RU2329017C1 - Method of diagnostics and functional treatment of myopia and other refraction anomalies - Google Patents

Abstract

FIELD: medicine; ophthalmology.

SUBSTANCE: diagnostics includes detection of critical flicker fusion frequency (CFFF) to colour stimulus - red, dark blue, green. CFFF to each emission colour is evaluation at various gradation of the fixed parameters: brightness: - subthreshold, 2 - threshold, 3 - superthreshold, flash angle: 15°, 30°, 45°, off-duty ratio: 1 to 3. There distance 25 cm is provided from an eye to colour stimulus. Those colours, brightness levels, off-duty ratio and flash angle associated with decreased CFFF indicate diagnosed myopia or other refraction anomalies accompanied with sensor-motor dysfunction. It is followed with flashing light exposure of specified chromaticity, brightness, off-duty ratio and flash angle starting with frequency 20% below threshold being lower frequency gradually increased to frequency value exceeding it by 20% being upper frequency, thereafter in a reverse order. Exposure is repeated within 5-10 minutes daily, within 10-15 days.

EFFECT: method provides developing of diminished accommodative-sensory resources of visual analyser.

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Description

The technical field to which the invention relates.

The invention relates to ophthalmology, more specifically to methods of light diagnostics and therapy of myopia and other refractive errors, which use LED optical radiation.

As you know, the leading pathogenetic factor in the emergence and development of myopia is the weakness of the accommodative apparatus of the eye (Avetisov E.S. Myopia. M., Medicine, 1999, 286 p.). However, in addition to motor impairments, with progressive myopia and accommodation dysfunctions observed with other refractive errors, sensory impairments are also noted, namely, a decrease in the frequency-time contrast sensitivity - the critical frequency of flicker fusion (CSFM) to color stimuli, an important clinical indicator characterizing functional visual analyzer lability (Golubtsov K.V., Kuman I.G., Heilo T.S. et al. // Information Processes, 2003, vol. 3, No. 2, C.114-122; Iomdina E.N., Egorova T.S., Golubtsov K.V., Egorova T.S. ligature state with temporary accommodation contrast sensitivity of the eye. // Conference Proceedings "Biomechanics of eyes 2005", Moscow, 2005, s.48-51). It has been established that for all refractive errors accompanied by accommodation disturbances, the CESM rate for red, blue, and green stimuli is reduced to one degree or another, while with progressive myopia this decrease is most significant, directly proportional to its degree, and is especially pronounced when a blue stimulus is presented ( Iomdina E.N., Egorova TS, Golubtsov K.V., Egorova TS Connection status of accommodation with temporary contrast sensitivity of the eye. // Proceedings of the conference "Biomechanics of the eye 2005", M., 2005, p. 48-51), what can life l is associated with the development of ophthalmoscopically unidentifiable myopic changes in the fundus. In this regard, for a detailed diagnosis of the nature of the course of the myopic process and other refraction anomalies, as well as for functional correction of the revealed violations, more complete information about the state of temporary contrast sensitivity of the visual analyzer is required. Such a diagnosis is necessary to select individual modes of targeted and effective functional therapy.

State of the art

The closest analogue of the proposed method for the diagnosis and treatment of myopia and other refraction anomalies is a method for determining the critical flicker fusion frequency (CSCF) on color stimuli and a functional treatment technique aimed at correcting sensorimotor eye indices with accommodation disturbances for various refraction anomalies (E.N.Iomdina, TS Egorova, IV Egorova, KV Golubtsov, State of sensorimotor parameters of the visual analyzer in children with functional treatment of accommodation disorders // Bulletin of Optometry, 200 6, 5, p. 48-50). The disadvantage of this diagnostic method is the significant dependence of the research results on the distance between the eye and the source (shaper) of variable color radiation, which is not recorded objectively during the study. In addition, the study is carried out at one predetermined value of the color stimulus brightness, its duty cycle and the angle of illumination, which does not allow the determination of CPSM, taking into account the individual anatomical and functional features of the examined organ of vision, primarily associated with the existing refractive error. Accordingly, the treatment technique used, based on these data, does not provide a targeted effect on sensorimotor indices characteristic of a given eye. At the same time, in order to obtain more complete information about the state of the sensorimotor system of the eye with myopia, hyperopia or astigmatism, it is necessary to study the temporal contrast sensitivity (CFSM) for color stimuli at various brightness ranges (from sub- to suprathreshold) at a strictly fixed distance from the eye, different flare angles (from a narrow to a wider zone of retinal irritation with a flickering color stimulus), as well as with different values of the duty cycle of presentation of color flickers. The identification of the individual reaction of the sensorimotor system of the eyes with refractive errors to a change in the listed environmental factors that are most important for vision should be used to prescribe appropriate functional treatment regimens. This treatment should be aimed at the development of reduced accommodation and sensory capabilities of the visual analyzer in order to prevent the progression of myopia and increase visual function with other refractive errors.

