Oxford Handbook of Ophthalmology

1108 Pages·2014·14.88 MB·English

by  Alastair Denniston

OXFORD MEDICAL PUBLICATIONS
Oxford Handbook of
Ophthalmology
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Oxford Handbook of
Ophthalmology
Third edition
Alastair K.O. Denniston
Consultant Ophthalmologist
& Honorary Senior Lecturer
Queen Elizabeth Hospital Birmingham
University Hospitals Birmingham NHSFT
& University of Birmingham, UK
Philip I. Murray
Professor of Ophthalmology
& Honorary Consultant Ophthalmologist
University of Birmingham
& Birmingham & Midland Eye Centre
Sandwell & West Birmingham Hospitals NHS Trust, UK
1
3
Great Clarendon Street, Oxford, OX2 6DP,
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First edition published 2006
Second edition published 2009
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v
Foreword
It is my great pleasure to write the foreword for this third edition of the
Oxford Handbook of Ophthalmology by Alastair Denniston and Phil Murray.
From the outset, the handbook has been closely aligned to the needs of
trainees who have delighted in its ubiquitous support in clinic, theatre, and
casualty, and for its help in preparing for postgraduate exams. It has also
become popular with senior ophthalmologists who want a portable ‘vade
mecum’ for those times when they have to stray outside their subspecialty.
Although small in dimensions, it is quite remarkable how much is contained
within it. With its standardized format and pithy style of writing, informa-
tion is easily navigated, accessed, and remembered.
This new edition is completely revised and updated to reflect the exciting
advances in knowledge and treatments of the last few years. In addition, as
subspecialization continues to grow, so has the authorship team. Alastair
Denniston and Phil Murray have assembled an excellent team across all spe-
cialties, comprising established clinical leaders, balanced by senior trainees,
to ensure that the text is up to the minute and relevant. The scope of the
book continues to impress, with advances in medical retina and refractive
surgery rubbing shoulders with new sections on patient-reported outcome
measures and Bayesian statistics. New trainees may also be particularly
pleased to welcome a new chapter ‘Theatre notes’ which will help them
navigate theatre with greater confidence, correctly identifying surgical
instruments and understanding issues around sterilization and so on.
I hope this new edition of the handbook will continue to help you to
improve the care of your patients. The patient remains at the heart of all we
do. Lists are more than just a way to pass examinations—they help to make
us think around diagnoses and management, and they will help to ensure
we do not miss something that may be sight- or even life-threatening to our
patients. The Oxford Handbook of Ophthalmology continues to demonstrate
its essential place among the books that help us all learn, enjoy, and deliver
the wonderful specialty that is ophthalmology.
Sir Peng Tee Khaw
Professor & Consultant Ophthalmic Surgeon,
Director, National Institute for Health Research Biomedical Research
Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology,
London 204
vi
Preface to the
third edition
This is surely the most exciting time to be involved in the care of patients
with eye disease. Our understanding of ocular pathology is increasing expo-
nentially; our treatment options are multiplying faster than ever before, and
the sophistication and specificity of some investigative tools and treatments
are quite breathtaking. Now is also a period of great hope for our patients,
as they continue to benefit from the success stories of the last decade (such
as anti-VEGF therapies for neovascular age-related macular degeneration
and other retinal diseases) and become increasingly aware of the dawn of
gene therapy, cell-based therapies, and personalized medicine.
There are, however, two occasions when an ophthalmologist may have
cause to regret this explosion of knowledge: first, in their youth as they have
to hurdle an apparently never-ending succession of exams; and second, in
their old(er) age when they have the equally challenging task of distilling all
that knowledge into a single lucid volume of text. It is our great privilege—
on behalf of a wonderful team of authors—to present to you this third
edition of the best-selling Oxford Handbook of Ophthalmology. We trust that
this edition will continue to provide you with knowledge—that essential
information you need in an easily accessible format—but also that it may
inspire you as you care for patients suffering from ophthalmic disease.
AKOD, PIM
204
vii
Preface to the first
edition
Welcome to the first edition of the Oxford Handbook of Ophthalmology.
The aspiration of the OHO is to be your portable repository of knowl-
edge, accessible in emergencies and easily dipped in and out of between
examining patients. It provides immediate access to the detailed clinical
information you need—in casualty, clinic, theatre, and on the wards. It is
also highly suitable for revision for postgraduate examinations. It is not
exhaustive, and we would expect it to complement, rather than replace,
your collection of desktop ophthalmology heavyweights.
The core of the book comprises a systematic synopsis of ophthalmic dis-
ease directed towards diagnosis, interim assessment, and ongoing manage-
