RU2845161C1 - Method for restoration of binocular vision in conditions of soft haploscopy in patients with conjugate strabismus with simultaneous nature of vision - Google Patents

Abstract

FIELD: medical science.

SUBSTANCE: invention relates to medicine, specifically to ophthalmology. A patient from one metre is presented with a white square on a black background, where the patient sees the green and red squares at a distance from each other. Further, the patient needs to approach the white square on the black background until the visible green and red squares merge into one, after merging it is necessary to increase the distance until the squares diverge into two adjacent squares. Then it is necessary to approach to their fusion again, wherein treatment is started with a white square of 15×15 cm, after it is possible to maintain the stable fusion of two squares into one from a distance of up to one metre, treatment is started with squares with dimensions of 10×10 cm, 5×5 cm, 2×2 cm respectively. Treatment is carried out daily for 15-25 minutes until the colour squares merging with size 2×2 cm into one with distance of one metre.

EFFECT: method enables restoring binocular vision in the soft haploscopic environment in the patients with conjugate strabismus with a simultaneous nature of vision.

1 cl, 2 ex

Description

The invention relates to medicine, namely to ophthalmology, and is intended to restore the binocular nature of vision in patients with concomitant strabismus with a simultaneous nature of vision.

The ability to see binocularly is a higher visual function, which consists of simultaneously directing the visual axes to the object of fixation and combining monocular images from each eye into a single visual perception. Thanks to binocular vision, we perceive the world in three dimensions, can determine the distances between objects, their volume, relief, depth and spatial location. The effectiveness of binocular vision is ensured by the interaction of the sensory, optical and oculomotor systems, and also includes elements of volitional control, reflex eye movements and a sense of body position.

When monocular visual fields merge, objects located in any part of it simultaneously irritate the retina of both eyes. Double vision of monocular images is suppressed by the fusion mechanism - the unification of the right and left visual fields into a single image in the higher visual centers of the brain, provided that the monocular images falling on the corresponding areas of the retina are similar and do not differ from each other.

The goal of concomitant strabismus treatment is to restore full binocular vision. Concomitant strabismus treatment includes optical correction of ametropia, pleoptic methods, surgical correction of deviation, as well as orthoptic and diploptic treatment to restore binocular functions and develop accommodative abilities. Complex orthoptic treatment using a synoptophore, color tester and computer training is usually carried out three times a year. However, there is often a problem of regression of the achieved effect between courses of treatment, which can delay the process for many years. In such cases, regular home training can improve and consolidate the results, but existing treatment methods are not always suitable for home use and may have age restrictions.

A method for restoring binocular vision is known, which consists of conducting an orthoptic stage of treatment on a synoptophore, where, under conditions of rigid haploscopy, the patient is presented with objects for fusion at an objective angle of strabismus with alternating or simultaneous stimulation of the retina. As the ability to merge monocular images of large objects is restored, they move on to smaller objects, the treatment is carried out for 10-15 minutes with a course of treatment from 20 to 40 (Methodological recommendations for organizing the treatment of children with strabismus and amblyopia in specialized preschool institutions, Moscow. - 1978. - 27 p.).

The disadvantage of this method is that the treatment is carried out under conditions of rigid haploscopy and when switching to conditions of natural haploscopy, a low percentage (20-25%) retains the obtained result; other disadvantages include the need for daily visits to a medical institution and a high workload for medical personnel.

A method for developing binocular vision using computer programs for combining images is known. Treatment is carried out in anaglyph glasses that take into account the child's refraction and is carried out at home. The complexity of the tasks increases due to an increase in the speed of movement of images, a decrease in their size and the thickness of the reference lines (the program "Little Wizard" is registered under the computer number 2013618972).

The disadvantage of this method is that the program is aimed at connecting dissimilar objects presented to each eye, rather than merging similar objects.

The closest analogue, taken by us as a prototype, is the method of restoring binocular vision (SU 1409266 from March 15, 1988), which consists of conducting visual exercises to merge double images of color test objects (anaglyphs) through positive and negative spherical lenses. The patient is shown color anaglyphs through red-green glasses from a distance of 30-35 cm, while simultaneously using spherical lenses of equal power, which decrease or increase as binocular fusion is restored. The treatment lasts 15-20 minutes. During the treatment, the distance to the color test is increased from 0.3-0.35 to 4-5 m.

The disadvantage of this method is the constant work of medical personnel with the patient, since positive and negative spherical lenses must be changed to carry out the treatment, as well as the need for daily visits to the medical institution, which increases the cost of treatment. Also, the disadvantages include the need for a room longer than 4-5 meters, which is not always possible in medical offices.

The objective of the proposed invention is to restore binocular vision under conditions of soft haploscopy in patients with concomitant strabismus with the simultaneous nature of vision in red-green glasses using white squares on a black background.

The technical result of the invention is the restoration of binocular vision under conditions of soft haploscopy in patients with concomitant strabismus with a simultaneous nature of vision.

The specified technical result of the invention of restoring binocular vision under conditions of soft haploscopy in patients with concomitant strabismus with a simultaneous nature of vision is achieved by the patient being in red-green glasses at a distance of one meter from a white square on a black background, where he sees two squares - red and green, located at a distance from each other. Then the patient approaches the white square on a black background until the visible red and green squares coincide in a red-green rectangle, and then merge into one square. After the squares merge into one, the patient must gradually increase the distance until the single square goes back into the red-green rectangle and splits into two squares located next to each other. Then the process should be repeated, approaching the white square on a black background again until the visible red and green squares merge into one square.

