to the whole retina; however, the possibility of a "regional exclusion"
should not be excluded to begin with; but in the inductive sciences it
is for us to ask first, whether an incident really happens, and not
whether it is possible. The fact from which Alfred Graefe draws his
inference is not, as we have just seen, to be explained in any other
way, and the ophthalmoscopic test described on p. 65 proves that also in
these cases of "regional exclusion" both eyes are used for vision.
In many cases of periodic squint the condition of binocular vision is
very interesting. Binocular fusion may be quite absent even in normal
position of the eyes; on the other hand the non-occurrence of diplopia
in squint does not prevent the occurrence of perfect binocular fusion
with a normal position. In periodic outward squint I have sometimes seen
binocular fixation without the existence of binocular fusion; the
excluded eye deviates outwards, but as soon as it is free it puts itself
into fixation, whilst neither with prisms nor stereoscope can anything
other than alternating vision be proved, _i. e._ neither binocular
diplopia nor fusion.
If squint arises when the habit of binocular single vision has become
confirmed, diplopia is always present, at least at first; even children
of six to seven years old make this statement uninvited, but they soon
get accustomed to the new relations, and after a short time it is
impossible to make them see double images (see Case 42). Habits cling
more closely in adults, therefore that form of convergent squint in
particular, which usually develops quickly in myopia of average degree,
causes annoying diplopia to last for a longer time. For just when these
patients want to employ binocular vision in order to estimate distance
correctly, diplopia occurs to hinder and confuse them.
It is otherwise with the relative divergence which is developed in
consequence of myopia. At first diplopia is present here for a short
time; in this case circumstances are specially favorable to a temporary
suppression of the deviating eye; the fixing eye receives large distinct
images to which the attention is directed. Meanwhile the relatively
divergent eye is usually turned to other more distant objects that
furnish indistinct retinal images, from which the attention is easily
diverted. The habit of suppression may become so dominant that binocular
fixation continues to exist for distant objects and the presence of
binocular fusion is easily traceable, while for near objects, which are
monocularly fixed with relative divergence, it is impossible to render
the patient conscious of the images of the deviating eye.
Public-domain text, read in full here on John Shaqi.
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