Over a decade ago, in Vientiane with the Orbis Flying Eye Hospital, I was examining patients with a small group of Southeast Asian ophthalmologists from Laos, Cambodia, Vietnam, Thailand, and Myanmar. A middle-aged lady came in with a dense vitritis, and I could see through the haze with an indirect ophthalmoscope to an active macula-threatening toxoplasmosis lesion in the posterior pole. We started reviewing antibiotics available in that part of the world, and to help the discussion, I sent out to the bus where we had stashed a box of latest-edition Wills Eye Manuals. As we paged through the book’s section on toxoplasmosis, I became aware of a flurry of hushed whispers in the room, and looked up questioningly at my interpreter to find out what all the fuss was about. “It’s your book,” he explained, “Everyone is excited to see it. Once they saw a Xeroxed copy of it in Bangkok.”

How proud I was to tell the thrilled group that we had an actual copy of the The Wills Eye Manual for each of them, brought all the way from Philadelphia! Their palpable delight was a special reciprocal gift.

That pride finds its echo today as I peruse this new edition of what has become a standard work in the Eye Canon, the best-selling book in our field worldwide, compiled originally from a sheaf of famously helpful notes assembled by two Wills residents, Chris Rapuano and Marc Friedberg. That remarkable pocket compendium, shared with their fellow trainees for reference as they worked in the clinics and emergency room, grew into the first manual, published in 1990. Thirty years later, it retains its immediacy and clinical relevance, despite many iterations and changes, most recently to adapt it to online access including expanded video resources – and of course the reason for this is that it is still authored by Wills residents, who know what frontline patient care demands: ready, conveniently available, concise, accurate, and up-to-date information!

This foreword would not be complete without a grateful acknowledgement of the two giants no longer with us, whose editorial skills anchored the book for its previous three decades: Dr. William Tasman and Dr. Edward Jaeger. Peerless and indefatigable proofreaders and advisors, their mentorship and support have been key to the success and reach of the manual. May this new edition of The Wills Eye Manual serve as a special salute not only to the Wills Residency that these tremendous academicians served so ably, but also to the legacy of their irreplaceable editorial pen, wise counsel, clinical acumen, and unmatchable collegiality.

Julia A. Haller MD

Ophthalmologist-in-Chief

First Edition, 1990:

Editors: Mark A. Friedberg, M.D. and Christopher J. Rapuano, M.D.

Second Edition, 1994:

Editors: R. Douglas Cullom, Jr., M.D. and Benjamin Chang, M.D.

Third Edition, 1999:

Editors: Douglas J. Rhee, M.D. and Mark F. Pyfer, M.D.

Fourth Edition, 2004:

Editors: Derek Y. Kunimoto, M.D., Kunal D. Kanitkar, M.D., and Mary S. Makar, M.D.

Fifth Edition, 2008:

Editors: Justis P. Ehlers, M.D. and Chirag P. Shah, M.D.

Associate Editors: Gregory L. Fenton, M.D., Eliza N. Hoskins, M.D., and Heather N. Shelsta, M.D.

Editors: Adam T. Gerstenblith, M.D. and Michael P. Rabinowitz, M.D.

Associate Editors: Behin I. Barahimi, M.D. and Christopher M. Fecarotta, M.D.

Editors: Nika Bagheri, M.D. and Brynn N. Wajda, M.D.

Multimedia Editors: Charles M. Calvo, M.D. and Alia K. Durrani, M.D.

Editors: Kalla A. Gervasio, M.D. and Travis J. Peck, M.D.

Multimedia Editors: Cherie A. Fathy, M.D., M.P.H., and Meera D. Sivalingam, M.D.

It is our sincere pleasure to present the eighth edition of The Wills Eye Manual. This edition arises from the foundation laid by all preceding contributors and, as in years past, would not have been possible without the collaborative efforts, teamwork, and never-satisfied mentality of the Wills Eye residents, fellows, and faculty. Our hope is for readers to find within this text the most up-to-date information and collective clinical recommendations regarding the office and emergency room evaluation, diagnosis, management, and treatment of ophthalmic disease.

The eighth edition includes the results of major clinical trials since the last edition. Changing trends in the workup, categorization, and treatment of various ophthalmic specialties including trauma, oculoplastics, cornea, pediatrics, neuro-ophthalmology, uveitis, and retinal disease are reflected in this current edition. We are proud to share our updated multimedia component of The Wills Eye Manual, including an electronic database of various clinical conditions and the addition of new office and emergency room procedures. While incorporating current medical and technological trends, we strived to maintain the original goals of the founding editors, namely to provide a streamlined, concise, and readily accessible resource for healthcare providers approaching patients in need of eye care.

We hope you continue to utilize the eighth edition of The Wills Eye Manual and find it to be a convenient, easy-to-use guide for the management of ophthalmic disease.

Kalla A. Gervasio, M.D.

Travis J. Peck, M.D.

Our goal has been to produce a concise book, providing essential diagnostic tips and specific therapeutic information pertaining to eye disease. We realized the need for this book while managing emergency room patients at one of the largest and busiest eye hospitals in the country. Until now, reliable information could only be obtained in unwieldy textbooks or inaccessible journals.

As residents at Wills Eye Hospital, we have benefited from the input of some of the world-renowned ophthalmic experts in writing this book. More importantly, we are aware of the questions that the ophthalmology resident, the attending ophthalmologist, and the emergency room physician (not trained in ophthalmology) want answered immediately.

The book is written for the eye care provider who, in the midst of evaluating an eye problem, needs quick access to additional information. We try to be as specific as possible, describing the therapeutic modalities used at our institution. Many of these recommendations are, therefore, not the only manner in which to treat a particular disorder, but indicate personal preference. They are guidelines, not rules.

Because of the forever changing wealth of ophthalmic knowledge, omissions and errors are possible, particularly with regard to management. Drug dosages have been checked carefully, but the physician is urged to check the Physicians’ Desk Reference or Facts and Comparisons when prescribing unfamiliar medications. Not all contraindications and side effects are described.

We feel this book will make a welcome companion to the many physicians involved with treating eye problems. It is everything you wanted to know and nothing more.

Christopher J. Rapuano, M.D.

Mark A. Friedberg, M.D.