Media Type: Reference Textbook

Synopsis: Edited by internationally renowned authorities on ophthalmic drugs and their toxicities, this comprehensive text covers both the principles of drug therapy, mechanisms of their action and toxicity, and relevant evaluation and monitoring, and also the full range of side-effects on the visual system. Agents are classed by region of primary action and each drug’s effects are capsulized by a standard outline and brief text, complete with relevant citations. Although there are minor stylistic irregularities, this is the incomparable reference on all agents with proven or potential toxicities in the visual system.

Target Audience: Clinicians who care for patients with ocular disorders, both ophthalmologists and others who need rapid, concise consultation on medication-induced or drug-associated side effects.

Review: This text is the positive revision of the earlier Drug-Induced Ocular Side Effects (2001) and now includes adverse events from chemicals and herbal medicines. For those (of us seniors) who grew up with W. Morton Grant’s Toxicology of the Eye: Drugs, Chemicals, Plants, Venoms (1962, 1974), this reference is a welcome update from three internationally recognized authors in this field. Especially beneficial is the incorporation of the World Health Organization’s classification system, in which published adverse reactions are classified by the likelihood that the event is, actually related to the agent in question (certain, probable, possible, unlikely, unclassified, or unassessable).

The opening chapters summarize the principles of pharmacotherapy, options of ocular drug delivery, and types of toxic responses, followed by assessments of drug-induced side effects by clinical, electrophysiologic, and psychophysiologic methods. The text then addresses agents by class (e.g., anti-infective, analgesic, anesthetic, gastrointestinal, cardiovascular, and oncolytic, inter alia ) and their generic and proprietary names, followed by a text and outline format on each, terminated by a succinct reference list. The penultimate section, an Index of Side Effects, lists numerous anatomic features (e.g., ‘corneal edema’, ‘glaucoma’) and physiologic events (e.g., ‘accommodation-decreased or paralysis of’, ‘mydriasis’), each followed by agents color-coded by WHO categories, that will save the reader from flipping between the list and the relevant drug summary. The final section, the traditional Subject Index, includes both drug and agent names and key words.

Although not designed as an atlas, the text includes some color and black-and-white illustrations and photographs to clarify what words often cannot completely capture. Some are outstanding (‘sugar cracks’ in the lens; chloroquine bull’s eye maculopathy). Sadly, some are not well-reproduced, either from the cited original sources or, presumably, from the authors’ private collections: grainy, out of crisp focus, and frankly over-exposed. This is not the responsibility of the authors but rather the editors, as is the occasional mismatch between the subject Index and the actual pagination. For example, “Fluorescein” is indexed as pages “274-276,” but the actual text appears only on pages 275-276. A few other weaknesses pop up, again presumably the responsibility of the copy editor. For example, in the ‘Instructions to Users’ (page ix) detailing the WHO Classification System, the term “Unassessible/Unclassifiable” [sic] is defined and appears elsewhere. The correct spelling is “unassessable”. Occasionally, drug names are misspelled, an annoying, if forgivable error in a text of this import. An enhancement for future editions would be a searchable CD-ROM, a user-friendly option once available with the fifth edition of Drug-Induced Ocular Side Effects .

Nonetheless, this is an outstanding compilation of information on the consequences of both local and systemic agents on the eye and the visual system. Indeed, no other current resource of comprehensive toxicology of the visual system is available, and, while this volume may not necessarily reside on everyone’s library shelf, it is the essential reference to identify drug-induced reactions (and potential interactions) for ophthalmologists in practice and for all practitioners, students, and house staff who care for people with ocular disorders.