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Borish's Clinical Refraction, 2nd Edition


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Now updated and expanded to cover the latest technologies, this full-color text on clinical refraction uses an easy-to-read format to give optometry students and practitioners all the important information they need. Also covers a wide range of other aspects of the eye exam, including anterior and posterior segment evaluations, contact lens, ocular pharmacology, and visual field analysis. Four new chapters cover wavefront-guided refraction, optical correction with refractive surgeries, prosthetic devices, and patients with ocular pathology.

Table of Contents

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New to This Edition

    • New full-color design with full-color images throughout.
    • Completely updated and expanded to include current technologies.
    • A new chapter on Optical Correction with Refractive Surgeries, including keratoplasty, traditional refractive surgeries (e.g. LASIK and PRK), crystalline lens extraction with and without pseudophakia, the new presbyopic surgery, etc.
    • A new chapter on Wavefront Guided Refraction provides information on the advantages and limitations the Hartmann-Shack Method for objective refraction plus aberrometry and the refraction and the use of in the correction of the eye with spectacles, contact lenses, and refractive surgery.
    • A new chapter on Patients with Ocular Pathology reflects the most current knowledge of patients with ocular pathologies.
    • Provides information on Optical Correction with Prosthetic Devices, including corneal onlays, stromal implants, phakic intraocular lenses, etc.
    • Includes new chapters and/or discussions on such topics as: Aberrations of the Eye, Refractive Consequences of Eye Pathology, Diagnosis and Treatment of Dry Eye, Diagnosis of Pathology of the Anterior Segment, Diagnosis of Glaucoma, and Diagnosis of Pathology of the Posterior Segment.
    • Visual Acuity chapter expanded to include the effect of refractive error on visual acuity and statistics on how much of a change in visual acuity is significant.
    • Objective Refraction, Corneal Topography, and Visual Field Analysis chapters include the addition of new electro-optical and computer techniques and equipment.
    • Chapters on Multifocal Spectacle Lenses and Contact Lenses now cover newer progressive addition lenses and contact lenses that are now on the market.
    • Electrodiagnosis chapter revised to take a more clinical approach.

Key Features

    • Offer precise, step-by-step how-to's for performing all of the most effective refractive techniques.
    • Presents individualized refractive approaches for the full range of patients, including special patient populations.
    • Contriubtors are internationally recognized, leading authorities in the field.

