Editor,—I have read with interest the paper by Foley-Nolan et al 1 on the use of atropine as an alternative to occlusion for treating amblyopia. Presumably all the patients entering their trial had strabismus, otherwise there would not have been suppression but some degree of normal binocularity. It should be pointed out that the daily instillation of atropine into the fixing eye, as advocated by Worth,2 may be of use only in those cases in whom the visual acuity of the squinting eye is ‘not much less than 6/36’; in fact, the mean visual acuity in 36 of their atropine treated group was 6/60. But if amblyopia ex anopsia is of such magnitude that central fixation is lost, in the most distressing cases cycloplegia of the fixing eye will prove useless, the patient will keep on using the fixing eye, treated with atropine or not. Only occlusion, permanent occlusion, 6 days a week, will do the trick. On the other hand, if there is no strabismus, but orthotropia, and some degree of normal binocularity, the results of any treatment, and the pertinent indications, would depend on the ultimate cause of the disturbance.

I felt that a chance to clarify the point was in order.