RU2332968C1 - Method of prevention and treatment of obtained short-sightedness - Google Patents

Abstract

FIELD: medicine; ophthalmology.

SUBSTANCE: training is split into 4 stages. The first stage involves using spherical lenses with optical force of + 0.625 dioptre to + 1.25 dioptre are used; cylindricallenses + 1.0 dioptre, which axes are located in vertical and horizontal meridians, and prismatic lenses 1.5 dioptre located with their bases to wards each other. At the second stage of training, prismatic lenses with optical force of 2.0 to 3.0 dioptre their bases located in internal quadrants. The third stage involves using sphero-prismatic lenses with optical force of 0.5 to 2.5 dioptre of spherical component and 2.0 to 4.0 dioptre of prismatic component the lenses being located with their bases towards each other, force of lenses being raised in steps of 0.5 dioptre. At the fourth stage, cylinder lenses with optical force of + 1.25 dioptre are used which axes are located in both vertical and horizontal meridians, and prismatic lenses with optical force of 2.0 dioptre Lines "top-basis" of prisms are located in horizontal and slanting meridians which bases are located in internal quadrants.

EFFECT: increased efficiency of method due to creation of new treatment algorithm and expansion of qualitative and quantitative structure of lenses.

5 cl, 1 tbl, 1 ex

Description

The invention relates to medicine, namely to the prevention and treatment of eye diseases.

A known method of gradual microglaze for the prevention and treatment of myopia (2). The method consists in the following: at the beginning, false myopia is corrected with minimal negative lenses, giving a visual acuity of 1.0, and then a plus lens of 0.25 diopters is added. At the same time, visual acuity first decreases, but soon recovers, as a result of fogging, there is disaccomodation and weakening of the ciliary muscle spasm. Then, the strength of the positive lens is increased by another 0.25 diopters, after which visual acuity worsens, but after a while it is restored again. This continues until the strength of the added plus lenses is equal to the strength of the accommodation spasm, expressed in diopters.

However, the method is not effective enough for the prevention and treatment of myopia, since during training there is an impact on the same groups of muscle fibers without taking into account the uneven spasms of the ciliary muscle. In addition, during training, there is no relaxation of the ciliary muscle due to the divergent disaccommodation reflex, which is known to be caused by prismatic lenses.

The effect of treatment can also decrease (especially in the treatment of children of early school age) from a negative reaction to the treatment method itself (blurred vision).

There is also a known method of divergent disaccomodation for the prevention and treatment of myopia (3). The method consists in the fact that first visual acuity and the degree of myopia are determined by the subjective method, and then prisms are placed in front of each eye with a base to the nose for 1-2 apt diopters, as a result of which divergent disaccomodation occurs. After some time, visual acuity rises, after which the prism strength is increased again by 1-2 ave. And so, up to a total prism strength of 4-5 pr. Diopters for each eye and achieving maximum increase in visual acuity.

However, the method is also not effective enough, since during training only one and the same groups of fibers of the oculomotor muscles are involved, participating in divergence in the horizontal direction, which does not allow maximum relaxation of all fibers of the ciliary muscle. In addition, the reflex of micro-fogging with positive spherical lenses is not applied.

The disadvantages of both methods (2, 3) include the fact that the exposure time of the lens and the period of time spent on rest are not taken into account. Lack of adequate control over the regime of loads and subsequent rest can lead to undesirable overloads or, conversely, cause a weak training effect, which also negatively affects the results of treatment.

Another known method of treating acquired myopia with sets of simulators, adopted as a prototype (1). The method consists in applying a set of three simulators.

Exercise machine No. 1 represents sphere-prismatic lenses placed in a spectacle frame with the base to each other. Divergence of the eyes occurs in the horizontal meridian.

In the simulator No. 2, the base of the lens for the right eye is in the lower-inner quadrant, for the left eye - in the upper-inner quadrant. In this case, the top-base lines of the prisms of each simulator are parallel to each other. Simulator No. 2 allows you to diverge the right eye up and out, and the left - down and out.

