RU2008867C1 - Method of correction of binocular vision - Google Patents

Abstract

FIELD: ophthalmology. SUBSTANCE: test-object are shown for superposition. At first a pair of non-shimmering color test-objects superimposed one to the other without shift in colors where parts of shift and shift-free colors are available when their relative centers are in coincidence. Glance is fixed at specified for patient surface of background light field. Fields of view are separated for observing with single eye for single test-object. Then the same pair of shimmering test-objects (frequency is individual for each eye in the range of 0-10 Hz) is shown and patient should to shift them till moment of initial perception of superimposed test-objects is reached. In subsequent procedures after initial perception of superimposed test-objects is achieved, test-objects begin to oscillate along the line connecting their relative centers; frequency of oscillations is equal to 10 Hz. Test-objects mounted by patient are brought together under condition that subjective perception of their superposition is kept. Cure goes on till achieving objective and subjective superposition, in this situation separation of fields of view is performed by means of anaglyphic spectacles which have filter color corresponding to test-objects. Test-objects to be shown are formed in such a manner, that colors of combined parts being superimposed are summed additively and colors of parts which are not combined stay without changes. Liquid-crystal spectacles may also be used which have time gating of fields of view for each eye. Besides at first test-objects which have different shapes are used, and after result of subjective superposition is achieved the test-objects with different shapes are used. Pairs of test-objects are shown according to play program. Brightness and shapes of test-objects should be changed as acuity of vision is increased. Dimensions of test-objects are reduced as subjective superposition of test-objects is observed. EFFECT: improved reliability of correction. 6 cl, 1 dwg

Description

 The invention relates to medicine, namely to ophthalmology, in particular to the treatment of strabismus and amblyopia with the restoration of binocular and stereoscopic vision in children.

 In recent years, a comprehensive treatment system has firmly entered the practice of treating friendly strabismus, which consists of optical correction of ametropia, amblyopia treatment, operations on the oculomotor muscles, pre- and postoperative orthoptic, pleopto-orthoptic and diploptic methods of treatment. Using this treatment system, it is possible to restore the symmetrical position of the eyes in 75-85% of patients and achieve binocular vision in 25-50% of patients.

 Thus, the ultimate goal of treatment - the restoration of binocular vision - is far from always achieved. The lack of effectiveness of the applied treatment methods, the complexity of the objective control of the process of restoring binocular vision and existing methods of treatment, limiting the possibility of using them for the treatment of young children, makes us look for new ways to restore binocular vision.

 A known method of restoring the mechanism of bifixation. Binocular vision impairment and methods for its recovery. Under. ed. E. S. Avetisova. M.: Medicine, 1980, (p. 125), based on the presentation of one luminous test object to both eyes of a patient, subjective doubling of test objects by placing colored glass in front of one of the eyes and prisms of different strengths, which are installed alternately in front of each eye, by subjective fusion forked image of the test object.

 There is also a known method for restoring binocular vision, based on the presentation by one eye of one luminous test object, subjective doubling of the test object with glasses with red and green filters and negative lenses of increasing strength, which are set alternately in front of each eye, subjectively merging the bifurcated image.

 The essence of the known methods lies in the fact that with the help of prisms and colored glass or with the help of red and green glasses and negative lenses, the patient provokes a doubling of the luminous test object and it is suggested to subjectively split the bifurcated images into one. If he succeeds, doubling is again provoked by increasing the optical power of prisms from 2 to 10 prism diopters or the optical power of lenses from 0.5 to 2 Dptr and the patient is each time asked to subjectively merge the split images into one.

 A disadvantage of the known methods is the difficulty of using them for young children, for which it is difficult to formulate a task that they understand in each exercise, the impossibility of objective monitoring by the attending physician of the treatment process, long treatment periods (20-60 sessions), low efficiency of binocular vision restoration (45% of patients with bifoveal fusion, examined from 5 m with correction), the inability of the patient to actively participate in the treatment process.

 Partially indicated disadvantages are eliminated by moving and blinking test objects in the known method for restoring bifoveolar fusion taken as a prototype (see ed. St. USSR N 162424, A 61 F 9/00, 1985.

