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"It is surprising and rather disturbing that the actual numbers
of children with myopia and myopic astigmatism fall so far short
of those expected. That this is so is because of two factors.
Firstly many of the undetected cases are doubtless early and the
error slight. But these are just the cases it is important to detect.
Secondly some belong to the group of children under eight years
of age who have not been subjected to a test of vision chiefly because
they did not know the letters at the first routine examination.
Although the number of undetected cases of hypermetropic astigmatism
would seem to be very large this is not such a
serious matter, though it is probable that uncorrected hypermetropic
astigmatism predisposes to, or aggravates, such conditions
as tiredness, lassitude, and ' nervousness,' especially in children
whose general health is not of the most robust. That such a large
proportion (75 per cent.) of the cases of mixed astigmatism came
for refraction accords with the diminution in visual acuity usually
found in this complaint.
"The conclusion of the Committee, that ' there appears to
be a strong argument in favour of modifying the practice which
governs ophthalmic work in schools' is undoubtedly supported
by these findings, but to decide what would constitute a suitable
reform is difficult. The ideal is obviously that every child should
be examined by refraction instead of by vision testing, but this
would involve administrative reforms of such magnitude, and such
increase in expenditure that it cannot be contemplated for the
present. It seems probable however that the efficiency of the
routine visual examination could be improved by such simple
procedures as are mentioned in the report, such as testing acuity
with a convex lens of one dioptre. Furthermore the eyes of children
entering school might be tested by these means as soon as they
know the letters, by someone—doctor or nurse—specially instructed
in the methods of vision testing. And lastly, if possible to a