Book Review

Retinal Vascular Disease

N Engl J Med 2008; 358:1765-1766April 17, 2008

Article

Retinal Vascular Disease
Edited by Antonia M. Joussen, Thomas W. Gardner, Bernd Kirchhof, and Stephen J. Ryan. 778 pp., illustrated. Berlin, Springer, 2007. $169. ISBN: 978-3-540-29541-9

Retinal vascular diseases are leading causes of impaired vision and blindness worldwide. Consider that diabetes mellitus, an important cause of vision impairment, afflicts millions of people in the United States and is on the rise in developing countries. But diabetes is not the only condition that affects retinal vessels. Diseases ranging from Terson's syndrome (vitreous hemorrhage secondary to subarachnoid or subdural hemorrhage), to sickle cell anemia and its attendant retinal vascular lesions, to retinal vascular tumors are covered in Retinal Vascular Disease.

In this well-organized textbook, the authors start with a detailed review of the current basic science of retinal vessel development and pathology. The foreword written by Judah Folkman, a pioneering researcher on vascular endothelial growth factor (VEGF) who died recently, is especially poignant. VEGF is an underpinning to virtually all conditions in which neovascularization occurs (any of the ischemic retinopathies, such as diabetic and sickle cell retinopathy). Targets to VEGF receptors have led to important advances in the management of most neovascular eye diseases. Diabetic retinopathy and age-related maculopathy can now often be contained, if not cured. The research of Folkman and Lois Smith, a contributing author to this book, may help to shed light on one of the most vexing and important causes of pediatric blindness, retinopathy of prematurity.

Each chapter offers bullet points and outlines and is organized concisely by specific topic. This is especially useful for the busy practitioner. If a physician is treating a patient with possible Norrie's disease, for example, the physician can find a short and thorough description of its pathogenesis, diagnosis, and treatment. The reader can return to the outline to quickly review the chapter's main points. The index is thorough, and the contributing authors are experts in their respective fields. The chapters on diabetic retinopathy are as thorough as any available.

Most chapters contain sections on possible future treatments for retinal vascular diseases. These brief discussions could have come across as speculative, but instead they are evidence-based and helpful. The application of the results of molecular research to the prevention and treatment of retinal disease requires creativity and imagination. To read about the hopes of experts for gene-targeted therapies, molecular interventions, and new drug therapies is interesting. These sections also lend a note of optimism to the book. Clinical care for patients with retinal vascular diseases will continue to improve in the foreseeable future.

One particular chapter — on ocular coherence tomography — stands out. For readers who have not kept abreast of advances in ophthalmology, this chapter is essential reading. The diagnostic technique of ocular coherence tomography offers detail that is as precise as that offered by histology. Intraretinal cysts, layers of retina, and retinal blood vessels can be viewed at a cellular level. The illustrations included in this chapter are fascinating.

This is a book for ophthalmologists and nonophthalmologists alike. With 565 figures, and notations that clarify the terminology of ophthalmology, Retinal Vascular Disease offers information to readers who do not have training in ophthalmology but are curious about a particular patient or condition. The editors' disclaimer in the foreword — that it is impossible to publish a book that is completely current — is largely unwarranted. This text is as up to date as possible in both its clinical and its basic science reviews.

William V. Good, M.D.
Smith–Kettlewell Eye Research Institute, San Francisco, CA 94115
good@ski.org