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42
a very high proportion of the children suffer from astigmatism.
This high figure is doubtless due to the fact that as a general rule
all astigmatic errors are corrected except in the case of young
children and certain special cases. Many children need only a
small cylinder, but it is just these cases with a small refractive
error who suffer from eye strain with its accompanying symptoms
of headache, sore eyes, general debility or nervous twitchings, and
to whom a careful correction gives relief. It should, I think,
always be remembered that spectacles have a two-fold object—
firstly the improvement of defective vision, and secondly, the relief
of strain which is most noticeable in cases where the vision is not
markedly defective.
On account of the large proportion of cylindrical lenses prescribed
I have for some years ceased to order round lenses as a
routine, and now order round lenses slightly flattened at the top
and bottom, giving a larger lense surface than an oval, but preventing
the possibility of the lens ever being in the frame at the
wrong angle. My attention was drawn to this possibility by
discovering spectacles with round lenses in which the lenses were
no longer at the angle prescribed. In some cases this was due to
the lens having dropped out and having been replaced by someone
who has no knowledge of the required angle, and in other cases it
would seem that the lens has been pushed slightly out of place in
cleaning, probably due to the side screw becoming loose. For
many years the measurement of frames has been done by the Eye
Clinic Nurse, who has had special instruction in this work. This
arrangement, common to many Eye Clinics, has been quite
satisfactory.
Another factor which has, in my opinion, contributed considerably
to the increase in numbers attending the Eye Clinic is
the flat-rate charge for spectacles. This has been in force since
1924. Before that time prices varied according to the lenses prescribed,
with often a great difference in price between spectacles
of different strength, and the uncertainty about the cost of
spectacles undoubtedly deterred many parents from accepting
treatment for their children. Also, a flat-rate prevents children
with higher defects—which need more constant attention—from
being penalised by the higher cost of their spectacles. Our contract
prices are, nickel frames, 4/6, rolled gold frames 8/-, and
rolled gold with shellite rims, 9/6. Parents are asked only to pay
the actual cost of the spectacles, and in necessitous cases the
spectacles are provided free or at a reduced price. Nickel frames