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Excerpt
D. Leonard Werner and L. Press. Boston, MA: Butterworth-Heinemann, 2001;336 pages.
It is Sunday morning. You are in church. The subject of the minister's sermon is: Sin—sins of commission and sins of omission. A skilled orator, he first cites the gospels, shows how the teachings apply to his flock, and then bids them go and sin no more. That is precisely what Werner and Press have delivered—a very readable, useful sermon on the pitfalls in prescribing and how to redeem all sinners.
The first chapter, The Pearls of Conventional Wisdom, is the key that unlocks the remaining twelve chapters. Here are 22 “pearls”—nuggets of the common-sense approach to prescribing. They are the product of years of experience distilled by two esteemed teachers, refracting veterans.
These pearls, “perils of prescribing,” include such tidbits as being careful about lens design in high prescriptions, balancing accommodative (and focal) levels rather than equalizing the near acuities, and changes of less than 0.50 seldom help diminishing asthenopia. The tenor of the pearls is: restrain your enthusiasm. More problems come from over-prescribing than under-prescribing. A second chapter discusses the increased role of the autorefractor in this age of managed care. The doctor becomes the analyzer and arbiter, rather than the creator, of the refraction data.
Chapters 3–7 are devoted to the most commonly encountered refractive errors and the basics of prescribing for each. For example, in the chapter on astigmatism there is an excellent discussion of minimizing spatial distortion in prescriptions. Here, as in other chapters, there is emphasis on the need for flexibility in prescribing to achieve the most effective compromise between acuity and comfort; on being conservative in making changes; and on using the trial frame to confirm patient acceptance of the planned prescription. Each chapter is replete with illustrative cases in which the authors unabashedly confess their sins and point out which of the 22 pearls were neglected or contravened. These well-detailed case histories make up almost two-thirds of the book. They illustrate sins such as increasing the minus correction of the prepresbyopic myope; or ignoring the possible problems when significant plus is added in the presence of a high AC/A ratio. The text does not discuss the use of the distometer in high refractive errors so that the dispenser can calculate the effective lens power required for the new prescription. The significance of these vertex distance measurements could well be a twenty-third pearl.
Chapters 8–12 discuss contact lenses, the post-refractive patient, medical problems influencing refractive errors, cataracts, and low vision.
Chapter 13, The Dissatisfied Patient, the end of the sermon, comes to grips with “the wages of sin.” The book begins with the pearls and ends with the penalty for disregarding those pearls. The authors stress that a patient's problems are most often solved by listening and convincing him/her that you are sincerely interested and will leave no stone unturned to rectify the problem. True, the reader may get some vicarious satisfaction in reading that the experts, too, are human; however, the authors have driven home the truth that prescribing is a learned experience. I recommend this book for the neophyte. It is also a wake-up call for the experienced practitioner of eye care.
