RU2295935C2 - Method for adjusting astigmatism when eye axes deviation angles being different in two eyes - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves separating conjunctiva, removing cornea and a sclera portion. Eyeball content is removed. Nerve-ectomy is carried out by cutting out a hole having 5-7 mm large diameter on the scleral cup bottom. The so produced hole is stitched with silk thread with implant already fixed thereon which is fixed later to posterior eye pole. Synthetic hydroxyapatite cylinder is used as implant which size makes 2/3 of eyeball for producing the stump. Powder of antibiotic of wide activity spectrum is introduced into the scleral cup. The applied synthetic hydroxyapatite is chemically inert biocompatible material not coming into reacting with environment medium. Porous material structure allows contiguous spread of fibrous capsule shoots and blood vessels.

EFFECT: enhanced effectiveness in carrying out operation in single step; reduced risk of traumatic complications.

2 cl

Description

The present invention relates to ophthalmology and is intended to select the best tolerated astigmatism correction with the deviation of the axes of two eyes at a different angle from the vertical.

Correction of anisometropic astigmatism presents known difficulties. It is especially difficult to choose a correction for astigmatism with the deviation of the axes of two eyes at a different angle from the vertical, which is quite common (Radzikhovsky BL Astigmatism of the human eye. - M .: Medicine, 1969. - p. 144, Grosvenor TP Primary care optometry .- Chicago: The professional press, 1982.- p. 27-50). The difficulties of correction in such cases are that spectacle correction with different deviations of the axes from the vertical, as a rule, is poorly tolerated due to a significant distortion of space, double vision, the presence of shadows in the objects under consideration, which makes it difficult to carry out the usual actions, such as walking, especially down stairs, reading, writing, needlework, playing musical instruments, etc. Typically, these problems are exacerbated by the visual (difficulty in focusing, difficulty in moving the gaze from object to object), ocular (pain in the eyes and eyebrows, a feeling of heaviness in the eyelids, a desire to rub eyes, remove glasses) and general (headaches, dizziness, nausea ) complaints. This state of affairs significantly reduces the quality of life, makes some patients abandon their usual work, and causes neurosis. Patients often try to change glasses, refuse to correct astigmatism and try to use spherical correction, which, however, does not solve their problems, since refusing to correct astigmatism significantly affects the quality of vision. Meanwhile, the modern requirements for vision, as well as the modern level of spectacle optics make us look for new ways to correct astigmatism with the deviation of the axes of two eyes at different angles from the vertical to ensure the best quality of vision and, as a result, improve the quality of life.

Correction of astigmatism with the deviation of the axes of two eyes at a different angle from the vertical causes difficulties for ophthalmologists and optometrists, since currently there are no direct tests for the selection of correction and methods for assessing its tolerability in such situations.

Currently, for the selection of correction for astigmatism, an objective study of refraction is used (skioscopy or automatic refractometry), followed by subjective refinement of the force and axis of the cylinder of each eye using a cross cylinder (Radzikhovsky BL Astigmatism of the human eye. - M .: Medicine, 1969 - p. 70-73, Grosvenor TP Primary care optometry. - Chicago: The professional press, 1982. - p. 165-167). The disadvantage of this method is the poor tolerance of correction with two eyes open and, as a consequence, poor tolerance of glasses.

The closest analogue of the invention is a correction selection method using aniseikonimeters, which use the principle of comparing image sizes of a perceived object or measuring the distortion of the space visible through the device (Ames A., 1945, Shapiro E.Sh. Aniseikoniya with normal binocular vision and strabismus: Abstract of thesis .... Candidate of Medical Science - M., 1967. - 16 pp., Gerasimov R.A. Research Methods, Clinical Characteristics and Correction of the Meridional Aniseikonia: Abstract of thesis .... Candidate of Medical Sciences .science. - M., 1975. - 15 pp., Sorokina R.S., Abstract of thesis .... Candidate of Medical Science - M., 1976. - 15 s). The devices were difficult to use, they required the individual manufacture of spectacle lenses, but did not reflect the subjective state of the patient.

