RU2080845C1 - Method for treating amblyopia - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves showing article image to a patient, recording bioelectric activity of brain, determining its envelope amplitude. Received values are used for calculating threshold signal value including biofeedback in controlling article image. Article image is controlled in the mode of its appearing and vanishing on display screen. Threshold values are calculated every 10 s by applying a device. Treatment is carried out in the state of relaxation for amblyopia patients on the myopia background, mixed and myopic astigmatism background and in the state of activation in the cases of hypermetropia, hypermetropic astigmatism and aphakia background. EFFECT: enhanced effectiveness. 4 cl

Description

 The present invention relates to ophthalmology, in particular to the treatment of dysbinocular, anisometric refractive obscuration amblyopia of weak, high and very high degrees, as well as myopia of accommodation spasms and m. It is used to restore visual function in organic lesions of vision.

 A known method for the treatment of weak and moderate amblyopia (SU Copyright certificate N 1410972, A 61 F 9/00, 1988), which consists in presenting the patient with sinusoidal objects of increasing frequency and decreasing contrast. This method is based on irritation of the visual analyzer with contrast stimulants and is mainly used to treat mild to moderate amblyopia.

 There is a method of treating amblyopia by local blinding irritation with light from the central fossa of the retina: Avetisov's glare, which consists in irritating the central fossa of the retina from a helioneon laser bulb. The method is not effective enough and is not applicable when combining refractive amblyopia with organic eye diseases. (Guidelines for Pediatric Ophthalmology. Avetisov E.S. et al. M. 1967, p. 194).

 A known method for the treatment of amblyopia in children (SU Copyright certificate N 1688867, A 61 F 9/00, 1991), which consists in the fact that the subject image is presented to the patient, the bioelectric activity of the brain is recorded, its integral envelope is determined. The brightness of the image is modulated depending on the amplitude of the envelope with respect to the constant threshold set by the doctor using a potentiometer.

 Sessions were held at least twice a week for 15-20 minutes, each with a total number of 10-20.

 The developed method is effective for the treatment of amblyopia with monolateral strabismus, however, it does not make it possible to vary the modes and methods for treating various types of amblyopia, such as obscuration, refractive for hyperopia, dysbinocular asthmatism for hyperopia and hyperopia, and anisometric asthmatism for hyperopia and hyperopia. In this method, only treatment in the zone of setting the envelope below the threshold set by the doctor is important, which makes it impossible to treat a large number of the above cases.

 The objective of the invention is the treatment of all types of amblyopia in adults and children on the background of hyperopia, myopia, all types of astigmatism, the treatment of amblyopia on the background of organic changes in the fundus, the treatment of myopia and accommodation spasms.

 The method is as follows.

 One (healthy) eye is closed to the patient and a subject image is presented, which can be used as video films, slides, etc. The demonstrated material is selected taking into account the age, intelligence, as well as the patient’s interest and emotional state. A picture on the monitor appears and disappears depending on the level of activity of the functional state of the brain, which is determined by the electroencephalogram (EEG).

 During the session, EEG is recorded from electrodes located in the occipital and frontal areas of the skull. The total signal is fed to the EEG envelope formation unit of the Ambliocor-01 device (VK 8071 passport), the integral envelope is measured, the amplitude of which is compared with the threshold value. The threshold is also set, as in the known method, so that at least 50% and not more than 75% of the time for presentation of the subject image, the amplitude of the EEG envelope corresponds to the image visibility zone. At a time of less than 50%, the patient's interest in the demonstrated material decreases, and at a time of more than 75%, the motivation for the treatment is reduced.

 Using the Ambliocor-01 instrument, the threshold is automatically calculated every 10 s based on the previous EEG interval (analysis period 10 s). From the threshold device, the signal is supplied to the screen and turns it on when the amplitude of the EEG increases, or turns on when the amplitude of the EEG decreases.

 With farsightedness and farsighted astigmatism, accompanied by amblyopia, as well as with aphakia in patients, high-amplitude bioelectric activity of the brain is recorded, and accordingly the EEG envelope has a high amplitude. To improve visual function in such patients, they cause a desynchronization reaction to EEG, in which there is an increase in the index of high-frequency oscillations and, accordingly, the integral envelope of the EEG decreases.

 To obtain a desynchronization of the electrical activity of the brain, the patient activates attention, concentration, enhances the overall tension, that is, the session is carried out in the "activation" mode.

 With myopic astigmatism, accompanied by anisotropic amblyopia and dysbinocular amblyopia, low-amplitude electrical activity and, accordingly, a low amplitude of the EEG envelope are recorded.

