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Introduction

I love practicing pediatric ophthalmology, but I admit that we ophthalmologists often do not do a very good job of teaching others about our specialty. The reasons (excuses?) for this are twofold. First, there is an increasing time crunch during medical education, with students expected to master an ever-expanding body of knowledge. Unfortunately something has to give, and often that means students get little, if any, exposure to ophthalmology. Second, ophthalmology is a very specialized area. Learning to use even basic ophthalmic examination equipment, such as the direct ophthalmoscope, takes time and practice. Mastering more specialized equipment, such as the slit lamp and indirect ophthalmoscope, usually requires several months. In addition, the language, abbreviations, and notations that ophthalmologists use are arcane, such that an ophthalmology note often looks like it's written in hieroglyphics.

I have had the good fortune to do residencies and become board-certified in both pediatrics and ophthalmology, so I have firsthand experience with both sides of this knowledge gap. This book sprang from a desire to narrow that gap. The basic idea was based on this question: if I were practicing pediatrics and could have only one pediatric ophthalmology book on my shelf, what would it be? Most currently available pediatric ophthalmology books are either relatively short guides that cover the basics, or detailed texts designed for pediatric ophthalmologists. This book attempts to strike a balance between these two.

The book is divided into three parts:

• The first section (Evaluation of the Eye: Chapters 1 and 2) deals with the evaluation of pediatric ophthalmology patients. The first chapter describes the examination. It is divided into a section on the eye examination for pediatricians and a section on the techniques and instruments used by pediatric ophthalmologists. The second chapter describes ancillary tests used for evaluation of pediatric eye disorders.
• The next section (Symptoms: Chapters 3 to 23) provides a straightforward, focused, how-to approach based on specific clinical problems. This is the part of the book that can be taken off the shelf and used quickly when evaluating a patient in the office.
• The third section (Diseases: Chapters 24 to 34) is written in the style of a traditional medical textbook, based on diseases affecting different parts of the eye. It provides more detailed information than the second section, but not the voluminous amount found in textbooks written specifically for pediatric ophthalmologists.

The recommended evaluation and management of problems described in this book is based on a combination of personal experience and, when available, evidence-based medicine. Many medical problems can be addressed effectively in more than one way, and there are other acceptable approaches to many of these conditions. If possible, I recommend that you establish a relationship with a pediatric ophthalmologist, someone you can contact when you have questions or need a patient seen quickly. Together you can develop a plan for caring for your patients who have eye problems.

Finally, life is a work in progress. If you have any suggestions or recommendations for making this book better, please let me know.

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