The objective of the invention is to develop such a method for correcting astigmatism with deviation of the axes of two eyes at a different angle from the vertical, which would maximize the tolerance of correction with two eyes open, minimally affecting visual acuity.

The technical result of the invention is to improve the quality of vision.

The technical result is achieved by improving the tolerance of correction with two eyes open by selecting correction using binocular presentation of a cruciform lattice and turning the cylinder axis of a more ametropic eye in the direction of the axis of the other eye until the perception of kinks in the metrics of the intersection of the lines of the lattice and different definitions of horizontal and vertical vision stripes of the lattice, after which the cylinder axis of the more ametropic eye is turned in the opposite direction by the minimum value at which the fracture disappears, and the same clarity of vision of the vertical and horizontal stripes of the lattice is restored.

In the proposed method, the rotation of the axis of a more ametropic eye is applied to a position in which the difference in deviation from the vertical axis of the two eyes will be minimal, which ensures good tolerance of the correction.

The traditional cross-shaped lattice is used to determine the completeness of the monocular spherical correction and is a series of crossed horizontal and vertical lines forming the lattice.

Clarification of the strength of the sphere is carried out using a cross-cylinder. The cylinder is attached to the eye alternately with a horizontally and vertically oriented axis. With a correctly selected sphere, after changing the direction of the axis, clearly visible horizontal and vertical lines change places.

In the proposed method, when presenting a cruciform lattice to an eye with astigmatism, if the axis of the cylinder is outside the main meridian, a break is marked at the intersections of the lattice, and the clarity of vision of the vertical and horizontal lines of the lattice is different. The kink disappears, and the same sharpness of the horizontal and vertical lines of the grating is restored when the cylinder axes are in the correct (or close to the correct) position. The break in the lattice and the difference in the sharpness of the vertical and horizontal lines are all the more noticeable the more the direction of the axis of the cylinder departs from the correct one. The deformation of the lattice is clearly visible when binocular presentation of the lattice, even if there is an incorrect direction of the axis of the cylinder on at least one eye. The appearance of lattice deformation is mainly due to the individual sensitivity of the eye to the rotation of the cylinder axis.

The proposed method allows to improve correction tolerance due to rotation of the cylinder axis of a more ametropic eye and, consequently, to improve the quality of life in patients with astigmatism with the deviation of the axes of two eyes at a different angle from the vertical.

The method is as follows.

Patient refraction is examined objectively and subjectively by a generally accepted technique. The axis of the cylinders is refined using a cross cylinder. A spherical cylindrical combination of lenses with axes, the orientation of which corresponds to the results of refractometry, is installed in the test frame. The patient is presented with a binocular cross-shaped lattice. The cylinder axis of the more ametropic eye is rotated towards the cylinder axis of the less ametropic eye until the moment of lattice breakage and the difference in the definition of horizontal and vertical lines of vision. After a kink occurs, the axis is rotated in the opposite direction until the correctness of the lattice is restored. The value by which it is possible to rotate the axis of the cylinder while maintaining the correct vision of the lattice is evaluated as the threshold for a possible rotation of the axis and measured in degrees on the TABO scale.

For good tolerance of the correction with the rotation of the axis, it is important that when the binocular presentation is presented, the cross-shaped lattice looks symmetrical, does not have kinks at the intersections of the bands, and the vertically and horizontally oriented lines are clearly visible.

Clinical examples

Example 1. Patient B., 48 years old. The last 25 years wears LCD, has no glasses.

Vis in contact lenses OD = 1.0 \ OS = 1.0

Previously wore glasses with cylinders, which she did not tolerate well. Contact lens wear is currently contraindicated due to allergic conjunctivitis.

Automatic refractometry data.

OD-5.75-3.00 × 33 °

OS-4.75-2.25 × 172 °

Subjective correction for the highest visual acuity, refinement of the axes using a cross-cylinder.

