Introduction

Despite modern medicine's increasing reliance on laboratory data and burgeoning technology, diagnosis and management of clinical problems still depend greatly on the art of good communication, careful observation, and deductive reasoning. The case study method is predicated on problem solving, and is particularly effective when used in small group seminars as a focus for dynamic interchange between student and faculty. In contrast to the didactic lecture in which the student is a passive receptacle, the method of case study requires the student to exercise observational and deductive skills.

Early formats of this manual have been used successfully at Washington University, St Louis; University of California, Davis; Wills Eye Hospital, Philadelphia; and several other teaching centers throughout the United States. This manual was developed under the auspices of the American Academy of Ophthalmology.

To the Student

Each case study has a color photograph depicting the salient physical and ocular findings and a brief history. This information reflects situations that a primary care physician might encounter.

The history and the physical findings provide sufficient data to determine the diagnosis and to suggest appropriate therapy. Analysis of each case should include a description of the significance physical and ocular findings, the appropriate review of systems, a differential diagnosis, and a general management plan. To assist you in your workup of the patient, several leading questions have been posed with each case; your analysis should answer these questions.

Your instructor will outline the form in which the cases will be discussed. Background reading is an important prerequisite to individual study and to group discussion. The general references that follow are textbook that address much of the material covered in the 27 cases. The references should assist you in preparing each of the cases for presentation. You are encouraged to seek consultation from residents, faculty, and other students as well. The selected bibliography at the end of the manual includes individual chapters or review articles pertinent to specific cases.