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Clinical Cases in Contact Lenses.

Bergenske, Peter

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Optometry and Vision Science: September 2002 - Volume 79 - Issue 9 - p 562
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Clinical Cases in Contact Lenses. Ronald K. Watanabe. Boston: Butterworth-Heinemann, 2002. Pages: 232. Price: $44.99. ISBN: 0-7506-9044-5.

I keep a book by my backyard window that is a guide to the most common birds in my part of the country. Once in a while, I have a feathered visitor that I don’t recognize. The book is organized by color and size, so I can quickly identify the bird using the illustrations and description of markings. The discussion in the book is brief, but it really gives me what I need to know to identify and perhaps attract that species.

Clinical Cases in Contact Lenses provides a collection of case examples of numerous contact lens challenges that the practitioner needs to be able to quickly identify and solve. Each problem is illustrated by presentation of a representative case and illuminated by discussion of approaches to resolution of the problem. It is a “field guide” for contact lens problem solving.

The cases are arranged by area of emphasis: fitting dilemmas and complexities, optical problems, fit induced complications, and specialty fitting dilemmas. The title of each case states the problem to be discussed, so the index of the book provides a quick reference list that the reader may use to go directly to the case examples most likely to aid in solving a presenting problem

Each case presents the reader with a list of differential diagnoses for the case before giving the actual diagnosis and management for that case. The discussion that follows offers a concise but thorough discussion of the various possible approaches to the type of case that is represented. As an example, a case entitled “Poor Vision with a Toric Soft Lens” presents a case example and describes steps taken to resolve the particular case. It then goes into a thorough discussion of the various reasons for poor vision with a toric soft lens and describes approaches to each of these.

The list of differential diagnoses and the discussions are particularly valuable because there can be many reasons for any of the presenting problems, yet the case itself illustrates only one. For instance, “Redness with Rigid Gas Permeable Lenses” can be caused by any of, or a combination of, factors. Although the case example is one of desiccation, the differential and discussion sections go through the possibilities of abrasion, solution reaction, as well as allergic, viral, and giant papillary conjunctivitis. This is potentially of great value to a fitter faced with uncertainty in how to approach a patient presenting with this problem.

This is a book that will be of great help to the novice contact lens practitioner because it provides a quick reference to many of the most common and not so common contact lens problems that need to be solved for patients to be successful. More experienced practitioners will also find the cases interesting and helpful. The cases run the gamut from blurred vision that turns out to be caused by switched lenses to pain and redness caused by microbial keratitis. Each case has either a color photo or topography that helps to bring the example to life.

Like my bird guide, this is not a book that one is likely to read start to finish. Its place is that of a reference guide for clinical problem solving. I shared the copy that was sent to me with a number of my about-to-graduate optometry students. They expressed great interest in such a reference at this point in their careers, where their confidence and experience become challenged when they encounter problem cases. Realizing that in a matter of months they won’t have an instructor in the room or down the hall to guide them, such a book has great appeal.

The author and his contributing authors should be congratulated on this contribution to clinical teaching. It is well written, illustrated, and referenced. Certainly, it does not illustrate every possible contact lens complication, but neither does my bird book have every species on the planet. I particularly recommend Clinical Cases in Contact Lenses for students and new practitioners or for any contact lens fitter looking for a clinically useful reference on problem solving.


© 2002 American Academy of Optometry