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98
suspected squint and as these are serious they are given priority in arranging
appointments. Another class of cases examined at the clinic are those sent by
doctors in charge of welfare clinics. The importance of the latter I shall show
later.
Where indications are present for doing a refraction. Atropine is used as a
cycloplegic for very young children. For older children Gutt. Hyoscine or Gutt.
Homatropine and Cocaine are used as a mydriatic so as not to interfere with their
school work and progress. In many cases refractions are done without a mydriatic.
Where necessary, glasses are prescribed and the child is kept under supervision
and examined at appropriate intervals of about one year. This re-examination at
intervals is necessary as during years of growth refractions often change,
especially in cases of myopia.
Supervision is also necessary to ensure that glasses are worn as prescribed
and are in good repair and also to determine when glasses are no longer necessary.
Incidentally I deprecate the practice of prescribing glasses for all and sundry errors
of refraction as a routine practice. Only when specific indications for their need
are present should glasses be prescribed.
Attention is specially directed to those cases who are found to have a
unilateral amblyopia - often unsuspected - whether it is associated with a manifest
or latent squint or anisometropia. After correcting the error of refraction
with the appropriate glasses, occlusion is immediately begun and the visual
acuity, especially in the amblyopic eye, is reviewed weekly. Very close supervision
of these cases is kept by the orthopist to ensure that the occlusion is
efficient and not tampered with. Full explanations are given to parents as to the
necessity and importance of this treatment and to secure their co-operation which
is usually forthcoming. In this way, results obtained have been most satisfactory
and visual acuity in the amblyopic eye has very often improved from 6/60 or 6/36
to 6/6 or near 6/6. This is followed by a course of orthoptic exercises to reestablish
and maintain binocular vision.
A most valuable part of the work at the clinics is the opportunity afforded of
seeing very young children - sometimes infants - in the pre-school age. Squints
can then be treated at their inception which in many cases alone can guarantee a
successful result.
Such cases - where squint appears in the first or second year of life and
where there is a family history of a "lazy eye" - may develop an intractable and
irretrievable amblyopia by the time school age is reached. It is gratifying to be
able to see and treat these cases usually referred by the doctors at the child
welfare clinics.
Another type of case which is closely supervised at the clinic is the patient
with progressively increasing myopia. Advice is given as to their management
with a view to arresting it and where the clinical signs of progressive myopia are