Fundoscopy Made Easy

The authors of Fundoscopy Made Easy are Sujoy Gosh, a Clinical Teaching and Research Fellow, Andrew Collier, Honorary Senior Lecturer and Consultant Physician, and Mohan Varikkara, Con sultant Ophthalmologist, all at The Ayr Hospital, Ayr, UK, whilst Stephen Palmer is Head of the Department, Medical Photography and Audiovisual Services, NHS Ayrshire & Arran, UK. This publication is a concise, pocketsized reference book of 111 pages. It has been designed to provide basic knowledge of fundal examination and fundal image interpretation in an easily-consumable format. It is aimed at medical students and junior doctors, doctors who are preparing for examinations including the MRCP, optometrists and medical photographers. It sets out, not to offer an alternative to conventional textbooks or ophthalmological opinion, but to provide enough information to help identify or diagnose the most common retinal abnormalities. The fi rst chapter introduces the prin ciples and methods of direct and indirect ophthalmoscopy in a simple, straightforward way. The section on direct ophthalmoscopy provides the reader with a step-by-step approach which should, when followed, result in a good basic examination. Binocular indirect ophthalmoscopy and slit lamp biomicroscopy are covered much more briefl y. I feel that as the latter is currently the method of choice for detailed fundal examination in ophthalmology clinics and in the majority of optometry practices, a more detailed coverage would be helpful. The second chapter gives an insight into the more specialised examination techniques of fundal fl uorescein angiography, indocyanine green angiography and optical coherence tomography. Images of using these techniques are included to illustrate their advantages. Digital fundal photography has become commonplace in optometric practice and optical coherence tomography is becoming much more widely used in that environment. Chapter three gives a good description of the normal fundus, with good supporting photographs to aid the reader. The following sixteen chapters cover the more common fundal conditions. The majority of these conditions are covered by a good written description of the presentation and explanation of the condition. The photographs illustrate the conditions particularly well. The chapter on diabetic retinopathy has a good explanation of the condition and description of the range of presentations. The grading systems were well explained and the supporting photographs very useful. Laser photocoagulation treatment is explained and demonstrated in photographs which show how the ‘ spot ’ sizes of the newer treatment are much smaller than those seen in cases treated a number of years ago. The only chapter which I felt was too briefl y covered was the one on glaucoma, which contained only one photograph and less than a single page of text. As the condition needs diagnosing as early as possible to prevent visual fi eld loss, I feel that a wider range of magnifi ed optic disc photographs showing details of early glaucomatous disc changes (notching, etc.) should have been included. A photographic series showing cup-to-disc ratios from 0.1 to 0.9 would help those who are new to fundal examination. Overall, this is a good, pocket-sized book for those who need to master the art of fundoscopy. It accomplishes what the authors set out to provide, and will serve as a good primer for those who need to aquire this skill. It prepares the ground for ‘ not-so-pocket-sized ’ tomes that are needed to expand basic knowledge, such as the fundal atlases of Kanski or Spalton which provide deeper and broader knowledge of the presentations encountered in everyday ophthalmic practice (ophthalmological and optometric). I liked the fact that the book highlights the place for direct ophthalmoscopy in everyday medical practice. I still fi nd direct ophthalmoscopy a good starting point in an examination as it gives a good overall view of the eye from cornea to fundus. It serves as a springboard to the other techniques available, namely, binocular indirect ophthalmoscopy, slit lamp bio microscopy, fundus photography and optical coherence tomography.