Glaucoma: A Guide for Patients--An Introduction for Care-Providers: A Quick Reference.

Glaucoma: A Guide for Patients--An Introduction for Care-Providers: A Quick Reference

Josef Flammer, MD; K. Bucher, A. Funkhouser, R. Gerste, translators. Cambridge, MA: Hogrefe & Huber Publishers, 2003, 2nd rev ed. 416 pp. $16.95. ISBN: 0-88937-269-1.

Glaucoma is well recognized but often misunderstood by the medical and lay communities. The National Eye Institute estimates that 2.2 million Americans older than 40 years of age have been diagnosed with glaucoma and that another 2 million do not know that they have the disease. This underscores a major problem in diagnosis and treatment, in that patients with the most common form (ie, primary open angle glaucoma) are typically asymptomatic until the disease progresses to an advanced stage. Early diagnosis on the basis of a routine eye examination remains the best method of preventing visual loss. Finding ways to educate both the general public and health care providers about the nature of glaucoma and the need for periodic examinations is essential to achieving this goal.

Different patients are satisfied with variable levels of understanding of their health status. Given the time constraints in today's health care system, the physician-patient interaction allows for only brief explanations, and some patients are content with this limited knowledge base. Others will browse a standard pamphlet, and still others may seek information in medical textbooks. The author of Glaucoma has tried to facilitate this educational process with an overview of glaucoma that "creates a bridge between the professional and the interested lay reader." Information has been "reduced to the essentials and presented in a form that is simple and easy to understand," with the target audience including patients and health professionals alike.

The book consists of 420 pages and is divided into 2 sections. The first section has eight chapters on topics directly related to glaucoma, including an introduction ("What Is Glaucoma") as well as chapters titled Glaucomatous Damage, Classification of the Various Types of Glaucoma, Risk Factors, Pathogenesis of Glaucomatous Damage, Diagnosing Glaucoma, Therapy, and Living with Glaucoma. The second section has 13 chapters and 6 appendices on supplemental topics, including Anatomy and Physiology of the Visual System, Development and Optics of the Eye, Cataracts, Age-related Macular Degeneration, Diabetes, Lasers, and Eye Medications, as well as a Glossary. The table of contents has boxes next to each topic. The physician who recommends this book to interested patients can place a check next to areas relevant to individuals' diagnoses that they can read at their convenience.

The result is a review of glaucoma that is probably too comprehensive for the average reader. However, it does achieve the stated goal of filling the gap between a simple pamphlet and the professional literature, and it is recommended for those who desire a more in-depth understanding of the topic. It is well written and easy to understand. The author does a good job of explaining some complex principles, such as the theories surrounding the pathogenesis of glaucoma damage. Each chapter in the book is amply illustrated with several color photographs and drawings. The supplemental chapters are a nice addition, because a patient who is motivated to dig deeper for information on glaucoma will undoubtedly appreciate the information presented on related topics.

The discussion is sufficiently thorough that medical students, physicians, and other health professionals with an interest in glaucoma will also find the book useful. Some explanations, such as the discussion of apoptosis in reviewing pathophysiology, may be too elementary for the medical professional. Other areas, though, such as the glaucoma medication section, are good, up-to-date, quick reference sources for the busy practitioner. Several newer diagnostic techniques are mentioned, such as scanning laser tomography, nerve fiber layer analysis, assessment of ocular perfusion, and automated perimetry methods that use color and frequency doubling. The section "Living with Glaucoma" answers several frequently asked questions that could help the practitioner to address these issues with patients. As such, this book can also be recommended as a good introduction to current concepts in glaucoma for health care providers.

[c] 2004 Southern Medical Association

Loren W. Bennett, OD, MPH, FAAO 

James H. Quillen VAMC 

Mountain Home, TN