Vis OD = 0.06s-6.0-3.0 × 35 ° = 0.6

Vis OD = 0.08s-5.0-2.5 × 170 ° = 0.8

With binocular correction OD-5.5-3.0 × 35 °

OS-4.5-2.5 × l70 ° Vis OU = 0.9

However, the tolerance of such a correction is poor, after trial wearing it complains of double vision and distortion of the space, which is especially noticeable when turning the head.

A cross-shaped lattice is presented to a patient with selected binocular correction using a sign projector. With two eyes open, the axis of the right eye is rotated towards the horizontal meridian. A break in the lattice became noticeable when the axis was rotated by 15 °, i.e. when it is set to 20 °, the kink disappears when the axis is oriented to 25 °, horizontal and vertical lines are visible equally clearly.

In accordance with the result obtained after the control test wearing, the patient was given points:

OD-5.5-3.0 × 25 °

OS-4.5-2.5 × 170 °

Vis OU in selected points = 0.9

After making the glasses, full adaptation to the glasses came 7 days after the start of wearing the made glasses. In the future, the patient did not show complaints of intolerance to correction.

Example 2. Patient K., 74 years old. Previously wore glasses with cylinders, but there is no old data. Two years ago, an operation was performed to extract cataracts with IOL implantation in the right eye, after which, according to the patient, “the eyes became different,” he could not use the old glasses. 6 months ago, a similar operation was performed on the left eye. Since then he has not used glasses. The patient is active. Engaged in teaching and research, reads a lot, uses a computer. For reading uses a magnifying glass, when working with a computer uses a large font.

Automatic refractometry data.

0D-0.25 + 2.25 × 118 °

OS 0.0 + 2.5 × 85 °

Subjective correction for the highest visual acuity, refinement of the axes using a cross-cylinder.

Vis OD = 0.2s-0.5 + 2.0 × 115 ° = 0.8

Vis OD = 0.4s-0.0 + 2.5 × 85 ° = 1.0

With binocular correction OD-0.5 + 2.0 × 115 °

OS 0.0 + 2.5 × 85 ° Vis OU = 1.0

However, the portability of such a correction is poor, after trial wearing it makes complaints about the distortion of the space, which is especially noticeable when walking and moving the gaze from object to object.

A cross-shaped lattice is presented to a patient with selected binocular correction using a sign projector. With two eyes open, the axis of the right eye is rotated towards the vertical meridian. The different sharpness of the vertical and horizontal lines and a small fracture of the lattice in the places of the crosshairs became noticeable when the axis was rotated by 15 °, i.e. when it is set to 100 °, the correctness of the lattice is restored when the axis is oriented to 105 °. The difference in the direction of the axes of the two eyes was 10 °. Thus, when the axis of the right eye is oriented to 105 °, and the left eye to 85 °, the cruciform lattice looks symmetrical, no broken lines are noted, horizontal and vertical lines are clearly visible. After the control test wearing, the patient was given points:

OD-0.5 + 2.0 × 105 °

OS 0.0 + 2.5 × 85 °

Vis OU in selected points = 1.0

For reading and a computer, glasses with a positive addition of +3.5 and +1.5, respectively, were written out.

After making the glasses, the full adaptation to the glasses came during the first day of wearing. Does not use a magnifying glass, does not apply a large print.

Thus, the proposed method for selecting astigmatism correction allows you to choose the best tolerated correction for people with astigmatism with the deviation of the axes of two eyes at different angles from the vertical and achieve the best possible visual acuity with the best tolerance for correction, and therefore improve the quality of vision and quality of life in this category of patients .

Claims (1)

A method for correcting astigmatism with a deviation of the axes of two eyes at a different angle from the vertical, including selecting a correction for each eye using an autorefractometer and subjective astigmatic tests, characterized in that under the conditions of corrected astigmatism, they present a cross-shaped lattice with binocular and rotate the axis of the cylinder of a more ametropic eye in the direction axis of the other eye until the perception of kinks at the intersection of the lines of the lattice and different definition of vision of horizontal and vertical stripes of the lattice, after four ametropichnogo rotated about a cylinder axis of the eye in the opposite direction to the minimum value at which the perception of fracture disappears and the same clarity of vision of vertical and horizontal lattice bars restored.