When increasing the distance, the patient must try to maintain the resulting visible single square and not allow the merged square to split due to the vergence reserves of the eyes.

Combining squares into a rectangle and then merging the squares into one square has an advantage over using complex shapes (circle, star, mushroom, herringbone) because the squares have a large area of contact with each other when combined, forming a rectangle as a single whole, with their subsequent merging.

Treatment should begin with the presentation of a white square measuring 15x15 cm, since the larger the presented object, the easier it is to combine the visible red and green squares into a rectangle and then hold one merged square. Using the vergence reserves of the eyes, it is necessary to hold the entire merged square in the field of vision at different distances. Smaller squares are split into two faster and easier, holding one merged square is more difficult than a larger square. Treatment is carried out daily for 15-25 minutes until the 2x2 cm colored squares are steadily merged into one from one meter.

Upon achieving a stable fusion of red and green squares up to one meter from the presented white square measuring 15x15 cm on a black background, it is necessary to continue treatment under conditions of soft haploscopy with smaller squares of 10x10 cm, then 5x5 cm, then 2x2 cm. Treatment is carried out daily for 15-25 minutes until stable fusion of colored squares measuring 2x2 cm into one from one meter. The method is carried out as follows:

A patient with concomitant strabismus with a simultaneous nature of vision is offered restoration of binocular vision under conditions of soft haploscopy in red-green glasses using a white square measuring 15x15 cm, 10x10 cm, 5x5 cm, 2x2 cm on a black background. Treatment begins with a white square measuring 15x15 cm on a black background. It is necessary to put red-green glasses on the patient; if the patient has ametropia, treatment is carried out in red-green glasses with the necessary correction.

The initial distance is one meter, where the patient sees a red and green square at a distance from each other, when the patient approaches the presented white square, the patient first combines the red and green square into a red-green rectangle, and then the squares merge into one. From the moment the colored squares merge into one, it is necessary to slowly increase the distance from the presented white square located on a black background until the merged square splits into red and green, located next to each other.

Orthoptic treatment with a 15x15 cm square should be carried out until there is one square from a distance of one meter, only after a stable fusion of squares into one, smaller squares of 10x10 cm are presented, then 5x5 cm, then 2x2 cm, respectively. Treatment is carried out daily for 15-25 minutes until a stable fusion of colored squares of 2x2 cm into one from one meter.

The method is confirmed by the following examples:

Example No. 1.

Patient A.A.I., 7 years old. Strabismus angle according to Hirshberg +5 -+7°. The nature of vision is simultaneous.

Diagnosis: Convergent concomitant alternating strabismus, with a small angle of deviation after the surgical stage of treatment.

Restoration of binocular vision was carried out under conditions of soft haploscopy in patients with concomitant strabismus with a simultaneous nature of vision according to the above proposed method daily for 15 minutes. Using a white square 15x15 cm on a black background, stable fusion of red and green squares was obtained on the 9th day from a distance of one meter. Then the treatment was carried out with a white square 10x10 cm in size, with this square size, stable fusion of squares was obtained on the 20th day of treatment. When treating with a white square 5x5 cm in size on a black background, stable fusion of squares was obtained on the 35th day, and with a white square 2x2 cm in size on a black background, stable fusion was developed on the 68th day.

During treatment using the proposed method of restoring binocular vision under conditions of soft haploscopy in patients with concomitant strabismus with a simultaneous nature of vision, binocular vision was achieved on the 68th day of treatment.

Example No. 2.

Patient I.M.I., 10 years old. Strabismus angle according to Hirshberg -7 - -9°. The nature of vision is simultaneous.

Diagnosis: divergent concomitant alternating strabismus with a small angle of deviation.

Restoration of binocular vision was performed under conditions of soft haploscopy in patients with concomitant strabismus with a simultaneous nature of vision according to the above proposed method for 25 minutes daily. Using a white square 15x15 cm on a black background, stable fusion of red and green squares was obtained on the 8th day from a distance of one meter. Stable fusion of the red and green square when presenting a white square 10x10 cm on a black background was obtained on the 18th day, with a white square 5x5 cm on the 30th day, with a square 2x2 cm on the 58th day.

In the treatment according to the proposed method of restoring binocular vision under conditions of soft haploscopy in patients with concomitant strabismus with a simultaneous nature of vision, binocular vision was achieved on the 58th day of treatment.

Claims (1)

A method for restoring binocular vision under conditions of soft haploscopy in patients with concomitant strabismus with a simultaneous nature of vision, including the use of red-green glasses, characterized in that a white square located on a black background is presented to the patient from one meter away, where the patient sees green and red squares at a distance from each other, then the patient needs to approach the white square on a black background until the visible green and red squares merge into one, after merging, it is necessary to increase the distance until the squares diverge into two squares located next to each other, then it is necessary to approach again until they merge, while treatment begins with a white square measuring 15x15 cm, after it is possible to maintain a stable fusion of two squares into one from a distance of up to one meter, they begin treatment with squares measuring 10x10 cm, 5x5 cm, 2x2 cm, respectively, the treatment is carried out daily for 15-25 minutes until a stable fusion of colored squares measuring 2x2 cm into one from a distance of one meter.