Disclosure of invention

The essence of the proposed diagnostic and treatment method is to determine the critical flicker fusion frequency for each of the radiation colors (red, blue, green) at various gradations of the recorded parameters: brightness (1 - subthreshold, 2 - threshold, 3 - suprathreshold), exposure angle (15 °, 30 °, 45 °), duty cycle (from 1 to 3), while providing a fixed (25 cm) distance from the eye to the color stimulus. For those colors, brightness levels, duty cycle and exposure angle, where the maximum reduction in CFSM was found, the sensorimotor dysfunction characteristic of this patient with myopia or other refractive errors is diagnosed, and then they are exposed to the flickering light of the established brightness, color, duty cycle and exposure angle, starting from a frequency 20% lower than the found one (lower frequency), gradually increasing it to a frequency value 20% higher (upper frequency), then in the reverse order, the effect is repeated for 5-10 minutes ut daily for 10-15 days.

The technical result is achieved by determining the threshold values of CFSM in various conditions of visual activity - with certain gradations of the recorded parameters: color, brightness, duty cycle and magnitude of the exposure angle and subsequent therapeutic exposure with a flickering stimulus of the established color, brightness, duty cycle and exposure angle, starting with the frequency at 20% below the threshold - the lower frequency, gradually increasing it to a frequency value that is 20% higher than the upper frequency, then in the reverse order.

The method of diagnosis and treatment is as follows. All colors are shown successively to the patient, while the brightness levels, duty cycle values and exposure angle are varied. The moment of fusion of the pulses is recorded by the patient by pressing a button. Double-clicking the button repeats the last section of the program, i.e. the moment of the merger can be registered several times. The values of the specified parameters and the measured merge frequency are recorded in a computer database. Diagnostics can be carried out in 3 colors (green, blue, red), with several gradations of brightness (1 - subthreshold, 2 - threshold, 3 - above threshold), the brightest (above threshold) corresponds to the LED power of 1 mW, less bright (threshold) corresponds to power LEDs 0.9 mW, the least bright (subthreshold) - 0.8 mW (maximum light pulse power 0.8 Mcd), with several values of duty cycle (1, 2, 3) and several values of the angle of illumination (15 °, 30 °, 45 °).

In the treatment mode, the program circuit generates during the session time the prescribed values of brightness and illumination angle for all given colors and provides a change in the ripple frequency from the lower to the upper frequency with a given rate of change. The direction of the frequency change may change if necessary. For each patient, an individual mode determined by preliminary diagnostics is established on the CFSM research device: color, brightness level, duty cycle and exposure angle, while the frequency is set 20% below the individual threshold (lower frequency). Using known means, a frequency scan is performed from the set level to the level of 120% of the norm (to the upper frequency). Scanning is performed multiple times in the forward and reverse directions. The procedure time is assigned individually, it can be from 5 to 10 minutes daily for 10-15 days.

The use of the diagnostic and treatment method is illustrated by clinical examples.

Example 1. Patient S., 12 years old. Diagnosis: emmetropia OU. CFSM study mode: color stimuli (red, blue, green), subthreshold brightness, duty cycle (all values), exposure angle (all values). Diagnostic results: CFCF (period / sec) for all values of duty cycle and exposure angle and at a subthreshold level of brightness in both eyes is 42.3 for the red stimulus, 40.3 for the blue stimulus and 43.3 for the green stimulus. Diagnosis: these values refer to the age norm, dysfunction is not determined, treatment is not required.

