Edition 2000 of General Pharmacology for Primary Eye Care, by Professor Michael Doughty of Glasgow Caledonian University, presents itself with a little over 200 A4 pages arranged as a paperback. This latest edition has a greatly extended index with a new chapter on pharmacodynamics and extended chapters on the effects of systemic medications. The clarity of the typeface and layout has also been improved. It has been written specifically with optometry students and optometrists in mind. It will be particularly useful to optometrists taking therapeutic examinations, with a view to their future primary eye care role in this subject, and is still very reasonable at the new price £25.00. The College of Optometrists has proposed a higher examination in the pathology underlying systemic diseases, and the text within will give the optometrist much useful information for the treatment of these disease processes and their effects upon the eye.
There are now 23 chapters plus an appendix, and the subjects range from pharmacokinetics, the administration of medicines, bio-transformation and bio-elimination, drug interactions, the many neurotransmitters and their mechanisms, (not just the autonomic system), anaesthetics, anti-histamines, corticosteroids, oestrogens, progestins and oestrogens, fluid and electrolyte disorders, cardio-vascular medications, neuromuscular/skeletal disorders, endocrine disorders, anti-cancer medications, anti-bacterials and other anti-infectives.
The index is a comprehensive list of generic drugs used in general and ophthalmic medicine which are dealt with within the text. The author states he has made a particular effort to include drugs that have ocular side effects.
In reviewing this latest edition I decided to re-examine the two drugs I had used as previous examples. I first of all checked the index for atenolol, and found four references to it within the text. The first reference was in chapter 7 dealing with neurotransmission, and this dealt with the actions upon the adrenergic receptors. The second reference in chapter 13 dealt with the management fluid and electrolyte disorders. In this case atenolol is described as a relatively selective beta1 blocker, reducing cardiac output, and points out that other non selective beta blockers may also produce peripheral vasodilation. A new mention is also made to nebivolol in this group which has a specific effect in stimulating the release of the vasodilator nitric oxide. In chapter 14, atenolol is dealt with as part of the general management of angina, cardiac arrhythmias and hypertension. In this chapter atenolol is described with the many other cardiovascular drugs and their relative merits. In chapter 22, dealing with the effects of medications upon the external eye, it is pointed out that atenolol may reduce lacrimal secretion, but only in some sensitive patients. Also in this chapter there is a very useful table listing drugs and their side effects, atenolol is listed as sometimes causing conjuctival oedema and irritation together with a reduction in tears and reduced intra-ocular pressure.
My second choice was diazepam, another commonly prescribed medication, often in the form of Valium. The previous edition had 7 references within the text, and the list has now been extended to 10. As with atenolol it is similarly described in detail regarding it's comparative actions, uses and side effects. Particularly important is that the systemic uses and ocular side effects are dealt with in some detail, and not just the usual unhelpful remark such as blurred vision.
The three tables of the various drugs and their side effects on the eye are particularly useful, and enable a very quick way to check the side effects in detail.
Andrew Field.MSc.FCOptom.DCLP.FAAO.