 The prototype method, including projecting objects using a synoptophorum to merge at an objective angle of squint and blinking sources of illumination of objects, is based on the fact that in order to ensure a stable fusion, each optical head of the synoptophor is set respectively to half of the objective angle of squint, light fields, against which present objects for fusion, diaphragm, while alternately blinking light sources with a frequency of 2 Hz until bifixation occurs, followed by a smooth increase The flashing frequency is up to 8 Hz, at a frequency of 8 Hz, they switch to synchronous flashing of light sources with a gradual decrease in the blinking frequency to 2 Hz and switch to continuous illumination of objects, while, when the desired medical result is achieved, the degree of aperture is reduced, and the patient’s gaze before treatment fixed on both flashing objects, and during treatment alternately on each of them.

 The essence of the known method is as follows. The patient is offered to install his chin and forehead in the synoptophore facial installation, install the synoptophore optical heads at the interpupillary distance of the patient’s eyes, present each eye of the patient through the corresponding optical head with one of the alternately flickering test objects, the optical heads with the test objects located in them move until the installation stops eye movements and measure in this position the objective angle of squint. Optical heads are mounted at half objective strabismus angles and, in the absence of adjusting eye movements, they present alternately flashing test objects with a frequency of 2 Hz for fusion, that is, objects that differ from each other by additional marks introduced in order to differentiate images belonging to the right and left to the eye. Then, the patient's attention is drawn to the fact that each of the blinking test objects is located directly in front of the corresponding eye, that both test objects are clearly visible and when you look at one or the other test object, the eyes do not change their position (does not make installation movements ), that is, as if “looking in one place”, and therefore objects should be visible “as blinking in one place”, that their perception “in different places”, characteristic of strabismus, is incorrect, since there should not be two directions "right in front of you." Based on this, the patient is given the task: against the background of alternating flashes of test objects, learn to perceive objects for merging as located in one place. Then, the frequency of alternating blinks is gradually increased to 8 Hz, and they are constantly monitored so that there is a vision of one object in one place, if there is a vision of two test objects - the blink rate is reduced, and so on, until at a frequency of 8 Hz, the patient will not get a steady vision of one flashing test object in one place. After that, the simultaneous flashing of test objects at a frequency of 8 Hz is turned on and the patient is given the task of maintaining a single perception of simultaneously flashing test objects, that is, subjectively merge the images of two test objects into one. Further, reducing the blinking frequency gradually to 2 Hz while maintaining subjective fusion, they achieve stable binocular fusion of images of test objects in the patient’s brain.

 As can be seen from the description of the known method, the treatment procedure is rather complicated for young children, since the relationship between the patient and the doctor comes down only to a verbal explanation of what the patient should see and do. It is difficult for young children to understand these explanations, and the doctor does not have the opportunity to clearly show what the child should see. In addition, the child is only required to sit and look into the eyepieces of the synoptophore, he is not interested and uncomfortable to look into the eyepieces of the synoptophore during a 20-minute session, he gets tired, his attention is scattered. The efficiency of achieving binocular fusion is 50%, the number of necessary sessions is up to 90. These disadvantages are eliminated in the proposed technical solution, an active method of treating strabismus and amblyopia.

The technical result achieved is as follows:
the application of the proposed technical solution allows to simplify the treatment procedure, which provides the possibility of treating young children (3-4 years or less), reduces the time for the patient to master the main treatment methods, increases the efficiency of restoring binocular and stereoscopic vision;
the proposed method allows the doctor to objectively control the process and results of treatment and clearly, by way of showing, to demonstrate to the patient what is required of him during the treatment;
the proposed method provides for the active participation of the patient in the treatment process, including in a game form, which allows to reduce the time of each treatment session, which is especially important for young children.

 The essence of the proposed method is as follows. On the background light field, the brightness level and the color of which can vary as directed by the attending physician, pairs of colored test objects are formed in such a way that when one test object is superimposed on another color of the area where they are combined, it becomes a mixed of two colors of test objects color (additive addition of colors), and where not combined, remains the color of one or another test object.

 They provide the ability to move test objects in the background light field along any path according to the command of the patient or doctor during the treatment session with continuous registration of the coordinates of their centers.

 Set the test objects formed on the light field of the background in the patient's field of view superimposed on each other with an objective alignment of their centers. The patient's gaze is fixed in the plane of the background light field at a distance well known to him (for example, at arm's length) with the help of an additional object (image or object) mixed (or white). They show the patient test objects superimposed on each other, make sure that he sees them correctly and offer him to remember their location.

