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.