In the simulator No. 3, the base of the lens for the right eye is in the upper inner quadrant, and the lens for the left eye is in the lower inner quadrant. In this case, the top-base lines of the simulator prisms are parallel to each other. Simulator No. 3 allows you to diverge the right eye down and out, and the left - up and out.

During training, wearing an optical simulator No. 1, the patient should actively seek to consider the signs of the table to determine visual acuity, moving from large to small, from a distance of 3-5 meters. The duration of this exercise should not exceed 45-60 seconds. Next, the simulator is replaced by simulator number 2. The exercise itself is performed similarly to the exercise with simulator No. 1, also within 45-60 seconds. Then the simulator No. 2 is replaced by the simulator No. 3. The principle of treatment itself does not change. Then there is an alternation of simulators No. 2 and No. 3, and the training session ends with the simulator No. 1.

In the pauses created during the change of simulators, visual acuity control and short-term rest are performed. The main criterion for ending a workout is a feeling of light fatigue in the eyes.

The method of treatment with sets of simulators adopted as a prototype, despite the expansion of exercise options and the use of sphere-prismatic lenses, remains insufficiently effective. The use of spherical prismatic lenses with fogging effect at the beginning of treatment creates a negative psychoemotional effect on the patient. In addition, the training immediately begins quite actively, which is undesirable, because the stage of warming up the muscles, gradually preparing them for more intense loads is skipped. Despite the complex of fairly intense exercises, there is no complex of exercises with simulators that give the maximum allowable load, providing the highest treatment result. The training also ends methodologically incorrectly, since the last lens, again creating a fogging effect, reduces the patient’s emotional mood, which prevents the creation of serious motivation for the next training. The exact exposure time of the lens and the subsequent rest pause after it are not precisely regulated in a subjective way. In addition, a set of simulators, consisting of a small number of simulators, is practically not able to provide adequate loads both in their intensity and in variety.

To achieve high and lasting results of treatment, it is necessary to observe a number of basic principles for constructing the training process. Therefore, a training session should consist of several sets of exercises that are diverse in intensity, strength, and focus, involving all major muscle groups in the training. Periods of physical activity should alternate with pauses for adequate rest received by the load (4).

The aim of the invention is to increase the effectiveness of the treatment method by creating a new treatment algorithm and expanding the qualitative and quantitative composition of the lenses used for the manufacture of a set of simulators.

The simulators are prepared from standard frames, in which the lenses of the necessary optical power are placed.

The essence of the invention lies in the fact that a separate training is divided into 4 stages. At each stage, specific tasks are solved, due to which the effect obtained at each subsequent stage is prepared by a set of exercises at the previous stage.

So, at the first stage, the task is to form a positive psychoemotional state of the patient and warm up the main groups of eye muscles, preparing them for more intense loads (the principle of a gradual increase in loads). At the second stage of training, the task of a variety of exercises and bringing the load to an average level is solved. The third stage of the training solves the problem of achieving the maximum training effect due to the maximum allowable loads. At the fourth final stage, the problem of fixing the results obtained by moderate loads, essentially repeating the basic exercises from the previous complexes, is solved. At the end of the lesson, it is important not only to maintain, but also to increase a high psycho-emotional mood. This goal is achieved by using prismatic lenses that can emphasize the achieved visual result. The implementation of the principle of alternating loads and rest by doubling the pause between the stages of training allows you to avoid overload during treatment.

The treatment algorithm consisting of four sets of exercises is carried out using four sets of simulators made of spherical positive, cylindrical positive (reflexively causing the effect of microglaze), prismatic (allowing divergent disaccommodation in both horizontal and oblique meridians) lenses. The maximum optical power of the applied positive lenses was 2.5 diopters, and prismatic - 4.0 diopters. The minimum optical power of positive cylindrical lenses was 0.5 diopters, and prismatic - 1.0 diopters. Sphere-prismatic lenses have the highest efficiency, providing an effect due to the simultaneous summation of the results of microclouds and divergent disaccommodation, which are also included in the set of simulators.

Each set of simulators, designed for a certain set of exercises, is made of lenses that ensure their implementation. Exercise time and pauses between them are timed.

