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Doody's Review ServiceReviewer: Ashley Rohr, MD (University of Chicago Medical Center)
Description: This is an update of a book first published in 2006 that demonstrates the algorithm used in the U.K. for retinal screening by correlating colored fundus photographs and descriptions with the retinopathy grading system used by the English National Retinopathy Screening program. It also provides background information on diabetic eye complications in addition to describing key studies in the literature that demonstrate the importance of screening and maintaining intensive blood glucose control to help prevent such complications.
Purpose: The purpose is to illustrate the diabetic retinopathy grading system used by retinal screeners in the U.K., and to provide information on treatment and when referral to an ophthalmologist is necessary. According to the authors, this book can also be used by those preparing to achieve a Diploma in Retinal Screening in the U.K. Retinal screeners are those who analyze colored fundus photographs to determine if referral to an ophthalmologist is necessary based on the grade of retinopathy. These are worthy objectives for physicians and potential retinal screeners in the U.K., but they are less applicable in the U.S. and other countries that do not use retinal screeners, but instead refer all patients to ophthalmologists for a complete ophthalmologic exam. Overall, the book meets the authors' objectives by providing colored fundus photographs with detailed descriptions and explanations as to the grade of retinopathy and when referral for treatment is indicated.
Audience: This is intended for those interested in becoming retinal screeners in the U.K., as well as physicians specializing in diabetic management and ophthalmologists. In my opinion, it is geared more towards those who are interested in achieving the diploma in retinal screening because the focus is mainly on describing fundus photographs and when to refer to an ophthalmologist, not on the complete ophthalmologic exam including indirect fundoscopy and other ancillary testing briefly described in the book, such as OCT. There is only brief mention of treatments for diabetic retinopathy and macular edema, which would be of interest to ophthalmologists. The photographs are useful to beginning ophthalmologists because of the detailed descriptions. The authors include a professor of medicine at Newcastle University and a quality assurance manager for a retinal screening service. Although they are credible authorities, I would've expected an ophthalmologist to be involved as well.
Features: The handbook provides background information on type 1 and 2 diabetes, exam findings of different stages of diabetic retinopathy, literature supporting the need for screening eye exams and good blood glucose control, methods of screening performed in the U.K. including the retinopathy grading system, and then examples of colored fundus photographs with descriptions and correlation with the grading system. The best part and most unique feature of this book is the use of colored fundus photographs with detailed descriptions and explanations why the findings correlate with a particular grade of retinopathy, which makes the information easy to comprehend. The major shortcoming is that the intended audience is primarily retinal screeners, which gives it limited application outside the U.K.
Assessment: The high-quality information in this handbook is on target for its intended audience of retinal screeners in the U.K. In addition to excellent photographic exams of different stages of diabetic retinopathy with detailed explanations, it also provides information on quality control measures used to obtain adequate fundus photographs for analysis. It is likely useful for those studying for a diploma in retinal screening, but it is less useful for readers outside of the U.K. because the retinopathy grading scheme terminology is unique to that country and, in the U.S., all patients are recommended to have a retinal exam by an ophthalmologist, not just those deemed necessary by a retinal screener based on a fundus photograph. The book does provide background information on diabetes, exam findings in diabetic retinopathy, and possible treatments similar to many other books in the field.