Book reviews
ward rounds and clinical sessions. Perhaps Would you add to your clinical routine
the most serious competitors are those taking vaginal smears, anal accessed palpa-
downloadable to handheld personal tion for prostate cancer and taking blood
digital assistants, which also offer a wide and urine for laboratory analysis? Just how
range of additional functions accessed far would you extend the scope of your
through the hospital’s wireless web optometric practice? Should you restrict
service. Most hospitals have radio access to your investigations to the eye and the
the World Wide Web, on which there are visual system or take into your routine
numerous sites providing similar clinical examination procedures that involve diag-
information. There are also manuals that nosis of systemic diseases that can affect
can be stored on personal digital assistants the eye? Clinical Medicine in Optometric Prac-
that are far smaller than any hard copy tice issues a challenge that could raise a
manual and, in addition, provide many tsunami of wrath from the medical profes-
other useful functions. Perhaps, the fron- sion and leave most optometrists wonder-
tispiece quotation in Moorfields Manual ing why we might wish to go that far. The
regarding evolution is prophetic in that precept that ‘those who can, may’ would
modern technology may lead to Darwin- be taken to cosmic levels, if the informa-
ian extinction of hard-copy manuals tion contained in this book were to be
because of the longer survival of personal adopted by optometrists of most coun-
digital assistants. tries. There should be no dispute that
optometrists should determine our clini-
1. Hau S, Ehrlich D, Binstead K, Verma S. An cal routines but where should we draw
evaluation of optometrists’ ability to cor- the line of professional responsibility and
rectly identify and manage patients with
scope of optometric clinical practice?
ocular disease in the accident and emer-
gency department of an eye hospital. Br To be fair, the author makes few clear
J Ophthalmol 2007; 91:437–440. distinctions regarding what he designates
as part of his recommended optometric
field of clinical practice and what lies
beyond our purview and is for information
only. Examination techniques from head
to foot are outlined without suggesting
that they are outside our field. There is
one exception in the book, stating that
‘breast examination is not part of the
routine optometric examination’. It could
be argued that the information is provided
only to inform the optometrist of what
should be undertaken by medical practi-
tioners after our referral of a patient. It is
for the reader to decide how much of the
advice should be adopted but the preface
Clinical Medicine in to Clinical Medicine in Optometric Practice,
if indeed not the title itself, suggests a
Optometric Practice, seismic shift in attitude from that accepted
2nd edition by schools of optometry and practitioners
. in most countries. In clarification of the
intended purpose of the book, the preface
Bruce Muchnick states: ‘Part 1 discusses the medical diag-
USA: Elsevier, 2007 nostic armamentarium available to the
398 pages, RRP $130.00 optometrist, from physical diagnosis to
Reviewed by Dr DAVID M COCKBURN, laboratory testing and radiology’. Indeed,
Victorian College of Optometry, The this section explains the procedures men-
University of Melbourne, Australia tioned above and a great many more. Any
reasonable interpretation must be that
© 2008 The Authors Clinical and Experimental Optometry 91.5 September 2008
Journal compilation © 2008 Optometrists Association Australia
the author is suggesting that optometrists
undertake investigations, many of which
would be outside the usual scope of
practice of general medical practitioners
in Australia, New Zealand, Canada, the
United Kingdom and Asian countries.
These contentious aspects of the book
should not devalue the information it con-
tains. It is a remarkable contribution, par-
ticularly as it appears to be almost totally
the work of the author; no contributing
authors are acknowledged. It is well orga-
nised, well written and with the caveat that
this review ‘is within the limits of this
reviewer’s knowledge’, the field it covers is
topical and accurate. Those sections that
covered topics with which I was unfamiliar
enabled a painless basic understanding.
The book could satisfy the need of schools
of optometry in the teaching of clinical
skills as applied to general medicine.
Perhaps, it will encourage more emphasis
on the important areas of general medi-
cine that we already teach and apply but
often with no great emphasis. There must
be room for improvement in techniques
that are currently within our clinical
ambit, such as measuring blood pressure,
carotid auscultation, corneal foreign body
removal, blood glucose measurement and
the ability to provide cardio-pulmonary
resuscitation.
Clinical Medicine in Optometric Practice has
four parts beginning with Diagnostic Pro-
cedures, followed by Clinical Medicine in
Optometric Practice, The Eye in Systemic
Disease and concluding with three appen-
dices and an index. There is a bibliogra-
phy rather than a list of references at the
end of each chapter. This is a fault because
the reader is not able to verify statements
in the book other than to search and read
the entire list, with no certainty that veri-
fication is indeed included in this list. Any
future edition should provide annotated
references to ensure credibility.