The first stage is carried out using a set of simulators with the smallest cylindrical, spherical and prismatic lenses accepted for optical power. A set of exercises begins on a simulator of optical power of at least 1.0 diopters with prismatic lenses that exclude the effect of blurring vision. The following lenses with a positive spherical force of 0.625 diopters and a cylindrical force of 1.0 diopters provide additional "buildup" of the ciliary muscle and its relaxation. The optical power of the lens does not exceed 50% of the maximum optical power for all used kits.

The second stage is carried out using a set of simulators exclusively with prismatic lenses with a power from 2.0 to 3.0 ave. Diopters providing a variety of exercises due to divergence of the eyes in different directions. The optical power of the lens does not exceed 75% of the maximum optical power for all used kits. An additional effect is provided due to the relaxation of individual sections of the ciliary muscle, and intensive training of all oculomotor muscles occurs, with the exception of the internal straight line. However, according to the principle of reciprocal innervation, its relaxation and improvement of hemodynamics occur. This fact is important, because very often there is a spasm of the internal rectus muscle with asthenopic syndrome and the initial stage of acquired myopia.

As a result of the influence of the first two sets of simulators and the subsequent pause for rest, the spasm of the ciliary muscle is partially reduced, the eye muscles are in working tonus and are ready for higher loads.

The third stage is carried out using a set of simulators of sphere-prismatic lenses of increasing optical power from 20% to maximum - 2.0 pr. Diopters, and the weakest simulator has a prismatic component of 0.5 diopters and prismatic (the most optically strong simulator has a spherical component of 2, 5 diopters and prismatic - 4.0 prism diopters). As a result of the third stage of training, the maximum possible result for a particular patient is achieved. The pause allocated for rest between the individual stages of the training is 2-3 times the pause between exercises with separate simulators.

The fourth stage is carried out using a set of simulators consisting of positive cylindrical and prismatic lenses of optical power 50% lower than the maximum value of the maximum optical power for all sets used. Exercises of the fourth stage due to their moderate intensity allow us to consolidate the functional results achieved in the previous stages. The training ends with a simulator with prismatic lenses at a high emotional recovery, because the patient notes a significant increase in visual acuity due to divergent disaccommodation and, of course, seeks to continue training treatment in the future.

The method is as follows.

Before starting treatment, an ophthalmological examination is performed, which consists of checking visual acuity and accommodation reserves, refractometry. Ophthalmoscopic, biomicrocopic and echobiometric studies are also carried out. The patient is located in front of the table to check visual acuity at a distance of 3-5 meters from it. The simulator is placed before the eyes for 10-30 seconds, during which the patient actively tries to consider the signs of the table, moving from large to smaller and less distinguishable. A pause to rest after doing the exercises is 5-15 seconds. Each simulator has its own serial number. When performing the exercises, the training begins with the simulator number 1, consisting of prismatic lenses 1.5 diopters, placed in a frame with the base to each other. Training continues with simulator number 2, consisting of spherical lenses with a power of +0.625 diopters. With the simulator No. 3, consisting of cylindrical lenses (+) 1.0 diopters, with the vertical position of the axes, the following exercise is carried out. Training continues with simulator No. 4, consisting of cylindrical lenses with a power of (+) 1.0 diopters and horizontal axes. Simulator No. 5, consisting of spherical lenses of +1.25 diopters, performs an exercise that completes the warm-up complex (the optical power of these lenses is in the range from 25 to 50% of the maximum value). This is followed by a longer pause for a rest for 15-45 seconds, i.e. 2-3 times the pause for rest between the change of individual exercises.

The second set of exercises is designed for a more intense load of the ciliary and oculomotor muscles with the aim of divergent disaccommodation in various directions and to remove the accommodation spasm in certain sections of the ciliary muscle. It is carried out using prismatic lenses. The optical power of the used lenses is 50-75% of the maximum. The second set of exercises begins with simulator No. 6, made of lenses with an optical power of 2.0 apt. On the TABO scale, the base of the vertex-base line of the prism of the right eye is located in the oblique meridian (bas 320 °), the left also in the oblique (bas 140 °). The simulator No. 7, made of prismatic lenses with a power of 2.0 ave., The line “apex-base” of which for the right eye is the base in the 40 ° meridian, and for the left eye in the 220 ° meridian, muscle groups participating in movement in these directions, and also there is a relaxation of the fibers of the ciliary muscle associated with this group.

