001 and OR for 41-60 years vs. >60 years: 2.14, 95% CI 1.67, 2.74, p<0.001), median household income (OR for <$35,667 vs. >$59,445: 1.59, 95% CI 1.08, 2.34, p<0.001), insurance (OR for None vs. Medicare: 6.92, 95% CI 4.41, 10.86, p<0.001 and OR for Medicaid vs. Medicare: 1.54, 95% CI 1.18, 2.01, p=0.002), race (OR for Black vs. White: 2.62, 95% CI 2.00, 3.43, p<0.001 and OR for Other vs. White: 2.02, 95% CI 1.58, 2.59, p<0.001), and commute distance (OR for 5-10 mi vs. ≤5 mi: 1.73, 95% CI 1.17, 2.55, p=0.006). Appointments with longer lead times and scheduled with glaucoma or retina specialists were also significantly associated with greater no-shows. Certain patient and appointment characteristics were associated with no-show status. These findings may assist in the development of targeted interventions at the patient, practice, and health system levels to improve appointment attendance.

Implementing Telemedicine Visits in an Underserved Ophthalmology Clinic in the COVID-19 Era.

Introduction:Many of the potential barriers to providing telehealth services already disproportionately impact vulnerable populations. The purpose of this study was to assess the incorporation of synchronous ophthalmology telemedicine visits in a tertiary university-based ophthalmology clinic for low-income and uninsured patients in the COVID-19 era.Methods:The records of 18 patients who were due for an in-person visit in the medically underserved patient clinic at our institute were reviewed. Patients considered high risk of ocular morbidity progression were approved to proceed with an in-person visit. Patients with non-urgent visit indications were attempted to be contacted by telephone to be offered a telemedicine telephone visit as an alternative to a postponed in-person office visit.Results:Clinical triage by an attending ophthalmologist determined that 17 patients (94.4%, n = 18) had visit indications appropriate for evaluation by telemedicine. Six patients (35.3%, n = 17) were successfully contacted and offered a telemedicine visit as an alternative to a postponed in-person office visit. All 6 patients accepted, scheduled, and completed a telemedicine visit. Eleven patients (64.7%, n = 17) were not able to be successfully contacted to offer and schedule either a telemedicine visit or a postponed in-person office visit. Patients who were not able to be successfully contacted were on average younger in age and more likely to be female, Hispanic/Latino, from Latin America, with a preferred language of Spanish.Conclusions:Synchronous ophthalmology telemedicine visits can be successfully incorporated in a tertiary university-based setting for low-income and uninsured patients. The primary barrier to providing telemedicine visits in this population was the ability to successfully contact patients to offer and schedule these visits.

Training of Residents and Fellows in Retinopathy of Prematurity Around the World: An International Web-Based Survey.

To characterize retinopathy of prematurity (ROP) training practices in international residency and fellowship programs. A publicly available online-based platform (http://www.SurveyMonkey.com) was used to develop a 28-question multiple-choice survey that targeted ROP screening and treatment methods. The authors solicited training programs in the Philippines, Thailand, and Taiwan. Programs from three countries participated in the survey, and a total of 95 responses collected from residents, fellows, and attending ophthalmologists were analyzed. A descriptive analysis demonstrated that 45 participants (47%) reported 1% to 33% of ROP screenings were performed under direct supervision of attending ophthalmologists, and 35 (37%) reported the use of formal assessments. The majority of participants (Country A: 87%, Country B: 71%, and Country C: 75%) estimated 1% to 33% of their practice was spent screening for ROP. Notably, 44 participants (46%) reported performing zero laser photocoagulation treatments for ROP during training (Country A: 65%, Country B: 38%, and Country C: 38%). International ophthalmology trainees perform a limited number of ROP examinations and laser interventions. ROP screenings are often unsupervised and lead to no formal evaluation by an attending ophthalmologist. Limited ROP training among ophthalmologists may lead to misdiagnosis and ultimately mismanagement of a patient. Loss of vision and exposure to unwarranted treatments are among the implications of such errors. The findings highlight the need to improve ROP training in international ophthalmology residency and fellowship programs. [J Pediatr Ophthalmol Strabismus. 2019;56(5):282-287.].

