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amount of vision to be amongst modern traffic. The probable result of ordering such treatment
would be that the child would not wear the spectacles at all, thereby losing the benefit of the
correcting lenses. Actually I have known this to occur—a boy of 9 came to the Clinic having a
severe squint, and with very little vision in the squinting eye. He was wearing spectacles with
an occluder over the lens of the fixing eye. He had been treated for squint at a London
hospital for several years and had been ordered constant occlusion of the fixing eye. This treatment
had been faithfully carried out by the mother, but with apparently no result, as the vision
was still extremely poor. On enquiry as to how the boy managed to do his school work I found
that the boy had always removed his spectacles the moment he was away from his mother. One
could not blame the boy, as it was asking too much of an intelligent child to expect him to submit
continuously to very impaired vision when by removing the spectacles reasonably good vision was
obtained.
With older children, therefore, one is forced to give second best treatment, viz., occluding
the fixing eye for certain periods daily. Where the vision of the squinting eye is very poor I
ask the mother to cover the fixing eye as much as possible when the child is at home; when there
is sufficient vision to allow school work to be done a second pair of spectacles is ordered and an
occluder attached to the lens of the fixing eye; this pair of spectacles is worn in school, and the
child is allowed to sit in the front row in class. In either case the child has use of both eyes
when in the streets.
Naturally the effect of exercising the squinting eye by occluding the fixing eye depends
largely on how conscientiously the treatment is carried out, and in many cases no benefit is
achieved because instructions have been ignored or only carried out spasmodically.
In cases where the vision of the squinting eye is improved so that the disparity in vision
between the eyes is not great or is abolished, an endeavour is made to develop the fusion faculty
and obtain binocular vision.
Occlusion of the fixing eye is stopped, or reduced in time, and the child is given exercises
with a Drawing Stereoscope. This is not done at the Eye Clinic as time does not permit, but
is arranged on a Saturday morning, the exercises being supervised by a nurse who fits in the
work with her other duties such as Minor Ailments. There is a stereoscope available for use at
the three Centres—Hounslow, Isleworth and Heston, so as to make it as easy as possible for
children to attend; a Saturday morning was chosen to prevent loss of school attendance.
Only those children whose parents are willing to co-operate are recommended for these
exercises—no possible good can be done unless the child attends regularly. Actually once a
week is usually insufficient to obtain the best results, but it is impossible to spare more time, and
by selecting suitable cases benefit is received and in some cases steady binocular vision has
resulted.
I feel that much more could be done by regular Squint Training Clinics held two or three
times weekly with a greater variety of apparatus, but so far this has not been possible to
arrange and the number who would benefit by such treatment is not large. Such Clinics are
held at some of the London hospitals, but the distance is too great for our children to attend twice
or thrice weekly for months.
Last year we made a modification of the drawing stereoscope which has increased its usefulness.
In the original device the pictures to be traced are enclosed in a Printator block, a bone
style is used for the tracing, and after use the slide is pulled out and the drawing is obliterated
so that the picture can be used indefinitely. In use, however, with young children, we found
that the child pressed so heavily with the style, that the impression remained on the celluloid and
the pictures could only be used a few times. To obviate this I had the pictures (black and white
drawings) removed from the Printator block and mounted on wooden plaques the same size, the
work being done for us most neatly and expeditiously by the Handicraft Class of the Bulstrode
Senior Boys' School. Tracing paper cut the size of the plaque is then placed over the picture
and attached firmly to the plaque by broad rubber bands, the child traces with a soft pencil and
the sheet is removed, the picture being ready for use again for another child or for the same
child next week. Not only has this modification removed the necessity for frequent replacement
of the picture sets—an expensive matter—but it has also given a permanent record of the child's
achievement, as, after use, each tracing slip is labelled with the child's name and date, so that
there is a visual record of the progress made.
To sum up—treatment of Squint at our School Eye Clinic consists of :—
1. Refraction and provision of necessary correcting lenses.
2. Exercise of the squinting eye by occluding the fixing eye either constantly or
periodically.
3. In suitable cases, training of the fusion faculty and establishment of binocular
vision by the use of a drawing stereoscope.
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