It has been experimentally established that divergence of the eyes under the influence of prismatic lenses located with the base in the inner quadrants (both in the upper and lower), symmetrically to the vertical axis, gives an additional relaxing effect for the ciliary muscle. In addition, this exercise option contributes to the additional training of diverging muscles. Therefore, after a pause for a rest of 5-15 seconds, an exercise is carried out with a simulator No. 8, in which prismatic lenses with a power of 3.0 diopters are used. The base of the vertex-base line for the right eye is in the meridian of 330 ° and for the left eye in the meridian of 210 °. This is followed by an exercise with simulator No. 9, also made of prismatic lenses with a power of 3.0 diopters, however, the base of the vertex-base line is in the upper-inner quadrants. For the right eye - in the meridian of 30 °, and for the left eye - in the meridian of 150 °. It has been experimentally established that this exercise gives a high visual effect, apparently because this type of divergence in ordinary visual activity is not in demand and not trained. Exercise with a simulator number 10, composed of prisms with a power of 2.5 diopters, located with the base to the nose, is performed in the classical version.

After completing the second set of exercises and rest for 10-30 seconds, the ciliary muscle and oculomotor system are in a state of readiness for an adequate response to high loads, up to the maximum. Exercise is performed using spherical-prismatic lenses, the base located to each other. Simulator No. 11 consists of lenses having +0.5 diopters spherical and 2.0 diopters prismatic components. Next are exercises with stronger lenses. The step of increasing the optical power of both spherical and prismatic components is 0.5 diopters for each subsequent simulator. The most powerful are the lenses located in the simulator No. 15, where the spherical component is 2.5 diopters and the prismatic component is 4.0 diopters. The pause between exercises is 5-15 seconds. The third set of exercises provides the maximum training effect due to the simultaneous combined effect of reflexes of microfogging and divergent disaccommodation.

The last fixing set of exercises is carried out after a pause for rest for 10-30 seconds. The optical power of the lens does not exceed 50% of the maximum. With the help of simulators No. 16 and No. 17, the effect of micro-fogging caused by cylindrical lenses +1.25 diopters is fixed. sequentially in the vertical and horizontal meridians.

Simulators No. 18 and No. 19 consist of prisms with an optical power of 2.0 diopters. In the simulator No. 18, the base of the lens of the right eye is in the 330 ° meridian and the left - in the 210 ° meridian. In the simulator No. 19, the base of the lens of the right eye is in the 30 ° meridian, and the left - in the 150 ° meridian, according to the TABO scale. The simulator No. 20, consisting of prisms with an optical power of 2.0 prism diopters located base to each other, repeats the classic version of divergent disaccommodation. The last complex, creating a load that is quite easily tolerated by the patient, consolidates the achieved effect obtained as a result of training, moreover, it provides a positive psycho-emotional mood for the next training session and for the entire course of exercises.

An example of a specific application of this method: patient L; 11 years old, a student of the 5th grade of a lyceum school noted a deterioration in vision from 9 years. Last year he uses glasses for distance. She underwent treatment twice in the myopic center with temporary improvement.

Visual acuity in the right eye was 0.1 s core. (-) 2.25 diopters = 1.0; on the left eye - 0.2 s. (-) 2.0 diopters = 1.0.

The length of the PZO was 24.4 mm in both eyes. The stock of accommodation was 2.5 diopters in both eyes. Diagnosed with mild progressive myopia, spasm of accommodation in both eyes.

A course of training treatment has been prescribed. Training was conducted daily for 3 weeks, with the exception of weekends. The exposure of one lens lasted 30 seconds. The pause between the change of lenses was 5 seconds, between the complex of exercises - 10 seconds. The entire training time was 12.5-15 minutes.