Delivering mobile eye care to underserved communities while providing training in ophthalmology to medical students: experience of the Guerrilla Eye Service.

ObjectiveThe objective of the study was to characterize the population served by the student-led Guerrilla Eye Service (GES), a mobile outreach program that delivers comprehensive ophthalmic care to underserved communities in the greater Pittsburgh area.Patients and methodsPatients attending GES missions at a single urban free clinic from 2012 through 2017 were included in this retrospective case series. All patients underwent a comprehensive eye examination at no cost, with referral to a university eye clinic if necessary. Demographic characteristics, past ocular history, reasons for attendance, and ophthalmic diagnoses were recorded. Attendance rates and treatment outcomes of patients referred to the university eye clinic were also reviewed.ResultsWe reviewed records of 360 GES patients (mean age 43 years, age range 1–79 years; 56% [200] male; 37% [133] non-English speakers). The most common reasons for attending were blurry vision (28% [101]), need for new glasses (22% [80]), and referral for a diabetic eye exam (18% [63]). The most common diagnosis made was refractive error (59% [214]), and vouchers for free spectacles were provided. One-third of diabetic patients had retinopathy (32% [38]). Glaucoma suspect (11% [40]), narrow angles (4% [13]), treatment-requiring diabetic eye disease (4% [14]), and visually-significant cataract (3% [11]) were diagnoses that most often prompted referral to the university clinic. In all, 114 patients were referred (32%), of whom 82 (72%) attended the follow-up visit. Other patients continued to receive longitudinal care through GES.ConclusionMedical student-led outreach programs under the supervision of an attending ophthalmologist can deliver regular eye care to underserved communities while providing referrals to a university clinic for those with advanced disease.

A nationwide survey of factors influencing adherence to ocular hypotensive eyedrops in Japan.

Few reports have investigated the status of adherence in Japan on a large scale. We aimed to investigate the status of adherence to topical glaucoma treatment and its associated factors. A nationwide survey was conducted as a prospective fashion. Participants in this survey were subjects with primary open-angle glaucoma, normal-tension glaucoma, or ocular hypertension or pseudoexfoliation glaucoma who had been prescribed anti-glaucoma ophthalmic eyedrops and whose ophthalmologist considered prescribing any fixed combination of ocular hypotensive eyedrops for the first time between 2011 and 2012. Subjects and their attending ophthalmologists independently completed a questionnaire by utilizing a fixed combination of ocular hypotensive eyedrops. A total of 1358 ophthalmologists from 1071 medical institutions participated in this survey. We registered 4430 subjects (2049 males and 2381 females). In total, data from 3853 subjects (87.6%) were analyzed after inclusion of subjects based on inclusion and exclusion criteria. Good adherence was defined as not forgetting instillation during the past week. Rates of good adherence reported by subjects and ophthalmologists were 72.4 and 78.5%, respectively (P<0.0001). The consistency of adherence evaluation between subjects and ophthalmologists was moderate [kappa score 0.5025 (95% confidence interval 0.4740-0.5309)]. Significant factors associated with adherence were size of clinic, age, gender, number of types of ocular hypotensive eyedrops, ease of instillation, preferred number of eyedrops, preferred frequency of instillation of eyedrops, and knowledge of glaucoma. Adherence to ocular hypotensive eyedrops among Japanese subjects was relatively good. Concordance of adherence between subjects' reports and ophthalmologists' responses was moderate. Size of clinic, number of types of ocular hypotensive eyedrops, ease of instillation, preferred number of eyedrops, preferred frequency of instillation of eyedrops, and knowledge of glaucoma were associated with adherence among Japanese glaucoma subjects.

UR Well Eye Care: a model for medical student ophthalmology education and service in the community.

