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21
The results obtained are not infallible, but in my experience
they are as accurate as those of older children. Vision testing by
reading Snellen cards is at best only a rough and ready method
of detecting visual defects, which is the first point made in the
Report, where it is suggested that a more searching test is necessary.
Testing vision by test cards can only give evidence of manifest
errors of vision. Under our present system if a child reads
6/6 or 6/9 and has no symptoms of eye strain such as headaches,
sore eyes, etc., he is passed as needing no treatment, yet he may
be hypermetropic or slightly myopic. Only a refraction with the
use of atropine to paralyse the accommodation will show the true
picture
The Committee of Inquiry states in the Report that on financial
and administrative grounds it cannot at present advise that
every child should have his eyes examined by refraction as a
routine measure, but it has recommended a modification of
tne usual procedure to enable early myopic cases to be detected
and followed up by fuller examination. It is suggested that before
each child is passed as requiring no treatment the examiner should
place a + 1 sphere before the reading eye. Under this condition,
in the words of the Report, if the child is hypermetropic he will
still read 6/6, possibly even more easily than before; if he is emmetropic
(normal) or slightly myopic the visual acuity will become
less than it was before, and in the latter case may diminish to 6/36 .
For practical purposes hypermetropic cases, i.e those whose
vision remains the same or is improved by the addition of + I
sphere may be neglected as relatively unimportant. The problem
then is to distinguish between normal vision and early myopia
in those whose vision is decreased by the addition of + i sphere
to the reading eye. After reading the Report I immediately put
into practice the suggestion of the second testing with a + i sphere,
and from the beginning of November to the end of the term all
children in the schools have been so tested.
I had no idea of the numbers whose vision would be adversely
affected by this procedure and desired to see what the probable
addition to the work would be if possible myopic cases were followed
up by refraction.
I give the results below—
The schools examined were those which still remained to be
examined this year, i.e. on the ordinary school programme and
not selected in any way. They comprised—