Published Reviews

    William J. Benjamin, Editor, Irvin M. Borish, Consultant;
    Borish’s Clinical Refraction, second edition
    Butterworth-Heinemann -Elsevier, 2006; hardbound, 1694pp, US$195, ISBN-13:
    Barry Masters
    Received: 1 April 2008 / Accepted: 2 April 2008
    # Springer-Verlag 2008
    Visual acuity is taken for granted until it changes, and then
    it adversely affects our ability to function. It is a supreme
    tribute to the clinical skills and the plethora of optoelectronic
    instruments that are available to optometrists and
    ophthalmologists that they can determine the altered
    refraction that is required to restore normal visual acuity.
    Before the era of photorefractive surgery, before the era of
    contact lenses, there were glasses (that is, two pieces of
    glass that are polished in such a manner to achieve the
    required alteration in the light paths by the process of
    refraction), and they are mounted in a frame to be worn on
    the bridge of the nose and the ears and thus remain
    stationary with respect to the visual axes of the eyes. With
    eyeglasses, as compared to hand-held single lens magnifiers
    that were used for reading, the hands are free and the
    glasses remain stationary with respect to movements of the
    head and the body. In the history of inventions, eyeglasses
    provide an example of a simple idea that when properly
    implemented provides individuals with a great improvement
    in their quality of life. What is the origin of high
    quality spectacles?
    In a thoroughly researched and beautifully illustrated
    new book, Renaissance Vision from Spectacles to Telescopes
    (Philadelphia, American Philosophical Society,
    2007) Vincent Ilardi provides new evidence that 15th
    century Florence was the center for the production of high
    quality spectacles. While Venice during the same period
    also produced eyeglasses, the emphasis was on items such
    as mirrors, vessels and similar objects that resulted in
    higher profits. The glass industry in Florence existed from
    the early 13th century, and by the time of the middle of the
    17th century it was producing high-quality glass that even
    Venice could not surpass.
    We now jump from 15th century Florence to the present
    and introduce Borish’s Clinical Refraction, Second Edition.
    For this edition, William J. Benjamin served as the editor,
    Irvin M. Borish served as consultant, and 58 clinicianscientists
    contributed chapters. Both the editors and the
    contributors deserve acclaim for their scholarly and clearly
    written and superbly illustrated chapters that comprise this
    one-volume tome on the principles and the clinical practice
    of refraction and associated subjects such as color vision,
    contrast sensitivity, ocular motility, and visual fields. The
    extensive scope of this volume is indicated by additional
    chapters on infants, toddlers, and children; patients with
    amblyopia and strabismus; patients with anisometropia and
    aniseikonia; patients with high refractive error; patients
    with keratoconus and irregular astigmatism; the elderly;
    patients with low vision; and a final chapter on the
    refractive effects of ocular disease.
    Borish’s Clinical Refraction provides the reader with two
    varieties of information.
    First, the clear explanation of the science related to the
    relevant topic; the anatomy, the physiology, the biochemistry,
    the neural pathways, the pharmacology, the optics, the
    materials and their optical and mechanical properties that
    comprise the lenses of glasses and contact lenses. Second,
    the art of the appropriate clinical practice that involves the
    physical examination of the eyes, clinical measurement of
    the optical properties of the visual system, measurements of
    the shape of the cornea, the aberrations of the visual
    system, and the logical approach to select and fit the
    appropriate glasses or contact lenses, or the procedures of
    various types of photorefractive surgery. The successful
    clinician needs to know both the basic science as well as
    the details of the procedures that are required for the
    diagnosis and management of refractive eye conditions, and
    the reference book provides the principles and the clinical
    procedures for the diagnosis and the management of
    refractive eye conditions. As expected, the bulk of the
    volume is devoted to a detailed, critical and comprehensive
    treatment of the following topics: the examination of the
    visual system, the various techniques to measure refraction,
    and the analysis and prescription of optical corrections.
    The strengths of Borish’s Clinical Refraction include the
    following: (1) a single volume book that is up-to-date,
    clearly written, well illustrated, and comprehensive, (2) the
    high quality black and white illustrations and the color
    illustrations and clinical photographs which provide graphical
    understanding to the text, (3) the well-designed and
    easily read and understandable tables which summarize,
    compare and contrast various parameters and procedures,
    (4) the full color clinical images which illustrate the
    pathology, clinical techniques, diagnostic readouts, diagnostic
    instruments, and the optical principles, (5) the
    references which provide additional resources, and (6) a
    detailed index..
    I now point out the utility for clinical practice and the
    detailed exposition of the basic principles that are found in
    each chapter of Borish’s Clinical Refraction. I will proceed
    by pointing out the significant features of two chapters, in
    order to illustrate the basis of my evaluation of this book.
    Again, these examples serve as exemplars of the remaining
    chapters in the book.