PurposeTo assess medical student ophthalmic educational exposure and service provided through the University of Rochester’s UR Well Eye Care (URWEC) program, a student-run initiative in which medical students provide supervised eye care to an uninsured urban population.DesignRetrospective chart review.SubjectsConsecutive patients seen at the student-run URWEC in Rochester, NY, USA between June 2008 and June 2013.MethodsOne hundred and forty-five of 148 charts of consecutive patients seen at URWEC over the 5-year period were identified and reviewed. Data on patient demographics, reason for visit, history, examination, diagnoses, and management were collected into a database.Main outcome measuresMain outcome measures included reasons for referral, student performance of ophthalmic examination components, ophthalmic diagnoses, and hours of volunteer service rendered.ResultsPatients came from a variety of countries and educational and racial backgrounds. The most common reason for referral to URWEC was diabetic screening eye exams (66/145, 46%). Student volunteers performed the following examination components in 79%–100% of visits under direct supervision of an attending ophthalmologist: visual acuity, pupils, extraocular movements, confrontation visual fields, intraocular pressure, drop administration, slit-lamp examination, and dilated fundoscopic exam. The most common diagnosis other than refractive error was cataract (29/145, 20%). Almost half of patients (66/145, 46%) were diagnosed with potentially vision-threatening conditions. Six hundred and thirty hours of community service were rendered by students and attending ophthalmologists during the 5-year period.ConclusionStudent-run eye clinics provide a longitudinal setting where students can receive one-on-one training with attending ophthalmologists, attain a broad clinical exposure, and provide a needed service in their communities.

Electronic Health Record Systems in Ophthalmology: Impact on Clinical Documentation

To evaluate quantitative and qualitative differences in documentation of the ophthalmic examination between paper and electronic health record (EHR) systems. Comparative case series. One hundred fifty consecutive pairs of matched paper and EHR notes, documented by 3 attending ophthalmologist providers. An academic ophthalmology department implemented an EHR system in 2006. Database queries were performed to identify cases in which the same problems were documented by the same provider on different dates, using paper versus EHR methods. This was done for 50 consecutive pairs of examinations in 3 different diseases: age-related macular degeneration (AMD), glaucoma, and pigmented choroidal lesions (PCLs). Quantitative measures were used to compare completeness of documenting the complete ophthalmologic examination, as well as disease-specific critical findings using paper versus an EHR system. Qualitative differences in paper versus EHR documentation were illustrated by selecting representative paired examples. (1) Documentation score, defined as the number of examination elements recorded for the slit-lamp examination, fundus examination, and complete ophthalmologic examination and for critical clinical findings for each disease. (2) Paired comparison of qualitative differences in paper versus EHR documentation. For all 3 diseases (AMD, glaucoma, PCL), the number of complete examination findings recorded was significantly lower with paper than the EHR system (P ≤ 0.004). Among the 3 individual examination sections (general, slit lamp, fundus) for the 3 diseases, 5 of the 9 possible combinations had significantly lower mean documentation scores with paper than EHR notes. For 2 of the 3 diseases, the number of critical clinical findings recorded was significantly lower using paper versus EHR notes (P ≤ 0.022). All (150/150) paper notes relied on graphical representations using annotated hand-drawn sketches, whereas no (0/150) EHR notes contained drawings. Instead, the EHR systems documented clinical findings using textual descriptions and interpretations. There were quantitative and qualitative differences in the nature of paper versus EHR documentation of ophthalmic findings in this study. The EHR notes included more complete documentation of examination elements using structured textual descriptions and interpretations, whereas paper notes used graphical representations of findings. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Neue Erkenntnisse zur unterschätzten Beeinträchtigung der Lebensqualität bei altersbedingter Makuladegeneration – ein Literaturüberblick

