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4. In cases where no improvement of the squint is obtained after 1 and 2 have been
tried, reference to hospital for operative treatment.
High Myopia.
There is no Sight Saving School in the Borough, as the numbers requiring such treatment
are too small to warrant such expenditure. Children with high or rapidly progressive Myopia
are sent to Special Schools outside the Borough or are given special desks in the Elementary
school, with restrictions as to their school work, and are kept under frequent observation at
the Eye Clinic.
III. Periodic re-examination of children for whom spectacles have been prescribed.
Sir George Newman, when Chief Medical Officer to the Board of Education, wrote in
his Annual Report for 1929: "All children with glasses should have their visual acuity tested
once a year, and if it is found there has been any change for the worse, they should be reexamined
by refraction. All children suffering from Myopia should be examined as a routine
measure every six months or a year according to the severity or progressive nature of the
defect."
Systematic re-examination as mentioned in the above extract was begun in this Borough
in 1924 and has been built up and improved in the the succeeding years. Ordinarily the interval
between examinations is 12 months, myopes however are seen oftener—9 months for slight
degrees, 6 months for severer defects, and a lesser period where considered necessary as in
children where the defect is rapidly progressing, and the effect of allowing school work requires
to be watched carefully.
Squints are usually seen every two or three months where squint training is ordered.
Parents are informed when the child should be seen again and re-examination notices
are sent at the expiration of the period asking parents to agree to further examination and any
necessary treatment. Children who are seen at short intervals such as two or three months
are given a definite future appointment at their last attendance. Not all parents respond to the
re-examination notices—ideally such cases should be followed-up but in practice time does not
permit of this being done, as we have always a long waiting list of children whose parents have
agreed to treatment. Therefore only severe cases are followed-up, and the others are left until
found again at Routine Medical Inspections or the School Clinic, when fresh endeavours are made
to have the child re-examined.
This procedure applies to all the School Medical work; parents are notified of defects
found and every facility is given for treatment to be obtained. If the parents do not avail
themselves of the treatment provided, the children have to be left until seen again at a subsequent
examination, when treatment is again offered. Serious cases however are followed-up
until treatment is obtained, and when necessary Court proceedings are taken.
Such a system leaves many gaps, but is inevitable with a limited staff.
In addition to systematic re-examination of children with visual defects, any child who is
attending the Eye Clinic can be seen by the Eye Nurse on Saturday morning without appointment,
in cases where parents think the vision is not as satisfactory as formerly, or there is some
complaint about the spectacles.
When spectacles are received a printed leaflet is given to the parent, setting out this
information, and parents are encouraged to bring the child to see Nurse if there is any suggestion
of difficulty with the spectacles, and where necessary, children are referred by Nurse to
the next Eye Clinic.
I consider this a most valuable adjunct to our Eye Clinic service, as there are many small
things which may go wrong with spectacles in the interval of periodic examination at the Eye
Clinic. Sides become loose, or the frames out of shape, and sometimes children have been found
wearing some other child's spectacles and then naturally complaining that he could not see
properly with them. Sometimes children complain about their spectacles in order to avoid
wearing them. All cases of complaint need immediate investigation—if there is something wrong
it should be put right at once, and if it is only an attempt to avoid wearing the spectacles it is
important that this should be demonstrated to the mother, so that she can then insist on the
spectacles being worn.
Repairs can be dealt with any day of the week by handing them into the Office, but the
clerk in charge is instructed not to send any spectacles for repair or renewal in cases where the
spectacles have been worn for nine months or longer. Such cases are referred at once to the
Eye Clinic as they may need a change of lenses.
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