 The fields of vision of the patient’s eyes are separated by glasses with filters corresponding to the test objects, if the test objects of different colors are presented to the patient, the fields of vision are separated using anaglyph glasses with filters of the colors corresponding to the test objects, if the test objects of arbitrary color are presented to the patient it is carried out by liquid crystal glasses with temporary gating of both the visual fields of each eye and the test object corresponding to this eye.

 After the patient put on the separating glasses, he is invited to move one of the test objects, alternately or simultaneously flickering with an individual frequency for each eye in the range from 0 to 10 Hz, to form the image that he saw without separating glasses, that is, to achieve subjective restoration of the originally established location of test objects in his brain (hereinafter referred to as "subjective alignment", if we are talking about objects of different shapes, or "subjective merging", if we are talking about objects of the same ormy, including virtually the same test objects such as stereo pairs designed for working depth of view). The patient moves the test objects and informs the doctor that, in his opinion, he combined (or merged) the test objects, i.e., the moment of subjective alignment or merging, however, at this moment the object centers of the test objects are at a certain distance from each other, which determine the vertical and horizontal components of the angle of squint.

 After achieving the subjective alignment of the centers of the test objects (or any other specified areas, for example, a slice of the front sight and the edge of the target's bullseye, as when shooting), the patient is asked to keep such an image as long as possible.

 A patient who has mastered the operation of combining images of test objects of different shapes is offered to combine test objects of the same shape (and further stereo pairs), while image centers are combined and a stable fusion of two identical images is worked out.

 Further, controlling the fact of the presence of subjective fusion of test objects of the same shape and size in the patient’s brain, they begin to objectively bring together test objects (the approach is performed by the attending physician, patient or automatically) with simultaneous counter-synchronous vibrational movement of the test objects, the oscillation frequency varies from 0 to 10 Hz. The rapprochement of test objects with simultaneous oscillatory motion continues until the beginning of the destruction of subjective merging, i.e., until the moment of subjective destruction of the originally established location of the test objects.

 Cyclically continue these actions until the objective restoration of the original location of the test objects with the objective alignment of their centers while maintaining the subjective alignment or merge them in the patient, and by changing the angle of squint they judge the result of treatment, and in one cycle show non-oscillating test objects of different sizes and forms and test objects of the same size and shape that oscillate with a frequency in the range from 0 to 10 Hz, and the presentation of test object pairs in sequence takes place according to the game th program, and from cycle to cycle size, brightness and shape requirements of test objects changes as the increase in visual acuity.

 The active method of correcting binocular vision can be implemented using the device shown in the drawing where 1 is a patient; 2 - a doctor; 3 - facial ophthalmic installation; 4 - screen; 5 - an additional object with which the patient's eye is fixed on the screen, for example, a screen frame; 6 - test objects (6a, 6b); 7 - scoreboard (can be disabled according to indications); 8 - glasses with filters; 9 - a device for the synthesis of test objects; 10 - device for changing the frequency of oscillations; 11 - control device (manual); 12 - device for changing the flicker frequency; 13 - a device for moving and oscillating test objects; 14 - device for measuring strabismus angles; 15 - automatic control device.

 Patient 1 is offered to fix his chin motionlessly in a standard facial ophthalmological unit 3, fix his gaze on the screen 4, located at a certain distance from the patient’s eyes, using an additional object or image identical for both eyes, for example, frame 5 framing the screen. The distance to the screen depends on the size of the screen, so for a screen measuring 33 cm diagonally, the distance to the screen should be about 60 cm.

 After fixing the gaze on the screen 4, two test objects 6a and 6b, created by the synthesis device 9, of different shapes and sizes of the type of test objects to be combined in a synoptophor, are presented within the frame 5, for example, a large square red frame and a small blue circle, or type test objects to merge in a synoptophor, for example, a red cat without ears and with a tail and a blue cat with ears but without a tail, that is, one test object of one color, and the second of another. Their centers are aligned so that the patient sees a small blue circle surrounded by a large square frame of red color or a cat of mixed color with a red tail and blue ears.

 On the scoreboard 7, according to the data from the measuring device 14, the value "Zero" is displayed, since the distance between the continuously recorded centers of the test objects 6a and 6b is currently equal to zero.

