NOTES, CASES, INSTRUMENTS A CASE OF CONVERGENT STRA­

BISMUS AND AMBLYOPIA Unusually excellent postoperative

results WlLBER F . SWETT, M.D.

SAN FRANCISCO

This case is reported because of the unusually good results in an individual with a long standing amblyopia and convergent strabismus.

The patient, a girl of 21 years, was first seen in November 1930, because of headaches and poor vision. She was particularly sensitive about her left in­ternal strabismus being otherwise an exceptionally attractive girl.

The eyes were entirely normal except for the hypermetropia and left inter­nal strabismus of 35 to 40 degrees which had been present since five years of age. The refraction under two per­cent homatropine was O.D. +2.50 D. sph., O.S. +4.0 D.sph. Glasses were prescribed as follows: O.D. +2.0 D. sph., vision = 20/20 +3.50 D.sph., vision = 20/100 (partly). . The vision of the left eye was not improved by the glass and there was no diplopia or fusion. She was in­structed to place a patch over the right eye and to use the left eye two to three hours daily. She was extremely co­operative and in six months complained of occasional spells of troublesome dip­lopia and the vision of the left eye im­proved from 20/100 (partly) to 20/50. This treatment was continued up to November 1932 (two years), at which time the vision of the left eye was 20/40 and the diplopia more constant, but no fusion could be demonstrated.

On November 23, 1932, I performed an advancement operation on the left external rectus by the Shoemaker technic and she made an uneventful re­covery with practically a perfect result. The following month she complained of headaches and almost constant dip­lopia. I had her practice daily on the stereoscope and by December 20 there was definite fusion.

She was seen again on February 1 at

which time the vision of the right eye was 20/20 and the left 20/20 (partly) with no diplopia, complete fusion and no further headaches or discomfort. She has remained the same since, with marked improvement of her mental outlook as well as appearance and nor­mal function of her eyes.

The complete recovery of normal vision and restoration of fusion with binocular vision in an amblyopic eye of sixteen years duration I think is worthy of note. Perhaps more of these individuals may be helped than we have previously thought possible.

490 Post Street.

AN INEXPENSIVE DEVICE TO FACILITATE ORTHOPTIC

EXERCISE K. C. BRANDENBURG, M.D.

LONG BEACH, CALIFORNIA

I have found the following inexpen­sive arrangement, suggested by a non-medical friend, to be quite simple and effective for strengthening inadequate convergence, and I am passing it along, knowing that others interested in or­thoptic training will find it equally valuable.

The flasher socket which is used in this arrangement is made by the Presto Products Company of New York. It retails for one dollar and a half and may be obtained through an electrical sup­ply house. On this socket is a screw by means of which the "off and on" in­tervals may be regulated. I have mounted two such sockets on my chart box, as shown, with a small toggle switch just below each one to turn the current on and off. One socket is set for a three seconds on, three seconds off, interval. The other, which I use less frequently, is set to flash on for five seconds and off for two seconds.

The patient is directed to look through the instrument or trial frame containing the desired amount of prism base out, at a card placed fourteen inches from the eye.

34S