Book Review

The Retina Atlas

N Engl J Med 1996; 334:1551-1552June 6, 1996

Article

The Retina Atlas
By Lawrence A. Yannuzzi, David R. Guyer, and W. Richard Green. 782 pp., illustrated. St. Louis, Mosby, 1995. $255. ISBN: 0-8151-3432-0

The Retina Atlas confirms the adage that a picture is worth a thousand words. This remarkable textbook has relatively few words but nearly 1700 beautiful color pictures, illustrating an array of disorders that can affect the retina. Retinal disease is a perfect subject for such a book; ophthalmologists have the unique opportunity to view internal structures by noninvasive means, and the visualized patterns of disease often permit a precise diagnosis on clinical grounds alone.

This atlas was designed to complement the three-volume textbook Retina (edited by Stephen J. Ryan. St. Louis: Mosby, 1989), which many believe to be the definitive general reference work on retinal disorders. Although the two can be used independently, the atlas follows the order and organization of the chapters in Retina that are devoted to medical disorders. (Surgical disorders, such as retinal detachments, are not covered.) The atlas provides additional illustrations not found in Retina (which contains no color illustrations), and one can easily turn to Retina for an in-depth discussion of the disorders pictured in the atlas.

The 782-page atlas contains 70 chapters covering retinal degenerations, cancers, vascular disorders, and certain injuries (e.g., toxic effects of drugs and light-induced damage). The longest section (21 chapters) is devoted to infectious diseases and other inflammatory conditions. A final section illustrates optic-nerve disorders.

Each chapter contains an introductory paragraph and a suggested reading list. Otherwise, they consist entirely of photographs and figure legends. The introductory material is not meant to be comprehensive, and uninformed readers could not use it to gain an understanding of the diseases. The reading lists, generally containing less than a dozen publications, are an eclectic mix of old and new, including case reports and descriptions of treatment. The reader is much better served by the longer, comprehensive lists in the corresponding chapters in Retina.

In contrast to the written material, the photographs present a wealth of information. Besides those from the authors' own collections, numerous photographs are contributed by other experts, ensuring that the very best illustrations of each disease are presented. The vast majority are of excellent quality, and even the less-than-perfect pictures are instructive because of the unique features they display.

The photographs in the atlas generally illustrate the characteristic features of a disease. Atypical or rare forms of disease are not always shown. Many montages are included, showing the extent of lesions throughout the fundus. There are photographs before and after treatment, but I would also have liked to see more serial photographs illustrating the natural history of disease. The micrographs provide important clinicopathological correlations. In addition, there is good use of selected fluorescein angiograms, as well as a few radiographs and ocular ultrasonograms, to highlight features of disease. Just for fun, there is a picture of Mount Everest in the chapter on high-altitude retinopathy, but for the most part subjects other than eyes, such as skin lesions or laboratory preparations, are used infrequently and judiciously.

The brief figure legends give the reader little help in interpreting the findings. Relatively few illustrations, for example, have arrows pointing to the signs mentioned in the legend. The reader must understand fundus anatomy and be able to recognize nonspecific processes (such as choroidal infiltration, cotton-wool spots, and macular edema). For selected fundus photographs and micrographs, however, there are corresponding line drawings that help orient the reader to subtle features.

Undoubtedly, many ophthalmologists will use The Retina Atlas often in the course of patient care, for teaching, and simply because of the fascinating spectrum of diseases it illustrates. Nonophthalmologists can also marvel at the diversity of clinical disorders, but the atlas will probably not be particularly useful to them in evaluating patients. Most of the photographs correspond to the views one might have with the indirect ophthalmoscope, and I suspect that it would be difficult for nonophthalmologists, even those who routinely examine the fundus, to reconcile these illustrations with what they see through the hand-held direct ophthalmoscope, which covers a much smaller area of the fundus at greater magnification. For the ophthalmologists, however, the authors have created an important resource.

Gary N. Holland, M.D.
UCLA School of Medicine, Los Angeles, CA 90095