 To improve visual function in such patients, it is necessary to increase the amplitude of the electrical activity of the brain. The patient is offered to calm down, relax, enter a state of calm wakefulness, that is, the session is carried out in the "relaxation" mode.

 The proposed method allows you to restore and fix the broken afferent and efferent nerve connections between the optical receptor of the eye and the visual center of the cerebral cortex.

 A closed system is created: optical receptors of the eye, the cortical center of the visual analyzer (brain), an electroencephalographic signal from the cerebral cortex, reproduction of the EEG signal, computer system, video system.

 Using the “activation” or “relaxation” mode allows reflex selection of the state of bioelectric activity of the brain, leading in the training process to consolidate those fluctuations that determine the improvement in the perception of the subject image.

 The proposed method is especially important in the treatment of children, as it is based on the positive emotions of the child, which support his desire to see and consider the details of the video shown.

 With a weak degree of amblyopia, 10 sessions are required, with an average degree of amblyopia, 10-15 sessions, and with a high degree of amblyopia, 20 sessions. Treatment leads to restoration of vision in almost 100% of patients.

 The developed method can be used in the treatment of refractive amblyopia against the background of organic eye diseases (retinal degeneration, retinal inflammation with gross focal infections, etc.).

 The use of this method does not cause irritation to the retinal epithelium.

 The method is illustrated by examples.

 Example 1. Child B, 6 years 11 months.

 Diagnosis: Wagner's syndrome, congenital myopia with astigmatism in both eyes (17 diopters), high-grade refractive amblyopia, divergent refractive alternating strabismus.

 Before treatment: VISOD 0.01 v / v 0.1 OS 0.01 v / v 0.1 childhood impairment. The relaxation mode is selected.

 Sessions were conducted on both eyes for 10 minutes under the condition of occlusion during the session alternately of one and the other eyes and occlusion at home of each eye for 2 hours.

 Selected cartoon "Tom and Jerry."

 In the first session, the child was explained: if the image of the film disappears from the screen, he needs to calm down, take a comfortable position in the chair and relax all the muscles, in this position the film will continue. After that, immediately after the child is carried away by the film, biofeedback is turned on, and when the monitor is turned on, the child himself found the necessary state for further viewing of the film.

 After 6 sessions: VIS OD 0.1 v / v 0.3 OS 0.1 v / v 0.3.

 In subsequent sessions, the child easily found the necessary position for watching a movie.

 After 14 sessions, VIS OD 0.1 v / v 0.5 OS 0.1 v / v 0.5.

 After 20 sessions: VIS OD 0.2 v / v 1.0 OS 0.2 v / v 1.0.

 Example 2. Patient K, 13 years old.

 Diagnosis: post-traumatic aphakia of the right eye, high degree obscuration amblyopia, VIS OD 0.02 w / v 0.1. Assigned contact lens +13 (far-sighted correction) for constant wear.

 Eye occlusion at home for 3 hours

 The activation mode is selected.

 The video "Prisoner of the Caucasus" was selected.

 Before watching the film, the child was explained that when the screen was turned on, in order to continue watching the film, he should focus on the plot of the film and increase muscle tension.

 In the first session, after watching the beginning of the film, biological feedback was turned on, and the child independently found the necessary state to turn on the monitor.

 From the 14th to the 20th sessions, isolated cases of screen off were observed.

 After 20 sessions, VIS OD 0.1 w / w 0.8.

Claims (4)

 1. A method for the treatment of amblyopia, including the presentation of a subject image, recording the bioelectric activity of the brain, determining the amplitude of its envelope and using the obtained values to determine the value of a threshold signal that includes biological feedback when managing a subject image, characterized in that the subject image is controlled when it appears or disappears images on the monitor, threshold values are calculated using the Ambliocor-01 device every 10 s and with amblyopia against the background of bli Oruk, myopic, and mixed astigmatism treatment is carried out in a state of relaxation of the patient, and in amblyopia on background farsightedness, hyperopia and astigmatism, aphakia treatment is carried out in the patient's state of activation.  2. The method according to p. 1, characterized in that when the patient is introduced into a state of relaxation, he is offered to calm down, take a comfortable position and relax.  3. The method according to p. 1, characterized in that when the patient is brought into an activation state, he is offered to focus on the material being demonstrated and increase muscle tension.  4. The method according to p. 1, characterized in that the course of treatment for a weak degree of amblyopia includes 10 sessions, an average degree of 10 15 sessions, with a high degree of amblyopia for 20 sessions.