    I begin with the chapter on corneal topography. The
    shape of the anterior corneal surface is important for both
    the diagnosis and the management of many ocular
    conditions. Because about two-thirds of the refractive
    power of the eye is located at the air/tear film interface
    that is adjacent to the anterior surface of the cornea, it is
    important to be able to determine the shape of the cornea. If
    the cornea was a portion of a sphere, the task would be
    simplified; of course, the human cornea is not spherical,
    and that is only the beginning of the array of difficult
    problems that must be solved to design and calibrate an
    instrument that is capable of measuring the shape of the
    cornea. It is of note that both Helmholtz and Gullstrand
    independently worked on the problem of designing an
    instrument to measure the shape of the cornea. In modern
    times, the personal computer was used to calculate the
    shape of the cornea from a target of concentric rings
    (Placido disk); the results depend on the assumptions and
    the limitations of the mathematical models and the details
    of the calculation algorithm. The important points of this
    chapter are the discussion of the accuracy and the
    assumptions that are implicit in the calculation of corneal
    shape. To emphasize these factors the authors have placed
    them in a summary box: assumptions and limitations
    inherent in standard keratometry. For example, in the
    section on keratometer principles we learn that the
    keratometer measures the radius of curvature of a small
    region of the central cornea. The value of this chapter is a
    critical discussion of the assumptions and the limitations for
    each type of instrument that is used to measure corneal
    shape. I stress this point, because so much of the
    commercial marketing literature either ignores or provides
    minimal discussion and evidence from peer-reviewed
    publications that provide experimental data in support of
    the accuracy and the precision of a particular instrument.
    More modern instruments use proprietary reconstruction
    algorithms to model the corneal surface. The Klein
    algorithm is presented as one solution to the problems that
    are inherent in the older two-dimensional algorithms that
    were used in reconstruction of the corneal shape.
    The highlights of the chapter on corneal topography
    are the critical and detailed discussions of the comparison
    of the various corneal-surface descriptors, the comparison
    of the various videokeratoscopic instruments, the role of
    alignment, focus and reference planes, the discussion of
    color maps and their interpretation, as well as the critical
    and important subject of the analysis of accuracy and
    repeatability. Corneal topographical mapping is an important
    measurement system, and the data is presented in
    various color-coded forms: surface elevation maps,
    dioptric corneal maps, axial curvature maps, instantaneous
    curvature maps and ray-tracing refractive power
    maps. The authors present a critical evaluation of the
    various approaches for the display of topographical maps.
    Wavefront refraction is the subject of another chapter
    that illustrates the exemplary features of Borish’s Clinical
    Refraction. Today it is possible to measure optical aberrations
    over the entire pupil that are smaller than the
    wavelength of the incident light. The primary purpose of
    wavefront aberrometers is to accurately measure the
    aberrations of the eye. This is particularly important for
    mitigating the unwanted effects of spherical aberrations and
    coma that occur with refractive surgery. The goal of
    developing wavefront refraction is to improve the precision
    and the accuracy of both autorefractors and subjective
    refraction for visible light. The wavefront distortion is
    measured by the root-mean-squared wavefront error, and an
    eye is considered to be emmetropic if the total distortion
    over the pupil is minimal. The most common form of
    wavefront sensor is the Shack-Hartmann wavefront sensor.
    This wavefront sensor measures the slope or the spatial
    derivative of the wavefront; the integration of the wavefront
    slope yields the shape of the aberrated wavefront. The
    authors provide excellent discussions of methods to
    interpret the wavefront aberration function, how to classify
    the aberrations in terms of Zernike polynomials, and a
    comprehensive analysis of various metrics to access the
    optical quality of the eye. Finally, they describe the
    challenge of using wavefront measurement to prescribe
    the most appropriate vision aids.
    In summary, Borish’s Clinical Refraction is a modern,
    comprehensive, didactic approach to the principles and the
    clinical practice of refraction. While the text emphasizes the
    examination of the eye and the visual system, the methods
    of refraction, and the prescription of various types of
    spectacles and contact lens, there is also a detailed analysis
    and discussion of the field of refractive surgery and
    prosthetic devices. The book is a useful textbook on the
    principles and the practice of refraction; the measurement
    and analysis of refractive errors and the detailed steps to
    treat, manage, and prescribe spectacles or contact lenses
    that serve to ameliorate the refractive errors and thus
    improve the quality of the patient’s lives. The second edition
    has many new features; for example, an expanded chapter
    on patients with keratoconus and irregular astigmatism. An
    important section is devoted to the special ocular conditions
    that are of importance to the clinician. In conclusion, I
    highly recommend this very practical book for its honest,
    critical, comprehensive, and scholarly approach.

