RU2830274C2 - Method for restoration of simultaneous vision in conditions of soft haploscopy in concomitant strabismus with functional suppression scotoma - Google Patents

Abstract

FIELD: medicine; ophthalmology.

SUBSTANCE: treatment is carried out in red-green glasses, wherein the mode of stimulation of the central region of the retina with functional suppression scotoma is selected taking into account the nature of monocular vision. In this case, the eye with the suppression functional scotoma is stimulated with a blinking frequency of 12, and the other eye with a blinking frequency of 1, said stimulation is performed daily for 15–30 minutes. Blinking frequency is then reduced as 10 and 1, 8 and 1, 6 and 1, 4 and 1, 2 and 1, 1 and 1, respectively, after achieving simultaneous perception at given frequencies; therapeutic course makes 10 to 30 procedures.

EFFECT: method enables to restore simultaneous vision in soft haploscopy, in treating functional suppression scotoma in patients with concomitant strabismus.

1 cl, 2 ex

Description

The invention relates to medicine, namely to ophthalmology, and is intended for the step-by-step restoration of binocular vision, in particular the treatment of functional suppression scotoma type "A" with abnormal retinal correspondence.

The highest visual function is the ability of binocular vision, which in turn consists of the simultaneous direction of the visual axes to the object of fixation and the fusion of monocular images from each eye into a single visual image, providing stereoscopic vision - a sense of the volume of objects, the degree of their absolute and relative remoteness in space.

When monocular visual fields merge, objects located in any part of it simultaneously irritate the retina of both eyes. The resulting doubling of monocular images is suppressed by a mechanism known as fusion - the fusion of the right and left visual fields into a single image, which occurs 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. If the images are distinguishable, fusion becomes impossible, then a mechanism of alternating perception arises, which is called binocular competition.

With prolonged competition of the retinas of the right and left eyes for the dominant image, suppression of one of the monocular images and the appearance of a functional scotoma are subsequently formed. Functional scotoma is called a loss of the visual field to relieve the patient of diplopia, which occurs only with both eyes open. This condition occurs in 68% of cases in patients with concomitant strabismus (E.S. Avetisov "Concomitant Strabismus", Moscow - 1977 - 306 p.). In the treatment of concomitant strabismus, most of the time is devoted to the restoration of the so-called binocular competition, until simultaneous vision or monocularly alternating vision appears, and only after that, they work on fusion reserves (E.S. Avetisov "Concomitant Strabismus", Moscow. - 1977. - 307 p.).

A method of treating functional scotoma of suppression is known by the method of alternate occlusion of each eye while looking at a Polaroid diplotoscope (N.I. Pilman “Correction of strabismus in children”, Kyiv “Health” - 1979 - 140 p.).

The disadvantage of this method is the long duration of treatment and its routine nature, the workload of medical personnel, because the patient, especially a child, does not have perseverance and is not able to perform this method well.

The closest analogue, taken by us as a prototype, is the method of disinhibition of functional scotoma, which consists in the fact that with the help of exercises in conditions of rigid haploscopy on a synoptophore, the patient is presented with objects for the right and left eyes at a separate blinking frequency of objects (starting with 2 Hz, then 3, 4, 5, 6, and 8 Hz), for 10-15 minutes with a course of treatment of 15 days or more (E.S. Avetisov "Concomitant strabismus", Moscow. - 1977. - 307 p.).

The disadvantage of this method is the treatment under conditions of rigid haploscopy on the synaptophore, the same frequency of presentation of objects for the right and left eyes, which is ineffective for stimulating the central zone of the eye with functional suppression scotoma (FSS).

The objective of the proposed invention is to treat functional suppression scotoma under conditions of soft haploscopy using red-green glasses, using the developed application computer program.

The technical result of the invention is the restoration of simultaneous vision under conditions of soft haploscopy, namely the treatment of functional suppression scotoma in patients with concomitant strabismus.

The specified technical result of the invention of restoration of simultaneous vision under conditions of soft haploscopy with concomitant strabismus with functional scotoma of suppression is achieved by alternate stimulation of the retina of each eye by means of presentation of objects with different frequencies, with more frequent presentation of the object 12:1 for the right eye, 1:12 for the left eye with FSP depending on the monocular nature of vision, with subsequent reduction of the frequency of presentation 10:1, 8:1, etc., 2:1, 1:1 after achieving simultaneous perception at the given frequencies.

Functional inhibition of the retina is associated with the fact that the perception of visual information of one eye is inhibited by the cerebral cortex to prevent diplopia arising in a patient with concomitant strabismus, and in order to break this inhibition, it is necessary to present a greater amount of stimulation to the eye with FSP. With more frequent stimulation of the eye with FSP with a gradual decrease in the frequency of presentation of the object, equality of the two eyes in the perception of visual information is developed.

