The Role of the Orthoptist in the Treatment of Squint

MANY people are aware that the old idea in the treatment of squinting children was to prescribe glasses as required, and then, if the appearance of the eyes did not improve, wait until at least fifteen or sixteen years of age before operating. This postponement of operation until early adult life was considered essential, so that it could be performed without general ana-sthesia, and with the cooperation of the patient, a more satisfactory cosmetic result obtained. These methods, though satisfactory in certain instances, were far from being so in the vast majority of cases. This will be obvious when one considers certain factors in connection with squint. In early childhood, it is probable that double vision accompanies most cases of squint. In the average case, however, the disadvantages of double vision lead to the suppression of the images seen by the deviating eye. This suppression is psychological, but ultimately the functioning of the eye becomes impaired, and the visual acuity of the squinting eye deteriorates rapidly. Happily the danger of loss of vision in connection with monolateral squint is being more and more realised, and by forcing the squinting eye into use, through occlusion of the good eye, a great deal has been done lately to overcome and prevent it. However, unless these squinting cbildren receive still further attention, once occlusion of the good eye is discontinued, they rapidly re-suppress, and amblyopia becomes established once more. One still encounters far too large a number of young adults who only possess 6/60ths vision or less, in the squinting eye. Other more obvious defects, in the old method of treating squint, are realised when one considers the disadvantages incurred by a child who is forced to attend school, suffering from a deformity. This invites taunts from his school-fellows, and, through lack of binocular vision, places the child in a disadvantageous position where games, studies, and later employment are concerned. Many people, including Claude Worth, realised these deficiencies, and felt that squinting children should receive much more attention. It is, however, chiefly to Miss M. C. Maddox, who worked in conjunction with her father, Dr. that we owe the modern methods employed in the treatment of squint. These methods are now known as "orthoptic treatment." Briefly, this treatment takes the form of regular binocular stimulation, on specially-constructed instruments, and by means of it, it is possible to obtain as an ultimate result in …