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Editor,—Congratulations to Newman and colleagues1 for bringing the subject of amblyopia to general attention once again.
After years of neglect in the morass of developmental trends and the shift of responsibility to parents, as advised by the Hall report and so much beloved by the cost cutting administrators, this is a breath of fresh air.
My experience over 30 years of paediatric ophthalmology evolved along similar lines. It was satisfying initially to pick up amblyopes from whatever cause at 3 and 5 years of age and to carry out the treatments with all the expense that involved.
However, in due time, I found by organising screening clinics during the sensitive period of visual development, with orthoptists at postnatal and infant welfare clinics, it was possible to pick up younger children with early visual defect before gross amblyopia had developed. This meant that there was early referral, with only slight visual suppression, which entailed only a short period of occlusion and treatment, which was cost effective for hospital attendances, and for the families indeed, in my region of South West Thames: full blown amblyopia was virtually eliminated at that time.
Perhaps the pendulum may once again turn towards really early assessment and referral, and hence lead to prevention rather than cure.
I would urge the authors and all concerned with paediatric management to direct their energies towards this goal and fulfil the aspirations of the giants of yesteryear such as Mary Sheridan and Ronnie MacKeith.
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