DIAGNOSING AND TREATING GLAUCOMA

“It is a great paradox that although we have the latest technology to diagnose glaucoma and a number of new medications/laser/ surgical techniques to treat glaucoma, glaucoma remains the leading cause of irreversible blindness worldwide.†So begins the preface to “Pearls in Glaucoma Therapy: A Practical Manual with Case Studies.â€

This concise text, written by Tanuj Dada, Parul Ichhpujani & George Spaeth, and published by Jaypee Brothers Medical Publishers, is an excellent and readable refresher course for those clinicians who are interested in fine-tuning their glaucoma diagnosis and management skills. Glaucoma is one of the few sub-specialties in ophthalmology that can be practised almost entirely by a general ophthalmologist.

This is because glaucoma is very common and can, for the most part, be treated without surgical intervention. Further, it is a frequent complication of other ocular pathology and surgical procedures, so every ophthalmologist, whether general or subspecialist, is confronted with glaucoma on a regular basis. Thus, it is essential that the ophthalmologist feels comfortable with this pathology and keeps up with the recent developments in diagnosis and treatment. This 130-page book is organised into 10 chapters, each with a simple goal: to answer the core questions in glaucoma treatment.

The most clinically useful are “Chapter 3: How to Work Up a Glaucoma Patient?†- Chapter 4: When to Start Therapy?†- and “Chapter 5: How to Set Target IOP?†These chapters are packed with the basic information and especially some up-to-date tips that a clinician might ask a glaucoma specialist, given the opportunity. For example, when should optic disc imaging techniques such as HRT, Gdx or OCT be used? How many baseline visual fields are required for the diagnosis of glaucoma, and how many more are needed to determine progression? What are common mistakes made in the initiation of glaucoma treatment? Also useful is the chapter dedicated to compliance issues.

Compliance is a particularly important issue in glaucoma, which is a chronic, generally asymptomatic disease requiring daily topical treatment with many potential side effects. Chapter 8 begins with the quotation, “Drugs don’t work in patients who don’t take them.†The question is: why don’t many of our patients correctly use their eye drops? The authors provide insight into the causes of this problem, and their solutions. Of course, theoretical knowledge is nice to have, but applying this knowledge in the clinic is a different story entirely.

Fortunately, this book includes case studies and clinical scenarios in which the reader can test his or her knowledge in the decision making regarding a particular case, and compare it to the advice provided by the authors. Each chapter ends with a “Key Points†section that summarises the central issues and provides the reader with a rapid overview of the chapter’s essential information. After having read the book, the reader can rapidly scan these sections as a reminder of what (s)he has learned.

Because of the book’s concise nature, it is ideal for a quick read rather than a great, sustained effort. It assumes a basic level of knowledge regarding glaucoma, and does not delve into the complex pathophysiology of the disease. So, it discusses the ocular hypotensive medications primarily in terms of their clinical value rather than their molecular structure and pharmacologic mechanisms of action. Instead, it focuses on clinically useful information that can immediately be applied to patient care. Thus, this book will appeal to residents during their glaucoma rotation; glaucoma fellows just starting their fellowship training; and general ophthalmologists interested in a rapid update of their glaucoma management knowledge and skills.