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100
APPENDIX E.
REPORT ON WORK IN THE EYE DEPARTMENT FOR THE YEAR ENDED
31st DECEMBER, 1930,
by
FRANK W. LAW, M.A., M.B., B.Chir., F.R.C.S., Ophthalmic Surgeon to the Council.
Owing to the different arrangement under which the work in this Department is now carried
out, it is impossible to compare figures or results for this year with those of any other year. Previously,
all routine ophthalmic cases were seen by the Medical Officers, who referred to the Ophthalmic Surgeon
only such cases as needed a specialist opinion ; there was thus virtually no separate Eye Department.
On my appointment as Ophthalmic Surgeon on March 13th, 1930, a separate Eye Department was
established, and it was arranged to hold sessions once a week at each of the three Clinics, at which all
Ophthalmic cases should be seen.
My duties were commenced on April 29th, 1930 ; the period covered by this report is thus that
of the last eight months of the year. In the interregnum during the alteration of arrangements, the
work had got considerably in arrears ; indeed, after about six weeks work there was a waiting list of
Refraction appointments at each Clinic of from two to three months—a highly unsatisfactory state of
affairs, resulting inevitably in a large percentage of unkept appointments. These waiting lists occurred
in spite of the fact that at each Clinic the number of appointments being made for each Session was
between 10 and 15—in some cases even 20 and over. The average time for a refraction and general
rapid examination (under Atropine) may be taken as 5 minutes ; it will be appreciated that this
number of Refraction cases, together with all the ordinary ophthalmic cases attending the Clinic, made
the Sessions of an unmanageable length.
The situation was relieved in part by the booking of the large numbers of appointments already
referred to, in part by the holding of special Refraction Sessions at extra times, at which none but
appointment cases were seen—usually about 30 in number. As a happy result, there is now no waiting
list at any Clinic—that is to say, any case having to return for refraction after the instillation of a
cycloplegic is given the drug, with instructions for its use, and told to return for the next Session. It is
expected that a considerable increase in the percentage of appointments kept will result.
The Department is mainly occupied with Refraction work, i.e., the examination, with a view
to the prescribing of glasses, if necessary, of cases referred from the School examinations as suffering
from defective visual acuity, or of children complaining of symptoms suggestive of refractive
error. In all cases where glasses are prescribed, the patient is instructed to return so that glasses may
be examined and checked as to accuracy of dispensing, and also to see that they fit correctly and
comfortably. The glasses are almost invariably prescribed from the objective examination alone ;
only in rare cases is a subjective test carried out, where this seems specially indicated, since generally
speaking subjective tests in the case of children are considered to be valueless.
The remainder—" treatment cases "—consists mostly of cases of Blepharitis (sore lids), Conjunctivitis
(" pink-eye "), Hordeola (styes), and Chalazia (cysts of the lids). One case of Chronic
Blepharitis—very severe and of long standing—was, on account of its resistance to treatment, referred
to Moorfields Hospital for the opinion of the Staff there, and sent to Paddington Green Children's Hospital
for intensive in-patient treatment ; a case of Lamellar Cataract is, at the time of writing, an
in-patient of the same Hospital undergoing operative treatment.
A few cases from the Clinics were shown at meetings of the Ophthalmological Section of the
Royal Society of Medicine, either on account of their extreme rarity or for the purpose of obtaining
the benefit of the opinions of the other Ophthalmic Specialists there ; these included cases of Bilateral
Corectopia, Pseudo-Coloboma of the Iris, Abnormal Retinal Pigmentation, and ? Staphyloma Posticum
Verum.