[Binocular function clarified]. / La fonction binoculaire explicitée.

Normal binocular function is defined as the bifoveal connection of the central and peripheral structures of the visual system. Binocular function in strabismus is defined as connections, more or less strong and more or less labile, of the fovea of the fixating eye with the "pseudo-fovea" of the deviating eye including all central and peripheral structures, and this connection represents, in fact, a progress of adaptation of all parameters to the new conditions of vision.

[Skiascopy. Some reflexions on the prescription of optical correction]. / La skiascopie. Quelques réflexions à propos de la prescription de la correction optique.

The skiascopy allows determination of the objective eye refraction, but this exam should not be interpreted mechanically. The eye is a living organ and several subjective factors should be considered, mainly the accommodation and oculomotor equilibrium. Based on her own experience, the author discusses the difficulties she had in prescribing optical corrections for 7 patients, after she had done the skiascopy. Transcription of data objectively acquired using skiascopy must consider also the psycho-physiological state of the subjective patient.

[Visual acuity study in the child 18 months to 2 years old]. / Exploration de l'acuité visuelle chez l'enfant de 18 mois à 2 ans.

Visual acuity for a child may be determined using objective instrumental methods (especially for children under 18 months) or using clinical examination at the optotype--subjective methods (for children after 18 months). The use of 2 or 3 different optotypes, which are attractive for children, is necessary because of their great capacity of memorizing the tests. The author presents a personal optotype model, with seven different images, which have to be recognized by the children from a distance of 2.5 m.

[Decrease of the functional affinity of rheumatoid factors under the effect of tiopronin]. / Réduction de l'affinité fonctionnelle des facteurs rhumatoïdes sous l'effet de la tiopronine.

Sixteen rheumatoid arthritis patients were serologically examined, before and after a 2-month treatment with tiopronine (TP). The titer of agglutinating rheumatoid factor (RF) as well as the level of non-agglutinating RF were significantly reduced in serum and synovial fluid (SF). The functional affinity of the remaining RF was attenuated in serum (p less than 0.01) and SF (p less than 0.05). Conversely, the proportion of asialylated IgG was enhanced in serum (p less than 0.05) and SF (p less than 0.05). These findings would suggest that TP might restore the efficacity of sialyl transferase at the B lymphocyte level.

[Primary intermittent exotropia and its treatment]. / L'exotropie intermittente primaire et son traitement.

After reviewing literature concerning IE, the following conclusions can be pointed out. The IE is a mild form of strabismus, provided that all the disturbed parameters, especially the processes on inhibition, should be involved in the treatment (in this case, prism looks to be the best method because of its efficiency all day long and because it does not force the patient to exercises more or less tedious.

[Treatment of strabismus with focused prisms in 1984]. / Traitement du strabisme par les prismes mise au point 1984.

The use of prisms in treatment of strabismus not only varies according to the author involved but often, a same author will change his opinion on the subject as time goes by. In the first case aetiopathological conceptions and the finality of treatment differ, in the second case improved theoretical knowledge and new possibilities in examination techniques and treatment etc., come into play. For this latter reason we wish to give complementary information and generally revise the publication on the use of prisms published in 1973 (18). The revised version in no way invalidates the previous work, it brings it up to date and gives further information on the severe forms of strabismus which, at the time of the first publication, constituted the failure group. These severe forms (both lesional and functional), the percentage of which has mostly increased during the last 15 years, are probably a consequence of 'suffering' during either the foetal or neo-natal stage. It could be that this 'suffering' gives rise to a minute isolated lesion within the sub-cortical motor centres (microlesions as described by neuropaediatricians). In situation, there are intermediary forms and come between the organic oculomotor disturbances of the cerebral palsied child and the strictly functional strabismus of the child who is otherwise normal. We have modified and adapted our diagnoses and techniques in view of the multiplicity of such forms and their resistance to conventional therapy. A better understanding of the process responsible, use of more sensitive methods of exploration, a longer period of functional readaptation and new techniques (particularly surgery-) all have a part to play in the new therapy. Where operating is concerned changes apply to the time selected, technique and number of operations performed: two or three stages are necessary. We give a general view of the extreme variety of clinical forms of strabismus and their causes and then give diagnoses and outlines for therapy based on four different type-cases. Clinical facts indicate that in severe forms it is possible to obtained a cure (bifoveality) on condition that the sub-cortical organic damage is very slight and that the optomotor dysfunction (which is its consequence) can be inhibited through satisfactory cortical functioning. However, such treatment requires rigourous participation of both the family and the child over a period of years. Unfortunately this treatment is possible only in a small percentage of cases.

