In recent years the specialized areas of optometry have been quite well covered by new texts, but the basic core of clinical practice has been neglected. Dr Grosvenor's new book, Primary Care Optometry, is a welcome addition to t he literature on this important area.Primary care is applied at the point of entry into the health care system by practitioners of all the health professions. Primary care practitioners treat a wide range of common conditions, refer special cases to a secondary care practitioner, and screen for general health problems as far as their different professional skills allow. In optometry fields such as pediatrics, low vision rehabilitation, contact lens practice and environmental optometry produce cases which are beyond the scope of the general practitioner. Grosvenor's book is not intended to cover these fields in sufficient depth for the specialist, but to give the general practitioner adequate working knowledge.The text is divided into three main parts dealing with basic science, the clinical examination, and management. Part one outlines the anomalies of refraction and binocular vision. It starts with a very simple (and rather out-of-date) description of the optics of the eye, visual acuity and accommodation. Next there are excellent chapters on the aetiology of refractive errors, and on normal and abnormal binocular vision.Part two provides a detailed description of the various facets of the optometric examination. These chapters have been very well planned so that the text can be used as a chair-side companion by the student.Grosvenor advocates a problem-oriented approach to consultations, starting with the history, working through a preliminary assessment, external and internal examination, refraction and binocular vision evaluation. At this stage he encourages a tentative diagnosis of the underlying condition. This approach has much to commend it over the alternative "measure-all" routines. Part two ends with chapters on auxiliary procedures (to which dynamic retinoscopy is relegated) and automatic refraction.The third section of the book, Optometric Diagnosis and Treatment, gives a straightforward guide to prescribing, followed by chapters on ophthalmic lenses and contact lenses. Finally, screening for general health problems, referrals and counselling are briefly covered.Primary Care Optometry seems to be written with the student, rather than the established practitioner in mind. Study questions are provided at the end of chapters, with the answers in an appendix. Other appendices are devoted to problem-oriented record cards, contact lens tables and relevant US standards. A brief glossary
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