Clinical Ocular Toxicology: Drug-Induced Ocular Side Effects (2009)

Clinical Ocular Toxicology:Drug-Induced Ocular Side Effects Frederick T. Fraunfelder, Frederick W. Fraunfelder, and Wiley A. Chambers. Philadelphia, PA: Saunders Elsevier; 2008. $149.00.FigureI pulled from my bookshelf the first edition (1976) copy of “Drug-Induced Ocular Side Effects,” the forerunner of “Clinical Ocular Toxicology.” The current book represents a retitled and substantive revision of the fifth edition of “Drug-Induced Ocular Side Effects,” and readers will note major advances and improvements in both the book’s presentation and content. Unlike previous editions, “Clinical Ocular Toxicology” has incorporated full-color photographs and illustrations, well-prepared summary tables, and new indexing formats, which make this book considerably more useful than its predecessors. The authors have also expanded the clinical sections to incorporate specific recommendations to clinicians on how to follow and manage patients taking various medications. In this new edition, there are five new chapters that discuss, in general terms, some of the scientific underpinnings of ocular toxicology. Readers will particularly welcome the addition of the World Health Organization (WHO) classification system, which addresses the probability of adverse drug events being actually related to the medication in question. These events are given the descriptors “certain,” “probable/likely,” “possible,” “unlikely,” “conditional/unclassified,” or “unassessible/unclassifiable.” These classifications greatly assist the clinician in understanding just how probable it is that an encountered ocular event is actually related to the medication. The book begins with a broad overview of pharmacotherapeutic principles, followed by a discussion of ocular drug delivery as related to adverse events (toxicology). Methods for evaluating drug-induced visual side effects are covered rather superficially, whereas the role of electrophysiology and psychophysics in ocular toxicology is discussed in great detail. The reporting of suspected drug reactions is covered, with emphasis given to the National Registry of Drug-Induced Ocular Side Effects. The Food and Drug Administartion’s Medwatch program, as well as reporting mechanisms of the Uppsala Monitoring Center, a branch of the WHO, are also described. As in previous editions, the bulk of the text consists of listing and discussing actual or suspected drug-induced ocular side effects. There are approximately 240 pages that consider virtually every class of pharmacologic agent, including anti-infectives, agents affecting the central nervous system, analgesics, anesthetics, cardiac agents, hormones, agents used to treat neuromuscular disorders, antineoplastic agents, heavy metal antagonists, and drugs used in ophthalmic practice. Two additional chapters address chemically induced ocular side effects and adverse events induced by herbal medicines and dietary supplements. As in previous editions, a systematic format is used in each section: therapeutic class, generic name, proprietary name, ocular side effects, systemic side effects, WHO classification system, clinical significance, references, and management recommendations. This new edition has many strengths that make it particularly attractive to the practicing clinician. Numerous full-color clinical photographs have been incorporated to depict classic presentations of ocular side effects. The reader will also find a useful index of side effects that is color coded according to the WHO classification system. Because the index is arranged by side effect, the reader can easily identify medications that could possibly be implicated in the adverse event. This book has a few weaknesses. I noticed a number of pixilated illustrations of poor quality, such as the figure of ethambutol- induced optic atrophy on page 80 and the fluorescein angiography of amikacin retinal toxicity on page 50. I also noted several misspelled drug names and numerous instances of inattentive copy editing/proofreading, which are minor but, nevertheless, annoying in a book of this significance and stature. Moreover, there is an inconsistency between the recommendation on frequency of eye examinations for patients taking hydroxychloroquine and the reference given for that recommendation. The reference suggests annual visits for high-risk patients, whereas the chapter text suggests eye examinations more than once a year. Surprisingly, I could find no discussion on talc retinopathy. Despite some of the aforementioned shortcomings, I believe this book represents an outstanding compilation and the most comprehensive and scientifically defensible treatise on how medications can adversely affect the eye. Because it covers traditional medicines as well as chemicals and herbs, this edition should be readily useful to the optometry student and ophthalmology resident, who are learning this material for the first time, as well as for the practicing optometrist and ophthalmologist, who may encounter patients who are sustaining well-known or rare adverse events. This book is an excellent resource for identifying such drug-induced reactions and managing patients consistent with current standards of care. Jimmy D. Bartlett School of Optometry University of Alabama at Birmingham Birmingham, Alabama