[Accommodation in strabismus]. / L'accommodation dans les strabismes.

This paper describes clinical observations of optico-sensori-motor symptomatology prior to and during treatment for strabismus. These findings were compared with theoretical data of the binocular visual function. We consider that binocular function has the structure and the working of a "set" in cybernetic sense. In this psycho-physiological set, the accommodative system constitutes a "sub-set". The classification of accommodative disturbances as "pure or impure" and "typical or atypical" arises from the fact that a rebuilding of the visual function has occurred. Thus in "pure" accommodative strabismus the disturbances of accommodation results from "peripheral" accommodation and is easily reversible. In this situation ocular deviation has been perfectly corrected for and binocular vision normally built up since there is enough compensation of the whole optical correction. In "impure" accommodative strabismus the perturbation of accommodation affects the whole accommodation system and also the sensorial motor system. Thus there is a restructuring of the optico-sensori-motor set that is more or less reversible due to a variety of factors. From these investigations we conclude: every strabismus is accommodative in the sens that in every strabismus there is a disturbance of accommodative mechanism. Furthermore, we oppose believers of "all sensorial" and "all motor" mechanisms. Considering that strabismus is a disturbance of optico-sensori-motor binocularity, nothing can be only "accommodative", only "sensorial" and only "motor". From this it follows that treatment should not be only "motor", only "accommodative" or only "sensorial".

[Functional treatment of strabismus: theoretical bases--practical rules]. / Le traitement fonctionnel du strabisme: bases théoriques - règles pratiques.

Functional treatment of strabismus is no longer empirical, but has currently a scientific basis. To disperse the "doubts" surrounding functional treatment, it appeared necessary to situate it more clearly within its true framework, that of functional re-education in general. Indeed, although the terrain differs adults with a lesion and children whose binocular function is poorly or only partially developed - in both cases: - functional recovery is the result of changes within the central nervous system, changes which are possible due to the plasticity of the central nervous system. These modifications occur very slowly, sometimes over a period of years. - The crucial condition for success of treatment remains the same: the patient must participate actively, this being all the more essential in that recovery will take a long time. Although strabismus treatment must obviously consider physiological parameters (triad), psychological parameters are just as important, and as well as purely technical problems, other factors must also be taken into account: subject's motivation, length of treatment, communication with the doctor and medical team, attitude of the patient's family. This type of therapy is only justified as long as strabismus is considered to be a dysfunction of binocularity (this however, does not exclude surgery in some cases, and the operation is an integral part of the treatment). Functional treatment of strabismus is therefore difficult and disconcerting for the practising ophthalmologist. Disconcerting in that it differs radically from other types of eye therapy (medical or surgical); difficult in that the restraint it imposes is often in contradiction with the permissive society we live in. One of the main obstacles to be overcome is perhaps our own judgement as ophthalmologists; our opinion of the nature of strabismus, the possibility of a cure, to which must be added the application of the right technique, patient participation, etc. This study attempts to situate strabismus within the general framework of functional re-education, employing different authors' opinions of basic notions of neurophysiology relating to nervous plasticity and their application in cases of cortical lesions in adults. In Part II we shall outline why and how we have opted for functional re-education. The reasons why and the manner in which functional re-education was chosen are then outlined.