Features
Glaucoma identification and co-management
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The authors describe the burden of glaucoma outpatient appointments in the NHS (25-30 per cent of all ophthalmology outpatient appointments) and underline the need to expand capacity using optometric co-management/shared care schemes.
Clinical dilemmas
Most, if not all, optometrists working in a primary care setting have experienced clinical dilemmas relating to glaucoma detection: 'This optic disc looks a bit dodgy is it glaucoma or just a variation of normal? I referred three patients for suspect glaucoma recently and they were all discharged as normal.' If these sound familiar, this book will help. I headed straight for the chapters on visual fields and optic disc assessment and was not disappointed. The rest of the book was an excellent read with useful illustrations and photographs, and a good use of colour for navigation.
While most of the contributing authors are optometrists or ophthalmologists, chapters written by a pharmacist and epidemiologists provide a broader perspective, reflecting the multi-disciplinary nature of glaucoma co-management. The book begins with a chapter on the epidemiology of POAG, including a summary of population studies and current knowledge of risk factors. Chapter 2 deals with production and drainage of aqueous humour and Chapter 3 describes the histopathology and pathogenesis of changes to the optic nerve head in glaucoma.
Clinical techniques used in glaucoma detection and monitoring are described in Chapters 4 to 9, starting with gonioscopy. A clinician who wants a straightforward guide on 'how to do gonioscopy and grade the anterior chamber angle' will find this information in Chapter 4. Chapter 5 covers visual fields and gives a comprehensive description of Henson and Humphrey instrumentation.
Readers will find useful information about patterns of visual field loss in glaucoma, plus advice on dealing with practical difficulties in interpreting field plots due to variable reliability and repeatability of measurements.
The following chapter summarises other visual function tests which may detect glaucomatous change before conventional perimetry. Detecting change in visual fields is discussed in Chapter 7, and this is of particular relevance for clinicians involved in monitoring glaucoma patients.
Pressures and discs
Chapter 8 details intraocular pressure (IOP). Outlined here is its measurement, influencing factors (including the relevance of corneal thickness), its usefulness in detecting glaucoma and some IOP referral guidance. The 'practical advice' summaries - helpfully highlighted in coloured boxes - contained clinical pearls to assist with using IOP measurements in clinical decision making. More practical advice summaries on other subjects - for example how experienced glaucoma practitioners integrate theory into practice - would have been welcomed.
One section likely to be heavily used by optometrists is Chapter 9 on optic disc evaluation. It helps the reader differentiate normal from abnormal and describes, with photographs, the features of glaucomatous optic discs. Modern techniques for imaging the optic disc are described the sample printouts from HRT scanning laser ophthalmoscopy, GDx scanning laser polarimetry and optical coherence tomography helped to explain how these instruments work.
Medical and surgical treatment of glaucoma is described in Chapters 10-12 and will interest not just those already working in glaucoma management but any practitioner wanting to understand their patient's glaucoma treatment plan. The pharmacology of glaucoma pressure-lowering eye drops is covered, as is an up-to-date rationale for medical management of glaucoma based on recent large clinical trials. Finally, Chapter 13 describes how optometrists can contribute to glaucoma management in shared care/co-management schemes, with some examples of UK schemes.
Who is this book aimed at?
Any undergraduate, pre-registration or practising optometrist who wants to refine their diagnostic skills or expand their practice has much to gain by reading this book. Similarly, clinicians interested in referral refinement or co-management of glaucoma patients will find it useful. It is written primarily for the UK optometric community and the content is highly relevant to today's optometric challenges in primary and secondary care. It may be useful to other professionals interested in glaucoma such as nurse practitioners, orthoptists or trainee ophthalmologists. I would strongly encourage optometrists to read this excellent book and I will continue to refer to it in day-to-day practice. ●
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