Dentistry for the Pre-school Child

Kcith Lyle, C.B.E., M.D., M.Ch., M.R.C.P., F.R.C.S., Cvnthia Douthwaite, D.B.E., and Jill Wilkinson, D.B.O. (Pp. xii + 135. 25s.) London: E. & S. Livingstone, 1%0. THIS interesting and unique book is an abridged English version of Jean Sedan's Post Cure de L'Amblyope Reeduque. No more competent team could have undertaken this task than Keith Lyle and the othoptists at the High Holborn Branch of Moorfields Eye Hospital. The causes of amblyopia are briefly discussed and the objects and methods of treatment are outlined. The book is mainly composed of exercises, or games, devised to help the amblyope, and it is as suitable for use in the home as in the clinic. These include proof reading where deliberate errors have been made in extracts from 'Alice in Wonderland,' and various arrangements of numbers, designs, drawings, tracings, and photographs, all of which require attention to details and improve hand-eyc co-ordination. There are also a series of simple exercises for amblyopes with eccentric fixation. The theoretical considerations of the subject are brief, lucid, and up to date. Uniocular amblyopia in strabismus has long been recognised and treated, but there is still not universal agreement as to which is cause and effect. Jean Sedan emphasises that in amblyopia there is not only a defect of visual acuity, but also a defect of visual discrimination. This can be shown by measuring the difference between the visual acuity obtained with individual test types and that obtained with a line of letters on the test chart. Similarly, the acuity may vary when the test types are presented in different positions and planes. The inhibition of amblyopia is treated by occlusion of the fixing eye and progressive exercises such as reading and tracing, using the amblyopic eye. The importance of continuing these measures to maintain the improvement is stressed. Eccentric fixation, or extra muscular fixation, is a disturbance of spatial localisation which occurs in some cases of strabismus and does not respond to occlusion of the non-squinting eve. Such occlusion is more likely to reinforce the eccentric fixation. Occlusion of the amblyopic eye, however, breaks down the function of the false macula, and with the aid of ingenious instruments such as the euthyscope and the co-ordinator, which stimulate the true macula, normal macular fixation may be obtained. The restoration of full or useful vision in an amblyopic eye fully rewards the time and patience expended, and this book should prove most useful in sustaining the efforts of all c0ncerlned with the treatment of squilnt and amblyopia. V. A. F. A.