ment. Assessment boxes for common clinical conditions and algorithms for
important clinical presentations illustrate this practical approach. The infor-
mation is easily accessed, being presented in standard format with areas
of importance being highlighted. Key sections for the trainee include: clini-
cal skills, aids to diagnosis, and investigations and their interpretation. Basic
perioperative care and advanced life support protocols are included, since
specialists often find their general medical knowledge somewhat hazy at
times of crisis.
Primarily intended for ophthalmologists, this handbook is a valuable
resource for anyone working with ophthalmic patients, whether optom-
etrists, orthoptists, ophthalmic nurses, or other health professionals in oph-
thalmology. Whilst the earlier pages may be thumbed mainly by the trainee,
it is envisaged that even the experienced consultant will find the OHO use-
ful. We have tried to include information that you would not easily find
elsewhere: vision in context (low vision, registration and benefits, driving
requirements), management of systemic disease (diabetes, thyroid disor-
ders, systemic immunosuppression), a glossary of eponymous syndromes,
and NICE and RCOphth guidelines.
Although we have endeavoured to provide up-to-date, accurate,
evidence-based information, any comments would be gratefully received
so that we can make future editions even better. Point your web browser
to: M http://www.oup.co.uk/academic/medicine/handbooks, where you
will be able to have your say and to download any updates.
We hope the OHO will be an essential addition to your personal library
of ophthalmology textbooks and be an invaluable companion to you in your
practice of ophthalmology.
Alastair K.O. Denniston, Philip I. Murray
2006
viii
Acknowledgements
As authors and editors of this book, we are privileged to coordinate a won-
derful team of ophthalmologists, orthoptists, optometrists, visual scientists,
ophthalmic technicians, and other professionals who care for people with
eye disease. These people are not only experts in their fields but are pas-
sionate about ensuring that this wisdom is passed on to the rest of us.
These authors continue to distil the complexities of their subspecialties in a
way that is concise, clear, memorable, and easily applied in clinic, theatre, or
eye casualty. We are deeply indebted to them, and the junior authors who
assisted them, for all their hard work.
There are also many senior ophthalmologists who, like us, can measure
the passage of the years by their contributions to successive editions of
this handbook. Significant contributors to previous editions include: Miss
Susan Mollan, Mr Arun Reginald, Mr Geraint Williams, Mr Paul Tomlins,
Mr Anil Arilakatti, Miss Rosemary Robinson, Mr Paul Chell, Miss Monique
Hope-Ross, Mr Graham Kirkby, Miss Fiona Dean, Prof Sunil Shah, Mrs
Waheeda Illahi, Mr Mike Burdon, Sonal Rughani, Mr Vijay Savant, Mr Sumit
Dhingra, Mr Rajen Gupta, Mr Joseph Abbott, Mr James iDOC Cameron,
Mr James Flint, Mr Tahir Masoud, and Mr David Lockington. We also thank
Rizwana Siddiqui, Musarrat Allie, and Dr Peter Good for images. We are
grateful to Angela Luck for yet more beautiful anatomical illustrations and
her ongoing appreciation of the artistic merits of the slit-lamp. Additionally,
new for this edition, we thank Altomed and John Weiss for kindly giving us
permission to include images of their surgical instruments, and to Paul Sims
of Action for Blind People for his valuable input to the ‘Vision in context’
chapter.
It has been a great pleasure to work with the staff of OUP throughout.
We thank Kate Smith, Elizabeth Reeve, Michael Hawkes, Beth Womack,
and Anna Winstanley for their enthusiasm and practical assistance.
AD wishes to thank his wife (Sarah) and his two boys (Arran and Ewan)
for their critical assessment of this work and allowing the evolving manu-
script to join us for almost all of our holidays. He also wishes to thank
his clinical mentors (Marie Tsaloumas, Andrew Dick, Phil Murray) for their
ongoing advice and encouragement.
PIM wishes to thank his family (Tricia, Hannah, Ella) for trying to keep out
of his way while attempting to write this book. He is grateful to Out of the
Blue Jazz Orchestra and The Soul Providers for almost keeping him sane
and thanks his local garage who keeps his 997 Porsche 993 Targa (which
he may have reluctantly sold by the time this edition hits the shelves) on the
road—except in the snow and ice. He also thanks Birmingham public trans-
port and all the colleagues who have given him lifts to and from work. He
does not wish to thank Brentford FC who seem only capable of scoring or
letting in goals in the 95th minute and their abject failure in taking penalties.
AKOD, PIM, 204
ACKNOWLEDGEMENTS ix
Additional acknowledgements
We are indebted to a number of colleagues from across the UK and the
rest of the world who have given us invaluable feedback which has helped
direct the development of successive editions. We thank: Mr Ajay Tyagi,
Mr Sam Elsherbiny, Mr Sam Mirza, Mr Velota Sung, Dr Zakaria, Dr Hannah
Baker, Mr Maged Nessim, Dr Imran Khan, Dr Anna Gao, Miss Lei Liu,
Mr Nachiketa Acharya, Mr James Denniston, Dr Estelle Manson-Whitton,
Mr Ali Bell, Dr Ed Moran, Miss Vaneeta Sood, Miss Anne Williams, Miss
Katya Tambe, Dr Liz Justice, Mr Imran Masood, Mr Pravin Pandey, Miss
Dipti Trivedi, and Mr Richard Lee.