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myopia is from 12 to 15, and it thus follows that the proportion of myopes
in secondary schools is much higher. It has been the custom to see all
myopes every six months until it is apparent that the myopia is not
increasing. Thus it is possible to keep the strength of the glasses up to
the amount of the myopia, to enable the children to get the best vision
possible and to avoid having to make considerable changes in the strength
of the glasses. One welcomes the new arrangement with the Middlesex
County Council which will allow us to keep our myopic children under
observation during adolescence.
"One of the most difficult class of cases to deal with is that of
squints. There were seen 152 such cases this year among the elementary
scholars. The greatest proportion of such cases are convergent concomitant
squints associated with hypermetropia. They start generally
between the ages of 18 months and 5| years, sometimes coming on quite
suddenly, often after some depressing incident, or more gradually as an
occasional squint. The results of treatment are in many cases disappointing.
In 62 cases a serious degree of amblyopia or failure of
binocular vision resulted from the child coming up for treatment either
with a hopelessly amblyopic eye or a squint so firmly established that
there was no hope of obtaining fusion, or from the attendances being so
irregular that treatment was of no avail. A good many of these cases
had previously been treated elsewhere. In 58 cases a good result was
obtained, the eyes being straight and vision 6/6 or 6/9 in each eye.
"In about 30 cases a poor result had been obtained in spite of
regular attendance, and in a certain number of these orthoptic treatment
might have been of considerable benefit. In 66 cases one cannot say
yet what the final result will be.
"If any good is to be obtained from orthoptic treatment the vision
of the amblyopic eye must be improved to about 6/12 and the child
should be about 4 years old, otherwise it is difficult to control the attention
sufficiently. Furthermore, attendances must be regular, not less than
weekly.
"In the first instance the fixing eye has to be occluded to improve
the sight of the squinting eye. It will be seen that in many cases this
could not be attained. Furthermore, this must be done early. Under