Foreword

Ophtho Notes: The Essential Guide is a compendium of ophthalmology knowledge and review subjects expressed in a concise and factual manner. As such, this work forms a useful clinical review for the resident as well as the practicing ophthalmologist.

From residency into clinical practice, ophthalmologists are deluged with large volumes of well-written basic science materials from experts in their respective fields. New residents in ophthalmology are sometimes overwhelmed with the depth and breadth of material that places them at risk of ‘‘missing the forest for the trees.’’ While there is no substitute for mastering the basic sciences, residents may benefit from this pocket review, especially when under less than optimal clinical and time pressures as on morning rounds and during the weeks prior to exams.

This compendium may also serve a different but equally useful purpose in terms of providing a relevant, concise, and quick review for busy professionals in their clinical practice. In addition, medical students interested in a career in ophthalmology would find it a quick overview of basic materials.

While admittedly abbreviated and lacking scientific notations, the author has combined into one book not only his own accumulated notes from years of training and experience, but has attempted to expand it for even more completeness and value. The author also encourages the reader to consult references by leading authorities in the field, thereby having the option to add to or update the material from his or her own study.

With pleasure, I take this opportunity to commend Dr. Goodman for his effort to assist ophthalmologists in-training as well as clinical ophthalmologists through the communication and sharing of his collective ophthalmology notes.

HOWARD V. GIMBEL, M.D., M.P.H., F.R.C.S.C.

Gimbel Eye Centre

Calgary, Alberta, Canada

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Preface

Like most medical review books of this type, Ophtho Notes: The Essential Guide grew out of years of collected knowledge from various sources. It began as jottings and notes compiled as a ‘‘peripheral brain’’ during residency. As additional material was assembled and collated, the notes began to take on the form of a small book that soon became more complete.

The book is organized into chapters largely based on anatomic areas of the eye. The chapter sequence begins anteriorly and proceeds posteriorly (e.g., orbit, cornea, retina, etc.), much like the succession of a thorough eye examination that begins externally and moves orderly through the eye tissues.

Each anatomic chapter is organized in a similar fashion. The first section of the chapter, Anatomy and Physiology, discusses pertinent basic science material for that area. Next, the Signs and Symptoms section records common differential diagnoses by presenting complaint or exam finding. The third section, Exam and Imaging, contains important exam skills and tests for that anatomic region. This sequence was chosen because this is generally how a patient is clinically approached: a good understanding of the basic sciences is needed first, then patient history is taken, followed by examination, then a diagnosis can be made.

Following the three opening sections, the greater part of each anatomic chapter discusses diseases of that region organized by etiology. Every disease is classified into one of the following sections: Congenital and Genetic Disease, Infectious Disease, Neoplastic Disease, Metabolic and Degenerative Disease, Systemic and Vascular Disease, Physical Disease (trauma, toxic, etc.), and Inflammatory and Immune Disease. Each anatomic chapter then ends with a Surgery section discussing relevant surgical techniques for that ocular area.

Because this organization is consistent throughout the anatomic chapters, ophthalmic diseases can be easily referenced. For example, retinoblastoma is discussed in the Retina and Vitreous chapter under

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PREFACE xiii

the Neoplastic Disease section. However, the differential diagnosis for corneal edema (not a disease but a physical exam finding) is listed in the Signs and Symptoms section of the cornea chapter. Classifying disease by etiology allows better recollection and hopefully improved understanding of the material.

Several chapters do not lend themselves to anatomic organization. For example, the book begins with a General chapter that covers diverse topics such as genetics, optics, pathology, lasers, etc. Glaucoma is discussed following the cornea chapter because the inaugural pathology is in the anterior chamber angle. Glaucomatous diseases are classified based on whether they are congenital or primary or secondary and open or closed angle. Uveitis and intraocular inflammation precedes the Lens chapter because many uveitides involve the iris. After a brief discussion of the iris, the chapter classifies the uveitic diseases according to their primary presentation as anterior, intermediate, posterior, or panuveitis.

The Pediatrics and Strabismus chapter has an expanded Congenital and Genetic Disease section that chiefly discusses syndromes, phakomatoses, and other pediatric diseases not easily classified under a single anatomic chapter. However, most pediatric diseases are not discussed in this chapter and can be found based on their pathophysiology under the anatomic chapters (for example, as above, retinoblastoma is categorized in the neoplastic section of the retina chapter). Strabismic diseases are then organized into Esotropia, Exotropia, and Vertical Deviation sections. And lastly, the book ends with a chapter detailing common ophthalmic medications.

Because it is designed to be a concise review of ophthalmology, most subjects in Ophtho Notes are only briefly covered. Therefore the diagnostic, therapeutic, and practice recommendations contained in this work should be verified prior to use with information provided from an independent source and considered in light of a particular patient’s clinical condition. The ultimate arbiter of any diagnostic or therapeutic decision remains the individual clinician who assumes full responsibility for all patient care.

This work comes to you largely without quotes or references, although many such acknowledgments could be made, and a number of sources could be credited. Most of the material in this book was gleaned from reading, lectures, and clinical experience. As such, I owe a particular debt of gratitude to the faculty and residents of the San Antonio Uniformed Services Health Education Consortium (SAUSHEC) Ophthalmology Residency, San Antonio, Texas. Specifically, I am thankful for the contributions and review of the chapters by the

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xiv PREFACE

following ophthalmologists: R. Gary Lane, M.D., Charles Reilly, M.D., David E.E. Holck, M.D. (oculoplastics); Daniel A. Johnson, M.D. (cornea); Erin Doe, M.D. (glaucoma and lens); J. Brian Reed, M.D. (uveitis and retina); Martha Schatz, M.D. (neuro-ophthalmol- ogy); and Mary O’Hara, M.D. (pediatrics and strabismus).

In addition, I thank Emil Sauer, a talented Las Vegas artist, who illustrated most of the figures. Lastly, the grace of God and the love and patient support of my wife, Karen, receive the lion’s share of credit for making this work possible. I hope that you enjoy this book, and I welcome your comments or suggestions.

RANDALL L. GOODMAN, M.D.

Goodman, Ophtho Notes © 2003 Thieme

All rights reserved. Usage subject to terms and conditions of license.