Hilary A. Beaver - Geriatric Ophthalmology: A Competency-based Approach

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The Second Edition of Geriatric Ophthalmology: A Competency-Based Approach is a terrific and timely book especially for trainees in ophthalmology and related eye professions. And it will serve as a handy reference for those who are fully trained yet would like to update their skills in providing high-quality care to seniors. The Second Edition provides new information and up-to-date references to the continuously emerging science related to caring for the older eye patient. This pithy well-written book has been created by leaders in the emerging field of geriatric ophthalmology. It provides insightful and practical guidance for the common age-related eye conditions and the common comorbidities such as falls, dementia, and depression that profoundly impact the evaluation, treatment, and outcome of older eye patients. Indeed, the excellent eye professional will understand the unique issues their older patients manifest. Older patients dominate health care and more so in ophthalmology than most specialties. Yet American medicine has been slow to integrate geriatric concepts and principles into specialty medicine. For this reason, practical reference books are vital.

What is so different about the older patient? Many issues, but perhaps summarized by three characteristics: (1) the presence of a unique variety of comorbidities in each patient; (2) profound but variable loss of physiological function, especially in those over 80 or so; and (3) heterogeneity created by these variabilities. Together these phenomena result in a marked increased vulnerability in the older patient. This vulnerability makes the senior more prone to missed diagnoses and complications from surgical and medical interventions. Thus the excellent eye professional must carefully consider all comorbidities, some of which may not be obvious or listed on a problem list (such as early dementia or depression). These considerations are imperative in discussing the benefits and burdens of any evaluation or treatment in an older patient. The Institute of Medicine points out this need for all clinicians who deal with adults to become knowledgeable in geriatric principles appropriate to their practice [1].

This book is a reflection, in part, of a two-decade effort of the American Geriatrics Society with ongoing support of the John A. Hartford Foundation, and in the past the Atlantic Philanthropies, to introduce geriatrics into specialty medicine. As the late, visionary geriatrics leader, David H. Solomon, MD, in his prescient Foreword to the First Edition stated: The goal is to help all ophthalmologists to improve the quality of care they provide to the millions of patients suffering from age-associated eye conditions. This effort, called the Geriatrics for Specialists Initiative (GSI), has resulted, among other accomplishments, in innovations in specialty-specific graduate medical education and the creation of new knowledge through sponsoring the career development of specialists committed to the geriatric aspects of their specialty. This research and career development effort is now promulgated by an entry-level award of the NIA/NIH called Grants for Early Medical and Surgical and Specialists Transitioning to Aging Research (GEMSSTAR). The editors of this book, Hilary A. Beaver and Drs. Andrew G. Lee, have long been leaders in the GSI.

The book follows a common template based on recommendations of the Accreditation Council for Graduate Medical Education (ACGME) to focus on competencies. Chapters start with a typical clinical scenario followed by practical information on medical knowledge, clinical care, management, inter-professional communication skills, professionalism, and system-based practice and conclude with a review of the patient vignette now with an informed geriatric approach. Each chapter is inclusive and easily reviewed.

This is likely to be a book that teachers will want in the hands of their trainees, and it serves as a thoughtful and practical template for curricula.