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Welcome to the twelfth edition of Ophthalmology Lecture Notes! As in the past, our aim has been to make the diagnosis and management of eye disease a palatable process and once again we stress the value of a good history and careful clinical examination of the eye.

The eye is remarkably accessible. Optical and digital techniques continue to develop giving increasingly detailed access to the structures of the eye at cellular level. Specular microscopy can image the corneal endothelial cells which regulate corneal hydration and transparency; optical coherence tomography allows the layers of the retina to be dissected and recently allows the retinal vasculature to be imaged without the need for injection of fluorescein. Confocal microscopy provides a three-dimensional view of the optic nerve head. The shape of the cornea can be plotted digitally and, outside the globe, orbital structures and the visual pathway can be viewed by neuroimaging.

Therapeutically, lasers are used to relieve acute, angle closure glaucoma, to lower ocular pressure in chronic glaucoma, to open up an opaque lens capsule following cataract surgery and to seal retinal holes. They have an established role in reshaping the cornea to treat refractive errors of the eye and their role is now extending to use in cataract surgery itself. Sight-threatening diabetic retinopathy can be treated effectively by retinal photocoagulation, to remove the angiogenic stimulus to vasoproliferation. More recently, it has become possible to inhibit new vessel formation in diabetic retinopathy, macular degeneration and other retinal vascular disorders by intravitreal injections of antiangiogenic drugs. Roles for these drugs in treating oedema of the retina, see for example in diabetes, are also becoming established.

These techniques are matched by technological innovations in microsurgery, responsible for dramatic advances in cataract and vitreoretinal surgery. Optical function in cataract surgery is restored by insertion of a lens which unfolds within the eye. These are becoming increasingly complex allowing for the treatment of astigmatism and restoring near and distance vision in some patients without the need for glasses. Vitreoretinal surgery employs inert gases and silicone oil to flatten the detached retina and endoscopic probes which allow manipulations in the vitreous space and the dissection of microscopic membranes from the retinal surface. Glaucoma surgery is developing tiny drainage implants to reduce intraocular pressure.

Despite these advances, most ophthalmic diagnoses can still be made from a good history and clinical examination of the eye. This book aims to teach skills which will be useful to anyone engaged in medical practice. Many systemic disorders have ocular features which are critical in diagnosis. This book covers the ophthalmic features of systemic hypertension, diabetes, sarcoidosis, endocarditis, demyelinating disease and space-occupying lesions of the brain. It also explains how to recognize iritis, distinguish various forms of retinopathy and understand the difference between papilloedema and papillitis.

As in the eleventh edition, each chapter provides a set of learning objectives and a summary of key points, as well as bullet lists for emphasis. You can test your understanding with the questions and picture quizzes at the end of each chapter. In this edition, we have updated all the chapters and added to the extended matching questions (EMQs) and multiple choice questions to bring this small volume up to date.

Chapter 20 offers classical case histories, which will let you test your diagnostic skills. The final section of the book provides a list of further reading and the details of attractive websites which offer an expanded view of the speciality. Try some of these out.

We hope that you will have as much fun reading these Lecture Notes as we did putting them together.

Bruce James

Anthony Bron

Manoj V. Parulekar

This little guide does not presume to tell the medical student all that he needs to know about ophthalmology, for there are many larger books that do. But the medical curriculum becomes yearly more congested, while ophthalmology, still the ‘Cinderella’ of medicine, is generally left until the last, and only too readily goes by default. So it is to these harassed final-year students that the book is principally offered, in the sincere hope that they will find it useful; for nearly all eye diseases are recognized quite simply by their appearance, and a guide to ophthalmology need be little more than a gallery of pictures, linked by lecture notes.

My second excuse for publishing these lecture notes is a desire I have always had to escape from the traditional textbook presentation of ophthalmology as a string of small isolated diseases, with long unfamiliar names, and a host of eponyms. To the nineteenth-century empiricist, it seemed proper to classify a long succession of ocular structures, all of which emerged as isolated brackets for yet another sub-catalogue of small and equally isolated diseases. Surely it is time now to try and harness these miscellaneous ailments, not in terms of their diverse morphology, but in simpler clinical patterns; not as the microscopist lists them, but in the different ways that eye diseases present. For this, after all, is how the student will soon be meeting them.

I am well aware of the many inadequacies and omissions in this form of presentation, but if the belaboured student finds these lecture notes at least more readable, and therefore more memorable, than the prolix and time-honoured pattern, perhaps I will be justified.

Patrick Trevor-Roper

Numerous colleagues have provided valuable advice in their specialist areas, for which we are most grateful. The authors wish to thank Tom Meagher and Ramona Khooshabeh for providing additional pictures for the twelfth edition. Tom Butler provided substantial input to the chapter on clinical optics. We are particularly grateful to Professor Allen Foster at the London School of Hygiene and Tropical Medicine, who kindly provided the illustrations for the chapter on tropical ophthalmology. Richard James, Chris King and Ajay Mohite worked on the questions and assessments. Thanks are due also to Karen Moore and the staff at Wiley Blackwell for their encouragement, efficiency and patience during the production of this edition. We are also grateful to Shikha Pahuja and the copyediting team of Thomson Digital, for meticulous reading and production of the text.

Bruce James

Anthony Bron

Manoj V Parulekar

Don't forget to visit the companion website for this book:

www.lecturenoteseries.com/ophthalmology

There you will find valuable material designed to enhance your learning, including:

• Interactive MCQs
• Interactive EMQs
• Figures from the book

Scan this QR code to visit the companion website.