RU2175221C2 - Method for improving vision function in depraved vision patients - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves showing text to monocularly amblyopic eye for reading. Maximum reading speed is determined. Next to it, the eye with better vision function is included in the work. To reduce acuity of its vision, semitransparent filter is applied. In the course of vision acuity and amblyopic eye reading speed being increased, light filter transparency is increased before eye with better vision function. EFFECT: enabled fusion at finite distance.

Description

 The invention relates to medicine, namely to ophthalmology, and is intended to increase visual function in the visually impaired.

 There is a way to increase the visual acuity of the amblyopic eye while maintaining participation in the act of vision of the leading eye by penalizing the latter. (E. S. Avetisov et al. Penalization in the treatment of friendly strabismus in children, - "Bulletin of Ophthalmology", - 1977, - N 6. - P. 24-28). The essence of the method is to lower the vision of the better seeing eye when it is turned off incompletely (from penalite - fine, recovery). This is achieved either by atropinization of the better seeing eye, or by its hypo- or hypercorrection, as well as in a combination of these techniques. In this case, the leading, amblyopic eye becomes worse.

 Various types of penalization: for distance, for near, light, selective, complete, alternating, are intended to increase the visual acuity of the amblyopic eye and create conditions for binocular fusion (fusion).

 However, penalizing glasses, especially in combination with atropinization of the better seeing eye (“static” penalization), exclude the possibility of a functional, dynamic effect on binocular functions due to paresis of accommodation or the constant power of the penalizing eyeglass lens.

 Traditional penalization does not provide the possibility of a consistent, metered-increasing connection of a better seeing eye to the act of binocular vision. There are no conditions for monitoring the quality of visual perception (visual work) and the degree of participation of each eye in the visual act.

 The “dynamic” penalization allows the patient, while reading a coherent text, independently, while comprehending the words he has read, to control the quality of the text perception by the amblyopic eye. With an increase in visual acuity and reading speed with an amblyopic eye, using filters of different densities, dynamic correction of the degree of connection of the better seeing eye to visual work is possible with constant monitoring of fusion (binocular vision) and monocular and binocular reading speed.

 The technical result of the proposed method is: restoration of binocular vision by increasing the visual acuity of the amblyopic eye and creating conditions for the implementation of fusion (binocular fusion) at a finite distance.

 The technical result is achieved by creating conditions for increasing the visual acuity of an amblyopic eye by presenting test objects corresponding to its resolution, followed by including a better-seeing eye in the visual act using sequential dosed fogging with neutral filters (“dynamic” penalization) under speed control reading.

The method is as follows:
initially, the text enlarged for perception, for example, using a television magnifying device, is presented monocularly to the amblyopic eye for reading, and the maximum reading speed is determined. For this patient, they are seated at a table on which a TV monitor screen of a magnifying device is located at a distance of 60-80 cm from the patient’s eyes, the better seeing eye is closed with a tight occluder, and for the worse seeing eye, the magnification necessary for reading is determined. A book is placed on the coordinate table of the TV device and, moving the table from left to right, provide reading. Using the pen located on the front panel of the device control unit, gradually changing the magnification, they achieve a letter size at which the maximum reading speed is achieved, thus determining the most optimal conditions for the eye to work with. Reading speed is determined and recorded as the number of alphabetic characters read per unit time. It depends on the number of letters on the monitor screen and the speed of movement of the coordinate table.

 For 15-20 minutes, the amblyopic eye reads a text that is accessible to its perception, which ensures the training of its visual functions. Then, using a translucent, pre-selected (see below) filter, a better seeing eye is connected to the visual work, while the speed of the coordinate table does not change. Bagolini glasses are placed in front of each eye, a point light source is placed under the screen of the monitor, and they are convinced that the light lines intersect. During binocular observation of the text on the TV monitor screen, the patient continues to read for 15-20 minutes, every 5 minutes with the help of Bagolini lenses they are convinced of binocular observation of the text and the presence of fusion.

 Preliminary selection of filters is carried out according to special tables for proximity using a set of neutral filters. In front of a better-seeing eye, filters of different densities are sequentially placed in the test frame and a filter is selected that provides better visual acuity of the better-seeing eye, 1-2 gradations lower than the visual acuity of the amblyopic eye, provided that the font selected for the amblyopic eye is distinguished on the TV monitor screen, and fix the number of the filter.

 In subsequent sessions, in cases of increasing the resolution of the amblyopic eye, reduce the size of alphabetic characters on the TV monitor, and also accordingly reduce the density of the filter for a better-seeing eye.

 In the presence of a convergent strabismus, the distance to the TV monitor remains unchanged. With orthophoria, to strengthen the incentive for bifoveal fusion, after 4-5 sessions, reduce the distance to the TV monitor by 10 cm while reducing the size of the letters, first making sure that fusion at this distance is possible.

 The course of treatment is up to 20 lessons, the duration of one treatment session is from 30 to 40 minutes.

 Example. Patient K., 9 years old. Diagnosis: Congenital pathology: partial atrophy of the optic nerves of both eyes, right eye: moderate hyperopia, complex hyperopic astigmatism, high degree amblyopia; left eye: mild hyperopia, complex hyperopic astigmatism.

Visual acuity in the distance OD 0.04 sph + 3.0 D cyl + 2.5 D ax 30 ^o -0.1,
OS 0.07 with sph + 1.5 D cyl + 1.5 D ax 150 ^o -0.2.