Different forms of age-related macular degeneration (AMD) can lead to massive visual impairment up to blindness. Therefore, AMD has a high impact on patients' daily life and causes restrictions of their psychological well-being, autonomy and mobility. These restrictions influence their quality of life. It is difficult to define the term "quality of life". It consists of different aspects that can be measured with psychometric tests. Besides the general health status and the psychological well-being, the vision-specific functional status plays a central role for determining the quality of life of AMD patients. To compare the impact of different diseases on the quality of life, the utility analysis has been developed. It demonstrates the relevance of AMD for patients and shows that its impact on patients' life is comparable to those of other systemic diseases like carcinoma or HIV. The impairment of patients' quality of life by AMD is often underestimated by their attending ophthalmologists. Different medical treatments have influenced the quality of life of AMD patients. However, there is still a large group that cannot be treated. These patients benefit from rehabilitation with low vision aids or psychosocial interventions. Further clinical trials at a high evidence level using valid and comparable psychometric tests are necessary to improve the therapy for and the rehabilitation of AMD patients and to increase their quality of life.

Book Reviews

Alastair K. O Denniston and Philip I Murray, (eds) Oxford Handbook of Ophthalmology First edition 784 pages Oxford University Press , Oxford , 2006 ISBN 0 19 853037 4 and 978 0 19 853037 4 Price: € 38.40 The Oxford Handbook of Ophthalmology is part of the Oxford Handbook series of pocket-sized reference books for professionals. This first edition of the Handbook of Ophthalmology is primarily intended for ophthalmologists, but other medical professionals may also find it useful. The opening page of the book gives a useful list of common ophthalmic emergencies, with references to the specific pages on which these are mentioned. In addition, the ‘blue boxes’ throughout the book give details of clinical algorithms, tips and overviews of common ophthalmic procedures. Consequently, this book is immediately brought into the context of a clinical setting where the reader needs to resource concise and informative information rapidly. The book is comprised of 23 chapters, the first two of which focus on Clinical Skills and Investigations. A wide range of clinical examinations are described in an organized manner. This allows the reader to look up different types of examinations and acquire an overview of the value of these. The chapter is an excellent source of guidelines for the medical student, ophthalmology resident or ophthalmologist who needs to refresh his or her memory. The chapter on Investigations fulfils its purpose in the same manner by giving an overview of common ophthalmologic diagnostic tools and interpretations of the results of these. The third chapter, Trauma, is very comprehensive and user-friendly in terms of its descriptions of different kinds of trauma, their treatment and the main points to remember when looking at a traumatized eye. The fourth chapter covers Diseases of the Eyelids and subsequent chapters move systematically towards the inner eye, culminating in Chapter 14, which is about the orbit. Chapters 4 to 14 all start with descriptions of the anatomy and physiology of the region in question. Although these are very informative, the book would be improved by the inclusion of a small anatomical figure in every chapter rather than in a select few only. The final chapters then cover Intraocular Tumours, Neuro-ophthalmology, Strabismus, and Paediatric Ophthalmology, respectively. Overall, these are very useful in that they serve to provide the clinician with a quick reference to epidemiology, clinical signs, investigations and treatment. Complex diseases and problems are described concisely, in a manner that makes them easier to assess, although the text is sometimes a little simplistic. The chapter on Aids to Diagnosis is a very welcome addition for both the inexperienced and experienced doctor in that it provides tools for the assessment of presenting symptoms and differential diagnosis. Likewise, Chapters 20 and 21, on Vision in Context and Perioperative Care, respectively, are sources of useful and clinically oriented information that is otherwise difficult to find in ophthalmic textbooks. The last chapter, Miscellaneous, consists mainly of a short overview of eponymous syndromes and web resources to indulge most clinically oriented readers who have felt the lack of a complete reference book. The book is obviously written for clinicians interested in ophthalmology. Much of the text requires previous ophthalmic knowledge; the reader will not achieve a deeper understanding of the physiology and pathology of the conditions described by reading this book alone. All in all, the Oxford Handbook of Ophthalmology is an excellent tool for the medical student, ophthalmology resident and attending ophthalmologist. Not only is the text extremely helpful, but the size of the book makes it very attractive. It is quite astonishing how its layout makes almost 800 pages of ophthalmology easy to carry, read and understand. The book has the potential to become an essential part of ophthalmology training and deserves a presence in every educational ophthalmology department.