There is no question of the target read-
ership of Appendix 3, as its title is ‘Injec-
tion techniques specifically tailored for
the optometrist’. It provides clear instruc-
tions on the technique with good sup-
porting illustrations that would guide its
safe and effective application. There is a
written description of collection of venous
495
Book reviews
blood for analysis in Chapter 4 but unfor-
tunately, this is not similarly supported by
illustration of the technique. It might be
acceptable for suitably trained optom-
etrists to carry out these invasive proce-
dures in a hospital setting but it is difficult
to argue that they should be part of the
routine in private practice. Of course
about 60 years ago, it would have been
a heresy to suggest that nurses or ambu-
lance paramedics could carry out these
procedures or even that optometrists
should measure intraocular pressure but
despite the virulent opposition of the
medical profession at the time, it is clear
that given training, these professionals can
perform many invasive medical proce-
dures as well as, and dare we say some-
times more effectively than, many medical
practitioners.
Appendices 1 and 2 are possibly the
most valuable and certainly the least politi-
cally contentious sections of the book.
Appendix 1 is a table showing the systemic
actions of ocular medications, their side
effects and the clinical signs of these com-
plications. Appendix 2 is a table of the
ocular manifestations of systemic medica-
tions, together with their actions and side
effects. These and other tables in the main
text are compact and accessible sources
of information for the busy clinician.
I found this book very useful and
well-presented, covering the somewhat
neglected field of teaching of general
medicine in optometric courses and it
deserves a place in the library of every
school of optometry. How far the profes-
sion might wish to push the boundaries of
practice is an evolving process and in this
respect Clinical Medicine for Optometric Prac-
tice might simply be ahead of its time and
be providing us with a glimpse of the
future. Its shortcoming is that it appears
to advocate that optometrists extend their
clinical procedures into areas that are
presently far in advance of the current
optometric training in most undergradu-
ate courses. Clinical education and super-
vised experience form the essential basis
of any extension of optometric practice
and then only if it is in the direction that
the profession is willing to travel. There is
also the real risk of causing apoplectic
Clinical and Experimental Optometry 91.5 September 2008
496
shock in some medical and particularly
ophthalmological circles.
Clinical Procedures in
Primary Eye Care,
3rd edition
David B Elliott
Edinburgh, Butterworth Heinemann
Elsevier, 2007
342 pages, RRP $120.00
Reviewed by Dr BARBARA M
JUNGHANS, School of Optometry and
Vision Science, University of New South
Wales, Australia
When being introduced to complex tasks
everyone loves a recipe but approaching
primary-care optometry by simply using
a recipe is, pardon the pun, a recipe
for disaster. Nonetheless, to get started,
there are many recipe books on clinical
procedures in optometry. A decade ago,
David Elliott launched his first book on
primary eye care procedures as a recipe
book with the addition of helpful intro-
ductory blurbs for each procedure, practi-
cal tips woven into each recipe, relevant
comments on interpretation of results,
common errors in execution or interpre-
tation, and finally, useful references. The
second edition saw considerable change in
presentation but readers could easily lose
track of where they were in the greater
scheme of things, given the single-column
format, large type, poor differentiation of
Journal compilation © 2008 Optometrists Association Australia
headings and lengthy lists of procedural
steps enclosed in ‘boxes’ running over
several pages. Happily, the third edition
has resolved all these issues: a two-column
format, smaller type, plus use of tonal
variations of a single colour to differenti-
ate heading hierarchy and emphasise
important aspects of diagrams all contrib-
ute to making reading easier. The chapter
on refraction is also back in its original
and more appropriate place preceding
the evaluation of binocular vision.
There are two major differentiating fea-
tures for this new edition that push this
book far from being simply a recipe book.
First, David Elliott and the six contributing
authors have fully embraced the new
‘evidence-based’ approach to health care
and, wherever possible, argued the case
for inclusion of any procedures in the
optometric armoury through appropriate
citation of the literature. Second, the text
integrates with Elsevier’s online ‘Learning
Management System’ through the Evolve
website. The text is appropriately anno-
tated with a laptop icon indicating when-
ever the reader should view an associated
online video or colour photograph. Both
instructor and student can access various
online resources, such as an image collec-
tion, videos and downloads, either directly
through the Elsevier site or via virtual
classroom software, such as Blackboard.
The videos are generally well done,
though some lack a commentary and
others would benefit from the addition of
arrows and other supplementary markings
or closer views of the patient. The first
print run of the third edition of Clinical
Procedures in Primary Eye Care omitted any
mention of the URL to Evolve throughout
the text, which left the naïve reader who is
unfamiliar with the ‘Evolve’ logo none-
the-wiser until seeing the URL listed on
the bottom line of the back cover. The
author assures me that this will be rectified
in subsequent print runs. Other useful
inclusions in the latest edition are good
quality colour plates and a chapter on pro-
cedures relating to physical examination,
such as palpating lymph nodes and carotid
pulse auscultation with stethoscope.
The target audience for this book is
clearly the student of optometry; on
© 2008 The Authors