 The initial sizes and brightness of both test objects and their small parts are set using device 9 as prescribed by the doctor, depending on the patient’s diagnosis, taking into account his age and visual acuity. At each stage of treatment, the doctor selects the load on the patient’s eyes, corresponding to the state of vision of each eye. During treatment, the size and brightness of the test objects are changed using the same device 9 by commands from the control device 11 (commands can be issued by the patient or doctor).

 The patient is shown the location of the test objects, make sure that he sees them correctly and offer him to remember the image he saw. Then the patient is offered to wear glasses with red and blue filters 8. In the glasses, the patient sees with one eye red and the other with blue test objects, while subjective mixing of test objects is provoked by the separation of the fields of vision of the patient’s eyes.

 Similarly, the field of vision of a patient’s eyes can be distinguished by glasses with liquid crystal shutters and temporary gating (with a sufficiently high frequency, such as in a movie or television) of the field of view of each eye and each of the presented pair of test objects, for example, such as in the prototype.

 If the patient constantly wears corrective glasses with at least one eye (or for a given range) with optical power of the lenses that is not equal to zero, all further operations are performed with the usual glasses, and separating glasses are worn over them, while the frame or other the object used to fix the distance to the screen, after separation of the fields of view are visible with both eyes due to the choice of the appropriate color or during temporary separation - they are simply present in both fields.

 The patient says that he sees the doctor 2, and the doctor offers the patient to move one of the test objects flickering alternately or simultaneously with a frequency in the range from 0 to 10 Hz to subjectively restore the original location of the test objects, that is, restore that image, which he was asked to remember. Test objects are moved by sending commands from the patient-driven device 11 to the test objects 13 moving and oscillating device, and flickering is performed by sending commands from the device 11 or 15 to the device for changing the flicker frequency 12, and the flicker frequency is set individually for each eye.

 With subjective alignment, the distance between the centers of the test objects is objectively not equal to zero. At this moment, using the measuring device 4, the horizontal and vertical components of the squint angle are measured, which are defined as the corresponding components of the displacement vector of the center of one test object relative to the center of the other. At the same time, the doctor, seeing the objective position of test objects 6a and 6b on screen 4, can immediately judge the presence or absence of both vertical and horizontal strabismus in the patient. For example, the location of the center of one test object on the screen above or below the center of another test object indicates the patient has a vertical component of the angle of squint.

 Each patient is offered several options for pairs of test objects, after which the doctor selects one or more pairs for the treatment of a particular patient, depending on his age, psychophysiological characteristics and diagnosis.

 Options are suggested by your doctor. As a result, by selecting a suitable shape, brightness, and flicker frequency of alternately flickering test objects, which are very different in size and shape, the patient is trained to look with both eyes and learn to coordinate movement and vision of test objects, and by moving the flickering test objects simultaneously, there are few or completely different in size and shape type of test objects for merging is taught to merge test objects into one.

 If the patient can subjectively merge test objects and keep this merging while objectively bifurcating them, they are presented with superimposed test objects of the same shape and size (this includes test objects with a stereo effect) formed by synthesis device 9. This can be the same the sizes of red and blue circles, such that when they are superimposed on each other, the leading eye without separating glasses sees one mixed-colored test object (in glasses with filters, each eye of the patient sees his own test object, but both of them are located in one m place, unlike the prototype, where test objects are located in different parts of space, where each eye sees its own test object in its place in space and they can never be combined in one place).

 Further, with constant monitoring of the presence of subjective fusion on the part of the attending physician (by interrogating the patient or by adjusting eye movements (, on command from the automatic or manual control device 15 (11), using the moving and oscillating device 13, they counter synchronously oscillate with amplitude , the value of which is limited by the value of fusional reserves and counter gradual movement of test objects until the moment of destruction of subjective merger. for each patient and may vary from session to session depending on the patient’s condition. Frequency range from 0 to 10 Hz. Oscillatory movement of test objects can occur according to the doctor’s prescription both in horizontal and vertical directions, and along the line connecting test centers objects.

 Further, the treatment procedure is cyclically repeated, and the cycles continue until the objective location of the test objects is restored objectively (the distance between the continuously recorded centers of the test objects is zero) with a steady retention of subjective alignment or fusion (the retention time of test objects fused can serve as a measure of stable subjective fusion )

 PRI me R 1. Extract from the medical history N 18352 DGKB N 7, Moscow, patient P. born in 1982.

