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5 Myopic Astigmatism). In three cases only were spectacles prescribed but the remaining 17
were marked for examination next year (1933); and the test with the + ID sphere was continued
at all Routine Medical Inspections throughout 1933.
Of the 17 children whose vision in 1932 was diminished 5 Snellen lines when reading
through a + ID sphere it was only possible to re-examine 11 in 1933 (the others having left)—
in all cases the vision remained satisfactory.
In 1933 only two children had their vision diminished by 5 Snellen lines and on reexamination
their vision remained satisfactory.
The results of this additional test were so inconclusive, and definitely gave no help in
the detection of early myopes, that the test was dropped at the end of 1933, as it gave a considerable
amount of extra work without any advantage over the old system.
I am still of opinion, as I reported in 1933, that the most useful reform in the routine
vision testing of school children is to increase the frequency of these tests.
If all children could be tested annually instead of only at a 3 or 4 yearly interval, an early
myope would not remain long without detection and astigmatics would be found earlier. Each
child has a dental inspection annually, and it should be possible to arrange for vision testing
annually. The only difficulty is one of expense, and up to the present it has been impossible to
carry out this much needed reform.
II. Treatment.
Treatment at a School Eye Clinic consists chiefly in refracting each child to determine
the nature and degree of visual error, and the correction of such error by prescribing suitable
lenses.
Each new case attends the Clinic three times—first for preliminary examination when
the vision is noted, also any peculiarities such as squint. The parent is then given the necessary
ointment for dilating the child's pupils and paralysing the accommodation (Atropine 1%) with
instructions as to its use and a second appointment is given in a week's time. The school is
notified that during the use of the ointment no close work is to be done. All children of 14 or
over are treated as adults and are given 4 installations of Homatropine at the Clinic and the
refraction done during the same session. This gives adequate dilatation and lessens very considerably
the interruption of their school work.
At the second visit the refraction is done and spectacles prescribed, the measuring of
frames being done by the nurse.
The third visit is for the purpose of checking the lenses and the fit of the frames, also the
child's vision is tested with the new spectacles and the parents given any final instructions.
Squint.
Only non-paralytic squints are treated at the Clinic. A paralytic squint, being a symptom
of disease, needs treatment of a kind not available at a School Clinic and is referred to hospital.
Such cases however are rarely found in school children. Most concomitant (non-paralytic)
squints have some visual error, and this is corrected by suitable lenses.
Often the eyes become straight when wearing spectacles, but many still squint, though in
a less degree.
The next step is to improve the vision of the squinting eye which at first, even with
spectacles, is markedly less than the good eye. This is done by occluding the fixing or good
eye, or by the installation of atropine. The effect of this is to exercise the squinting eye, and
if begun at an early age and conscientiously carried out very good results are achieved.
Unfortunately, however, children are often not seen at the Eye Clinic until they are 8
years or older, when it is much more difficult to restore good vision to a squinting eye. 1
believe, however, that it is always worth while to exercise the squinting eye at whatever age
seen, since, even if the vision is not improved, one may be able to prevent further deterioration.
Undoubtedly the best results are achieved when a child attends at 3 or 4 years of age,
because then it is possible to order constant occlusion of the fixing eye for the necessary period
regardless of the amount of vision in the squinting eye. A young child does not resent having
its sion substantially cut down and there is no danger in doing so because the child is always
witn the mother and is not in the streets alone.
With an older child this constant occlusion is not possible in cases where the vision of
the squinting eye is very poor, because one thereby condemns the child to carry on its school
work and other activities with very imperfect vision—this is naturally resented by the child and
incidentally bv the teacher. There is also considerable risk in allowing a child with a very small
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