Visual acuity near OD 0.04 c sph + 4.0 D cyl + 2.5 D ax 30 ^o - 0.09,
OS 0.08 c sph + 2.5 D cyl + 1.5 D ax 150 ^o -0.2;
binocular - visual acuity with a correction of 0.2.

 The nature of vision in the distance with correction - simultaneous vision, near correction - unstable binocular.

 The maximum reading speed (MSC) of the 5-fold enlarged font with the right eye is 310 characters / min, the left eye is 550 characters / min, binocularly the MSC is 550 characters / min. With a filter of 90% density - MIF with the left eye - 290 characters / min, visual acuity with correction + filter of 90% density - 0.08.

 Conducted exercises according to the described method.

After 9 sessions:
Right eye: visual acuity in the distance and near with spectacle correction - 0.13, MSC - 345 characters / min, left eye: visual acuity in the distance and near with correction - 0.08, MSC - 300 characters / min, binocular - MSC - 350 characters / min

 The density of the filter on the left eye is reduced, the visual acuity of the left eye with a filter of 75% density is 0.12, MSC is 325 cpm, binocularly 350 cpm. The distance to the TV monitor was reduced by 20 cm with the corresponding change (decrease) in the size of letters on the screen.

 The nature of near vision is unstable binocular vision.

After 20 sessions:
The right eye: visual acuity with correction in the distance and near - 0.17, MUCH - 400 characters / min, the left eye: visual acuity with correction in the distance and near - 0.22, MUCH - 560 characters / min.

 Visual acuity with binocular correction - 0.25, MSC binocular - 600 zn / min.

 The nature of the distance vision is unstable binocular, near - binocular vision.

 Thus, after 20 sessions, visual acuity in the right eye increased from 0.1 to 0.17, MSC increased from 310 signs / min to 400 signs / min. Binocular - visual acuity increased from 0.2 to 0.25, the nature of distance vision changed from simultaneous to unstable binocular vision, near - from unstable binocular vision to binocular vision. MSS increased from 550 zn / min to 600 zn / min.

Example 2. 2nd year student Katya P., 9 years old. Diagnosis: Congenital underdevelopment of the organ of vision: microphthalmos, microcornea, postoperative aphakia of both eyes, periodic convergent monolateral strabismus of the left eye (up to 5 ^o ), horizontal nystagmus, weak amblyopia of the right eye, high degree amblyopia of the left eye.

Visual acuity in the distance OD with sph + 10.0 D cyl + 1.0 D ax 90 ^o -0.4,
OS c sph + 12.0 D cyl + 2.5 D ax 115 ^o -0.09.

Visual acuity near OD with sph + 13.0 D cyl + 1.0 D ax 90 ^o -0.35,
OS with sph + 15.0 D cyl + 2.5 D ax 115 ^o -0.1,
binocular - visual acuity with a correction of 0.4.

 The nature of vision in the distance with correction - monocular vision, near correction - simultaneous vision.

 The maximum reading speed (MSC) with the right eye is 500 characters / min, the left eye of the MSC font, enlarged 4 times, 210 characters / min, binocular - MSC - 500 characters / min. With a light filter of 80% density, the MSC with the right eye is 200 signs / min, visual acuity of the right eye with correction + a filter of 80% of density is 0.08.

 Conducted exercises according to the described method.

After 8 sessions:
The right eye: visual acuity in the distance and near with spectacle correction and a light filter of 0.08, MSC - 200 characters / min, the left eye: visual acuity in the distance and near with correction - 0.15, the MSC - 280 characters / min, binocular visual acuity 0 , 15, MSS - 300 characters / min.

 The density of the filter on the right eye has been reduced, the visual acuity of the right eye with the filter is 60% of the density is 0.12, MFR 280 characters / min, binocularly 300 characters / min. Due to the increase in visual acuity in the left eye, the sizes of letters on the TV monitor are accordingly reduced.

 The nature of near vision is unstable binocular vision.

After 20 sessions:
Right eye: visual acuity with correction in the distance and near - 0.45, MUCH 520 zn / min,
left eye: visual acuity with correction in the distance and near - 0.2, MSC - 355 characters / min.

 Visual acuity with binocular correction - 0.45, MSC binocular - 540 characters / min.

 The nature of distance vision with correction is simultaneous vision, near - vision is unstable binocular.

 After 20 sessions, visual acuity in the left eye increased from 0.09 to 0.2; MSS increased from 210 zn / min to 355 zn / min. Binocular - visual acuity increased from 0.4 to 0.45. The nature of distance vision has changed from monocular to simultaneous vision, near - from simultaneous to unstable binocular vision. The MSS of both eyes increased from 500 cpm to 540 cpm.

 Thus, the proposed method allows for the "dynamic" penalization, ensuring the restoration of binocular vision by increasing the visual acuity of the amblyopic eye, increasing the monocular and binocular reading speed and creating conditions for fusion (binocular fusion) at a finite distance.

Claims (1)

 A way to increase visual functions in visually impaired people, including penalizing a better-seeing eye by fogging it, ensuring equal visual acuity of both eyes, characterized in that they use a “dynamic” penalization, which consists in initially presenting a text enlarged to the amblyopic eye for reading of its perception, determine the maximum reading speed, and then, using a translucent light filter, which reduces visual acuity by 1-2 gradations of the better seeing eye compared to visual acuity of the amblyopic eye, a better seeing eye is connected to the visual work while maintaining the same reading speed, as the visual acuity and reading speed of the amblyopic eye increase, the transparency of the filters in front of the better seeing eye is achieved until the monocular and binocular reading speed is uniform.