TEXTBOOK ON KERATOCONUS - NEW INSIGHTS

This book opens with a very good question: “Why a textbook on keratoconus?†Until recently, slit-lamp evaluation and corneoscopy were the primary diagnostic tools, while contact lenses and corneal transplantation were the only two treatment options.

Although an early mention of keratoconus was first published in 1748 and the disease was clearly described in 1854, patients would have to wait until 1888 for treatment with contact lenses and until 1936 for the first successful corneal transplantation for keratoconus.

However, over the past 25 years, there has been a veritable explosion of diagnostic modalities and treatment alternatives, leading to the condition being recognised and successfully managed by a significant proportion of practising anterior segment specialists. Further, the increased importance of refractive surgery, and increased awareness of the potential problems of post-surgical complications related to keratoconus undiagnosed preoperatively, have pushed keratoconus up the ladder of importance in corneal disease.

Adel Barbara, a corneal specialist in Israel, has gathered a large group of experts to contribute to this textbook on keratoconus. The book is divided into three sections: 1: Epidemiology, Genetics & Pathology; 2: Diagnostics; and 3: Treatments. The book covers nearly every aspect of the disease, providing historical background, recent advances and insights and the current state of the art for each topic and technique.

Because of the incredible diversity of diagnostic options and therapeutic alternatives, keeping up with the current, evidence-based information is a daunting task for even the most motivated of practitioners. On the diagnosis side, there are a host of choices: videokeratography, wavefront analysis, Scheimpflug tomography, OCT, ultrasonic pachymetry, epithelial ultrasound and corneal hysteresis, besides the standard slit-lamp. Likewise, there are a host of choices for therapy: intracorneal rings, phakic intraocular lenses, topographic guided photorefractive keratectomy, improved lamellar transplant techniques, femtosecond laser corneal transplants and collagen corneal cross-linking, in addition to the well-known rigid contact lenses and corneal transplants.

While covering the epidemiology of keratoconus in Section 1, the author considers interesting questions such as whether the frequency of keratoconus is increasing, or whether we are simply better equipped, informed and alert to make the diagnosis. Considering the wealth of information and technology described later in the text, it seems that the latter is more likely. New research insights concerning systemic associations, genetic factors, inflammation, eye rubbing and biomechanics are all discussed.

Section 2 starts with the clinical presentation and differential diagnostic considerations of keratoconus. It then progresses, step-by-step, from corneal topography, Orbscan and Scheimpflug imaging to wavefront analysis, the ocular response analyzer and Artemis very high frequency digital ultrasound epithelial thickness profiles.

Section 3, which takes up more than half of the book, starts with corneal collagen cross-linking and goes on to discuss more invasive treatment options: Intacs intracorneal ring segments, the Ferrara ring, the Myoring, the many different types of keratoplasty and finally intraocular lens implantation.

What makes this textbook particularly interesting is the inclusion of clinical examples, case reports and literature reviews as well as “our own experience†summaries interspersed throughout the text. The latter discusses the authors’ own evolution in clinical decision-making, including reasons for the specific choices made, as well as a sort of inside information regarding the conduct of clinical trials.

Also helpful is that descriptions of surgical techniques are highly detailed. The book also incorporates results from many clinical studies, which are conveniently cited within the descriptions.

The textbook is attractively illustrated with many large-format colour photographs of surgical techniques and instrumentation as well as clearly legible corneal topographical images that assist the reader in understanding the methods described. Dr Barbara’s new text would be an appropriate choice for ophthalmology residents with an interest in anterior segment surgery, cornea fellows, general practitioners and corneal specialists.

BOOKS EDITOR
Leigh Spielberg
PUBLICATION
TEXTBOOK ON KERATOCONUS  - NEW INSIGHTS
AUTHOR
Adel Barbara
PUBLISHED BY JAYPEE HIGHLIGHTS