After the course of treatment, visual acuity in the right eye was 0.4 s core. (-) 1.0 diopters = 1.0 and 0.6 s (-) 0.75 diopters = 1.0 on the left.

Reserves of accommodation increased by 1.5 diopters and amounted to 4.0 diopters in both eyes. In the observation period of up to 0.5 year, the progression of myopia was not noted, the reserves of accommodation correspond to the age norm.

In addition, 21 patients aged 7 to 17 years were under observation. All of them underwent a course of training treatment.

The treatment results are shown in the table.

Visual acuity without correction Visual acuity 0.1-0.2 0.3-0.4 0.5-0.6 0.7-0.8 0.9-1.0 Total The number of patients before treatment 6 5 7 3 0 21 At the end of the observation period 0 four 6 7 four 21

As a result of treatment, an improvement in visual acuity was noted in 100% of patients. At the same time, visual acuity increased by 0.1-0.7, an average of 0.33, subjective correction decreased by 0.5-1.5 diopters, accommodation reserves increased by an average of 2.2 diopters.

Compared with known methods, this method for a short period of time can significantly improve visual acuity, relieve spasm of accommodation, improve the performance of the ciliary and oculomotor muscles, increase the reserves of adaptation of the visual system and, most importantly, stop the progression of acquired myopia.

Sources taken into account

1. Grigoryeva TS, Pozdeva N.V., Lyalin A.N. The results of the treatment of acquired myopia with a set of Zenica simulators in a city clinic and at home. In the book: "Actual issues of pediatric ophthalmology and retinopathy of premature infants." Yekaterinburg, 2004, p. 115-118.

2. Dashevsky A.I. "False myopia." M., Medicine, 1973, p. 89-90.

3. Dashevsky A.I. "False myopia." M., Medicine, 1973, p. 35.

4. Sports medicine. Reference Edition. M., "Ter pa - sport", 1999. S. 55-62.

Claims (5)

1. A method for the prevention and treatment of myopia, including performing exercises using optical simulators, consisting of positive spherical and positive cylindrical lenses, the optical power of which varies to a maximum of 2.5 diopters, prismatic and sphere-prismatic lenses, the optical power of which varies to a maximum of 4, 0 diopters, with a pause for relaxation, characterized in that the exercises are grouped into complexes with pauses between exercises in the complex for 5-15 s and pauses between complexes in 10-45 s, the first complex exercises are carried out with prismatic lenses with a strength of 25 to 50% of the maximum optical power, and then with positive spherical and cylindrical lenses with a strength of 25 to 50% of the maximum; the second set of exercises is carried out with prismatic lenses with a strength of from 50 to 75% of the corresponding maximum value of optical power; the third complex is carried out with sphere-prismatic lenses with a spherical component strength of from 20 to 100% of the corresponding maximum optical power, and the fourth complex is carried out using positive cylindrical and prismatic lenses with a force of 50% of the corresponding maximum value. 2. The method for the prevention and treatment of myopia according to claim 1, characterized in that in the first set of exercises use spherical lenses with an optical power of +0.625 and +1.25 diopters., Cylindrical +1.0 diopters., Whose axes are vertical and horizontal meridians, as well as prismatic lenses with a power of 1.5 diopters., located base to each other. 3. The method for the prevention and treatment of myopia according to claim 1, characterized in that the second set of exercises use prismatic lenses with optical power from 2.0 to 3.0 diopters, the bases of which are located in the inner quadrants. 4. The method for the prevention and treatment of myopia according to claim 1, characterized in that the third complex uses spherical prism lenses with an optical power of the spherical component of 0.5-2.5 diopters. and the prismatic component of 2.0-4.0 diopters. with the location of the lenses to each other, and the strength of the lens is increased in increments of 0.5 diopters. 5. The method according to claim 1, characterized in that in the fourth complex used cylindrical lenses with an optical power of +1.25 diopters., The axes of which are located in the vertical and horizontal meridians, and prismatic lenses with an optical power of 2.0 diopters., Lines " vertex-base "prisms are located in horizontal and oblique meridians, the bases of which are in the inner quadrants.