    Borish’s Clinical
    Refraction, 2nd Edition
    William J Benjamin
    St Louis: Butterworth Heinemann
    Elsevier, 2006
    1,694 pages, RPR $315.00
    Department of Optometry and Vision
    Sciences, The University of Melbourne
    I am compelled to agree with the editor
    that, like many books, this second edition
    is better than the first. Beginning with the
    basics, this book is smaller and has
    coloured pictures. More seriously, the
    extensive array of diagrams better illustrates
    clinical procedures, underlying
    principles and clinical findings and generally
    makes the text more inviting. Despite
    the reduced thickness, the new edition
    covers previously addressed topics pertaining
    to refractive error more comprehensively
    and in light of recent advances in
    research and clinical optometry.
    You receive ‘a set of steak knives’ with
    this edition. Despite the title, more than
    refraction is addressed. The book is organised
    into five sections: principles, adjunct
    examinations, the refraction, analysis and
    prescription of optical corrections, and
    special conditions. Research and clinical
    optometrists will recognise many of the 45
    authors who provide the breadth of knowledge
    across the 37 chapters.
    Factors associated with refractive error,
    relationships between ocular components,
    refractive changes in children and adulthood,
    progression of ametropias and control
    strategies are well reviewed. These last
    two discussions provide a sizeable source
    of information to benefit patient management
    and serve as a good foundation
    for patient advice regarding progression
    of ametropia. However, like most books,
    recent research findings are occasionally
    Methods of objective and subjective refraction
    at distance and near, including
    corneal topography, are particularly well
    discussed. The inclusion of wavefront refraction
    is in keeping with advances in
    aberrometry that are aimed at improving
    vision beyond the dioptre when correcting
    ametropia and which perhaps will be
    incorporated in more routine clinical examinations
    in the not too distant future.
    Various forms of refractive correction
    are reviewed, including the optical and
    clinical considerations of single vision
    lenses, multifocal lenses, contact lenses
    (including silicon hydrogels, options for
    presbyopes and RGPs) and surgical strategies.
    Although corrective techniques and
    approaches are constantly changing, I
    found the review of surgical procedures
    informative. General procedures, side effects,
    complications, contraindications and
    clinical features of marginal and good candidates
    are covered; topics that are important
    when a patient presents with an
    interest in refractive surgery or we think
    we have identified a suitable candidate.
    Chapters in the ‘adjunction examinations’
    section cover additional clinical
    procedures to evaluate a patient’s visual
    function, including visual field assessment,
    contrast sensitivity, colour vision
    and electrophysiology, in light of recent
    advances. Ocular examination techniques
    of the anterior and posterior segments
    are detailed and compare well with books
    that focus solely on general optometric
    procedures. These sections are particularly
    useful for third year to final year optometry
    students and clinical instructors.
    Clear instructions on basic physical examination
    techniques are provided to identify
    systemic signs of conditions that have
    ocular manifestations, and aid our diagnostic
    power. Regardless of whether systemic
    evaluation is actively performed,
    the text and illustrations represent reminders
    of physical signs we may notice
    coincidently during the course of an
    ocular examination.
    The final section addressing special
    conditions is a great concluding addition.
    It reiterates and integrates important
    issues and clinical techniques discussed in
    previous chapters, which are appropriate
    for examining particular patient populations,
    such as the elderly, children and
    patients with high refractive errors, low
    vision and keratoconus. The final chapter
    on the refractive effects of ocular disease
    provides a nice summary, encompassing
    both ocular and systemic conditions, to
    aid diagnosis and management of your
    patient, in light of their refractive error.
    The editor advises that this book was
    specifically written for the qualified eyecare
    practitioner and advanced student.
    This pitch is achieved and as no other
    book covers the breadth and depth found
    here, this edition qualifies as a valuable
    reference in our bookshelves. Students
    just commencing their optometric training
    would find this book to be a worthwhile
    investment and a valuable resource
    for their subsequent student and working
    years. The theoretical basis of many
    clinical procedures is provided, in addition
    to clear instructions on technique,
    expected findings and factors that impact
    on these tests. The theoretical basis serves
    students and practitioners well, enabling
    both to appreciate the rationale and application
    of alternative clinical tests and

Author Information

    By William J. Benjamin, OD, MS, PhD, Professor of Optometry and Physiological Optics, Director of Clinical Research and Senior Scientist, Vision Science Research Center, University of Alabama at Birmingham, School of Optometry, Birmingham, AL

Customer Reviews

  • Hardcover
  • Reference
  • 1712 Pages
  • Trim Size: 8 1/2 X 10 7/8 in
  • Imprint: Butterworth-Heinemann
  • ISBN: 978-0-7506-7524-6
  • Copyright: 2007