Example 2. Patient R., 13 years old. Diagnosis: mild hyperopia of degree OU. CFSM study mode: color stimuli (red, blue, green), brightness (all levels), duty cycle (all values), exposure angle (all values). Diagnostic results: CFSM (period / sec) for all values of duty cycle, exposure angle and threshold brightness are: OD for the red stimulus - 41.7, for the blue stimulus - 39.9, for the green stimulus - 42.9, on OS, respectively 41.5, 39.8, 43.0. Diagnosis: these values indicate a slight decrease in the CSFM at a threshold brightness, associated mainly with a weakening of the accommodative ability of hyperopic eyes. Identified mild dysfunction requires functional treatment, involving the presentation of a red and blue stimulus with threshold frequencies equal to 41.7 and 40.3, respectively (scan from 33.3 to 50.0 for the red stimulus and from 32.2 to 48, 4 for blue), when changing the brightness from subthreshold to threshold. Treatment in this mode was carried out for 3-5 minutes for 5 days. At the end of treatment, the CESF values were restored to the age norm at subthreshold brightness.

Example 3. Patient S., 14 years old. Diagnosis: high degree myopia OU. CFSM study mode: color stimuli (red, blue, green), brightness (all levels), duty cycle (all values), exposure angle (all values). Diagnostic results: CSFM at suprathreshold brightness, increased duty cycle (3) and the largest exposure angle (45 °) are 38.8 for the red stimulus, 34.9 for the blue stimulus, and 40.5 for the green stimulus. Diagnosis: these values indicate a marked decrease in sensorimotor indices associated both with disturbances in accommodation ability and with the latent development of dystrophic changes in the fundus of myopic origin. The functional treatment regimen included the presentation of a red, blue, and green stimulus with threshold frequencies of 38.8, 34.9, and 40.5, respectively (scan from 31.0 to 46.6 for the red stimulus, from 28.0 to 42.0 for blue, from 32.4 to 48.6 for green) when the brightness changes from subthreshold to threshold, the duty cycle is 3 at the beginning of treatment and 2 5 days after the start of treatment, with a flare angle of 45 °. The treatment was carried out for 5 minutes daily for 10 days. At the end of treatment, the CFSM indicators for all color stimuli significantly increased: for red to 40.0, for blue to 39.5, for green to 41.7 at subthreshold brightness; the volume of absolute and the stock of relative accommodation increased, uncorrected visual acuity increased.

Thus, the proposed method for the diagnosis and functional treatment of myopia and other refraction abnormalities allows to obtain more complete information about the state of the sensorimotor system of the eye with refractive pathology, as well as to use the obtained diagnostic data for effective functional treatment of these conditions.

Literature

1. Avetisov E.S. Myopia. M., Medicine, 1999, 286 p.

2. Iomdina E.N., Egorova T.S., Golubtsov K.V., Egorova T.S. The relationship between the state of accommodation and temporary contrast sensitivity of the eye. // Proceedings of the conference "Biomechanics of the eye 2005", M., 2005, p. 48-51.

3. Golubtsov K.V., Kuman I.G., Heylo T.S., Shigina NA., Trunov V.G., Aydu E.A.-I., Bykova T.A., Sofronov P.D. , Ryabtseva A.A. // Information processes, 2003, vol. 3, No. 2, S.114-122.

4. Rogatina E.V., Yakovlev A.A., Egorova T.S., Khvatova A.V., Golubtsov K.V. The critical frequency of flicker fusion to color stimuli in the diagnosis of diseases of the retina and optic nerve in children. Manual for doctors. M., 2001, 20 p.

Claims (1)

A method for the functional treatment of myopia and other refractive errors with sensorimotor dysfunction, including diagnostics - determination of the critical flicker fusion frequency (CFSM) for color stimuli - red, blue, green, characterized in that the CFSM is determined for each radiation color at different gradations of the recorded parameters : brightness: - subthreshold, 2 - threshold, 3 - suprathreshold, illumination angle: 15 °, 30 °, 45 °, duty cycle: from 1 to 3, while providing a distance from the eye to the color stimulus of 25 cm, and those x, brightness levels, duty cycle values and exposure angles, where a decrease in CFSM is detected, myopia or other refractive errors with sensorimotor dysfunction are diagnosed, and then they are exposed to the flickering light of the established color, brightness, duty cycle and exposure angle, starting from a frequency 20% lower than the threshold - the lower frequency, gradually increasing it to a frequency value that is 20% higher than the upper frequency, then the upper frequency, then in the reverse order, the effect is repeated for 5-10 minutes daily, for 10-15 days.