 DS: convergent, primary, permanent, alternating, friendly squint. Mows since 1,5 years. He visited a specialized kindergarten, where the following treatment was carried out: constant wearing of glasses, occlusion, hardware treatment, including synoptophore.

=

без очков (б/о)
Visus

=

с коррекцией сферической линзой
Sph 2,0
Dev 0-15^o conv alt
Характер зрения - одновременный, чередующийся с монокулярным.Upon receipt: Visus

=

without glasses (b / o)
Visus

=

with spherical lens correction
Sph 2.0
Dev 0-15 ^o conv alt
The nature of vision is simultaneous, alternating with monocular.

Synoptophor o / y = 10 ^o , s / y = 0 ^o (fusion)
Operation: 09/10/91

 The treatment of the proposed method since 12.09.91

=

б/о.After 10 lessons, eye condition:
Visus

=

b / o.

Dev 0 ^o
The nature of vision is binocular.

o / y = s / y = 0 ^o (merging).

 Fusion reserves +6.

 PRI me R 2. Extract from the medical history N 18350 DGKB N 7, Moscow, patient S. born in 1985.

 DS: convergent, primary, permanent, alternating, friendly strabismus OU.

 We noticed strabismus from 4 months, wears glasses constantly from 2 years. Since 2 years is in special. kindergarten, where he received pleopto-orthoptic treatment, treatment at synoptophore.

=

б/к и

в/о
Dev 12-15^o conv alt в/о и б/о.Upon admission to the department, the eye condition is as follows:
Visus

=

b / c and

in
Dev 12-15 ^o conv alt w / o and b / o.

 The nature of vision is monocular alternating. The mobility of the eyeballs in full. Hyperaduction of the III degree.

 10/29/91, produced in both eyes a recession of the internal rectus muscles. The postoperative period is smooth.

=

б/к и

в/о.From the 3rd day classes were scheduled for the proposed method. After 10 lessons:
Visus

=

b / c and

in.

Dev 0 ^o in / o and b / o.

 The nature of vision is simultaneous, alternating with binocular.

At synoptophore: s / y = o / y = 3 ^o
Fusion reserves from -8 to +4
From 01.20.92, the second course of treatment was carried out according to the proposed method.

=

б/к и

в/о
Dev 0^o в/о.After 10 sessions, eye condition:
Visus

=

b / c and

in
Dev 0 ^o w / o.

 The nature of vision is binocular.

At synoptophore: o / y +2 ^o , s / y +4 ^o (merging)
Fusion reserves from -9 to +14. (56) Copyright certificate of the USSR N 1162424, cl. A 61 F 9/00, 1985.

Claims (6)

 1. METHOD FOR CORRECTION OF BINOCULAR VISION, including presentation of test objects for combining, characterized in that first they present a pair of non-flickering color test objects superimposed one on top of the other without mixing colors, with the presence of mixing and non-mixing areas of colors when combining their conditional centers, fix a look in the plane of the background light field specified for the patient, the visual fields are divided for one eye to observe one test object, then they present the same pair of blinking with an individual frequency for each eye in tore from 0 to 10 Hz of test objects and offer the patient to displace them until the initial perception of superimposed test objects is restored, in the following procedures, after reaching the initial perception of superimposed test objects, oscillate test objects along the line connecting their conditional centers with a frequency to 10 Hz and bring the test objects set by the patient closer, provided that the subjective perception of their overlap is maintained, treatment is continued until the objective and subjective overlap match.  2. The method according to p. 1, characterized in that the separation of the visual fields is carried out with anaglyph glasses with the colors of the filters corresponding to the test objects, while the presented test objects are formed so that when superimposed on one another, the colors of the combined areas add up additively, and the colors uncoordinated areas remain unchanged, or with liquid crystal glasses with temporary gating of the fields of view of each eye.  3. The method according to p. 1, characterized in that the test objects of various shapes are used first, and upon achievement of the result of subjective overlay, test objects of the same shape.  4. The method according to p. 1, characterized in that the presentation of pairs of test objects is performed according to the game program.  5. The method according to p. 1, characterized in that the brightness and shape of the test objects change with increasing visual acuity.  6. The method according to p. 1, characterized in that the size of the test objects is reduced as a steady subjective merger of test objects.

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