The essence of the invention is explained as follows: a computer program for restoring simultaneous vision under soft haploscopy conditions contains two main modes - more frequent presentation of an object to the eye with FSP (a red object for the right eye with a monocular left eye, a green object for the left eye with a monocular right eye). The frequency of presentation for the eye with FSP is reduced after achieving simultaneous perception at a given stimulation frequency. The contrast of the presented objects is adjusted taking into account the density of the filters of the red-green glasses and the color of the object transmitted to the computer monitor. In addition to the treatment mode, the computer program contains a diagnostic block for determining the nature of vision in the form of simultaneous presentation of red, white and green figures. The method is implemented as follows:

The patient is offered treatment of functional scotoma of suppression under conditions of soft haploscopy in red-green glasses using a computer program for 15-30 minutes. Taking into account the nature of monocular vision, a program mode with an appropriate stimulation frequency of the central area of the retina is selected, with more frequent presentation to the eye with FSP with a frequency of 12:1, 10:1, 8:1, etc., 2:1, 1:1. The computer program contains a diagnostic block for determining the nature of vision in the form of simultaneous presentation of red, white and green figures, which allows you to select the program mode and evaluate the result of developing simultaneous vision during the treatment. The duration of treatment is selected individually, taking into account the age, intelligence, and psycho-emotional state of the patient, the course of treatment is from 10-30 procedures.

The method is confirmed by the following examples.

Example #1

Patient I.A.E., 5 years old. Strabismus angle according to Hirshberg is -8°. The nature of vision is monocular OD.

Eye stimulation was performed according to the above proposed method in red-green glasses on a computer with blinking frequencies of 12:1 and 10:1, for 15 minutes. On the 5th day of treatment, the nature of vision at frequencies of 12:1 and 10:1 became simultaneous, and at a frequency of 8:1 it remained monocular, from the 6th day stimulation was performed 8:1 and 6:1. On the 9th day, the nature of vision became simultaneous at frequencies of 8:1 and 6:1, and monocular at a frequency of 4:1. On the 10th-13th day, stimulation was performed at frequencies of 4:1 and 2:1, the simultaneous nature at these frequencies was obtained on the 13th day, then on the 13th-16th day, stimulation was performed with a frequency of 4:1, 2:1 and 1:1. On the 16th-18th day, simultaneous vision with stimulation of 1:1.

When treated using the proposed method of restoring simultaneous vision under soft haploscopy conditions, simultaneous vision was achieved on the 18th day of treatment.

Example #2

Child M.S.I., 7 years old. Strabismus angle according to Hirshberg +10°. Monocular vision OS.

Eye stimulation was performed according to the above proposed method in red-green glasses on a computer with blinking frequencies of 12:1 and 10:1, for 15 minutes. On the 3rd day of treatment, the nature of vision at frequencies of 12:1 and 10:1 became simultaneous, and at a frequency of 8:1 it remained monocular, from the 4th day stimulation was performed 8:1 and 6:1. On the 6th day, the nature of vision at frequencies of 8:1 and 6:1 became simultaneous, and at a frequency of 4:1 it became monocular. On the 7th-10th day, stimulation was performed at frequencies of 4:1 and 2:1, the simultaneous nature at these frequencies was obtained on the 10th day, then on the 11th-13th day, stimulation was performed with a frequency of 4:1, 2:1 and 1:1. On the 14th-15th day, simultaneous vision with stimulation of 1:1. The end result is simultaneous vision without stimulation.

Advantages of the proposed method of restoring simultaneous vision under soft haploscopy conditions:

- stimulation of the eyes with different frequencies, starting with a higher frequency of presentation of the object for the eye with FSP, with a gradual decrease to an equal stimulation frequency of both eyes, allows to break up the functional inhibition of the retina at different frequencies and achieve the inclusion of simultaneous vision in a shorter treatment period;

- under soft haploscopy conditions the patient is in conditions of visual perception that are closer to natural ones;

- treatment under soft haploscopy conditions is more comfortable for the patient than under rigid haploscopy conditions, since there is no forced position of the patient's head.

Claims (1)

A method for restoring simultaneous vision under soft haploscopy conditions in concomitant strabismus with functional suppression scotoma, characterized in that the treatment is performed in red-green glasses, while the stimulation mode of the central region of the retina of the eye with functional suppression scotoma is selected taking into account the nature of monocular vision: in this case, stimulation is started for the eye with functional suppression scotoma with a blinking frequency of 12, and for the other eye with a blinking frequency of 1, said stimulation is performed for 15-30 minutes daily, then the blinking frequencies are reduced as 10 and 1, 8 and 1, 6 and 1, 4 and 1, 2 and 1, 1 and 1, respectively, after achieving simultaneous perception at the specified frequencies; the course of treatment is from 10 to 30 procedures.