Tumours of the Eye. By Algernon B. Reese, M.D., D.Sc., F.A.C.S., Attending Ophthalmologist and Pathologist, Institute of Ophthalmology, Presbyterian Hospital, New York. Pp. 574 + x, with 511 illustrations, 122 in colour. 1951. London: Cassell &amp; Company Ltd. £7 7s

Tumours of the Eye. By Algernon B. Reese, M.D., D.Sc., F.A.C.S., Attending Ophthalmologist and Pathologist, Institute of Ophthalmology, Presbyterian Hospital, New York. Pp. 574 + x, with 511 illustrations, 122 in colour. 1951. London: Cassell &amp; Company Ltd. £7 7s

The Prevention of Disease in Everyday Practice

Journal Article The Prevention of Disease in Everyday Practice Get access The Prevention of Disease in Everyday Practice. By Givner Isadobe, M.D., F.A.C.S., Associate Clinical Professor of Ophthalmology, New York University Post-Graduate Medical School; Director of Ophthalmology, New York City Hospital; Attending Ophthalmologist, University and Beth David Hospitals; Associate in Ophthalmological Bacteriology, New York Eye and Ear Infirmary; Consultant in Ophthalmology, Correction Hospitals, New York, New York; and Bruger Maurice, M.D., C M . , F.A.C.P., Associate Professor of Medicine, New York University Post-Craduate Medical School; Attending Physician and Director, Department of Clinical Pathology, University Hospital; Visiting Physician, Bellevue Hospital; New York, New York. 964 pp., 50 illus., frontispiece in color. $20.00. St. Louis: C. V. Mosby Company, 1955. Aaron Arkin Aaron Arkin Chicago Search for other works by this author on: Oxford Academic Google Scholar American Journal of Clinical Pathology, Volume 25, Issue 12, 1 December 1955, Pages 1403–1404, https://doi.org/10.1093/ajcp/25.12.1403 Published: 01 December 1955

Tumors of the EyeTumors of the Eye. By ReeseAlgernon B., M.D., D.Sc. (Hon.), F.A.C.S., Attending Ophthalmologist and Pathologist, Institute of Ophthalmology, Presbyterian Hospital, New York; Ophthalmologist to Memorial Center for Cancer and Allied Diseases, New York; Clinical Professor of Ophthalmology, College of Physicians and Surgeons, Columbia University. A volume of 574 pages, with 511 illustrations, 122 in full color. Published

Tumors of the Eye<scp>Tumors of the Eye</scp>. By ReeseAlgernon B., M.D., D.Sc. (Hon.), F.A.C.S., Attending Ophthalmologist and Pathologist, Institute of Ophthalmology, Presbyterian Hospital, New York; Ophthalmologist to Memorial Center for Cancer and Allied Diseases, New York; Clinical Professor of Ophthalmology, College of Physicians and Surgeons, Columbia University. A volume of 574 pages, with 511 illustrations, 122 in full color. Published

Medicine Throughout Antiquity

Journal Article Medicine Throughout Antiquity Get access Medicine Throughout Antiquity. By Benjamin Lee Gordon, M.D.; Member, American Association of the History of Medicine and American Academy of Ophthalmology and Otolaryngology; certified by American Board of Ophthalmology; Attending Ophthalmologist to Shore Memorial Hospital, Somers Point, New Jersey; and to Atlantic County Hospital for Tuberculous Diseases and Atlantic County Hospital for Mental Diseases, Northfield, N. J.; Authorized Medical Examiner for Civil Aeronautics Administration, Dept. of Commerce, Washington, D. C.; Author of “The Romance of Medicine.” Foreword by Max Neuburger, M.D. Cloth. Price, $6.00. 845 pages with 157 illustrations. F. A. Davis Company, Philadelphia, 1949. Physical Therapy, Volume 30, Issue 9, September 1950, Page 406, https://doi.org/10.1093/ptj/30.9.406 Published: 01 September 1950