RU2102043C1 - Method for treating amblyopia - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves showing chess board fields which cell size is equal to 55-220 angular minutes, the fields reversing at 7-9 Hz frequency. Then chess board fields which cell size is equal to 3.5-14 angular minutes, are shown, the fields reversing at 1-3 Hz frequency. EFFECT: enhanced vision acuity.

Description

 The invention relates to medicine, in particular to ophthalmology, and can be used to treat patients with amblyopia with the correct function.

 To date, the treatment of this disease is relevant, because up to 70% of children with strabismus suffer from amblyopia (N.I. Pilman. “Correction of strabismus in children.” Kiev, Health 1976, p. 61).

 A known method of treating amblyopia with a laser. The treatment is carried out on a nuclear submarine retinometer-1. The source of laser radiation is a continuous helium-neon laser operating at a wavelength of 638 nm. Using the optical system of the device, an interference lattice is formed directly on the retina, consisting of alternating red and black bands. In the process of treatment, the angular sizes of the fringe bands and their orientation in the three main meridians change. Starting from the above-threshold size of the interference grating bands for a given patient, the angular value is reduced until the patient sees them separately. The procedure is continued for 5 minutes. After a 30-40 minute break, the procedure is repeated. The course of treatment consists of 10 sessions (West. Of. 1985, N 6, p. 57 60).

 However, the known method has several disadvantages: the need for the child to understand the task / determination of the above-threshold size of the bands /. This limits the application of the method in preschool children. Recently, information has appeared with the low efficiency of this method in the conditions of fairly tight control / West. oft. 1990, N 2, p. 19 21 /.

 There is also known a method for the treatment of amblyopia, which consists in the fact that a patient in a dark room from a distance of one meter with optimal optical correction is presented with a spatial grid in the form of a black-and-white checkerboard with a frequency of reversal of 9 12 Hz for 15 20 minutes. Then the patient goes into a lighted room and practices at the Sivtsev-Golovin table (standard sensory training). The size of the chess grid depends on the initial visual acuity. The treatment is carried out daily, the average course of treatment is 9 to 14 days. / A.s. N 1630821, V. B. Volkov et al. 1991 /. This method is adopted as a prototype.

 The disadvantages of the known methods include the fact that this method does not fully take into account the physiology of the organ of vision (the presence of x-, y-systems analyzing the image). In a dark room, however, for neurons with high spatial resolution, which are most affected by amblyopia, light adaptation is the optimal condition. With dark adaptation, they lose directional and orientation properties. In addition, there is a need for the child to understand the task (determining the size of the chess grid), limits the application of the method in young children.

 The aim of the present invention is to increase visual acuity and increase the percentage of curable.

 The goal is achieved as follows: treatment is carried out in a bright room, under conditions of light adaptation using a television monitor located at a distance of 1 m from the child, stimulating with high-contrast chess fields measuring 18 x 24 degrees and an illumination on the screen of 80 lux. Treatment is started by presenting chess fields with a large cell size and a high frequency of contrast reversal, then chess fields with a small cell size and a low frequency of contrast reversal. Depending on the type of amblyopia, treatment is carried out monocularly or binocularly for 10 12 minutes daily, 10 14 days.

 New in the proposed method is that we proposed to stimulate the visual analyzer of children with amblyopia with high-contrast chess fields with a large mesh size (55,220 arc.min) and a high frequency of reversal of 7 9 Hz, then with a small mesh size (3,5 14 angle. min) and a low frequency of reversal of 1 to 3 Hz.

 To implement the proposed method when choosing stimulation parameters, we proceeded from the idea that in the human visual system there are two relatively separate and at the same time closely interacting subsystems of vision. One of them is a high-speed y-system that analyzes low spatial and high temporal frequencies; another slow-conducting x-system that processes high spatial and low temporal frequencies. With amblyopia, as a rule, both subsystems of vision suffer. Based on this, in order to achieve a positive effect, it is necessary to stimulate both the x- and y-system. To activate the y-system, the optimal stimulus is a chessboard with a large mesh size of 55,220 angles. min, reversible with a high frequency of 7 9 Hz; for the x-system, a checkerboard with a small mesh size of 3.5-14 angles. min, reversing with a low frequency of 1 to 3 Hz.

 The method consists in the following: the treatment is carried out in a bright room, the child with optimal optical correction sits 1 m from the TV monitor screen, the stimulation is carried out monocular or binocular (with a decrease in vision in both eyes and the presence of binocular vision). Within 3 minutes, chess fields with a mesh size of 55,220 angles are presented. min, reversing with a frequency of 7 9 Hz, then show chess fields with a mesh size of 3.5 14 angles for 3 min. min, reversing with a frequency of 1 to 3 Hz, such a 6 min cycle is repeated again. During the course of stimulation of the visual analyzer, including 10 14 daily sessions, dynamic ophthalmological monitoring of the state of visual functions is carried out according to indications of visual acuity. The course of treatment is completed when there is no improvement in visual function for 6 sessions.

 Example 1. Child K. 4.5 years. Entered the children's eye sanatorium DGKB N 1 East. b-ni N 26 with a diagnosis of strabismus primary permanent friendly non-accommodating convergent monolateral, amblyopia of the middle degree of the left eye. Visual acuity before treatment: 0.9 on the right eye (with a correction of 1.0), 0.2 on the left eye (with a correction of 0.2 0.3). The stimulation of the left eye. The treatment was carried out in a bright room using a television monitor located at a distance of 1 m from the child, stimulating with high-contrast chess fields. For 3 minutes, chess fields with a mesh size of 55 angles were presented. min, reversing with a frequency of 7 Hz, then presented for 3 min chessboard with a mesh size of 3.5 angles. min, reversing with a frequency of 1 Hz, such a 6 min cycle was repeated again. In the course of treatment, including 12 sessions, ophthalmological monitoring of the state of visual functions was carried out. After completion of the course of treatment, visual acuity: increased on the left eye from), 2 (with a correction of 0.2 0.3) to 0.3 (with a correction of 0.4), visual acuity in the right eye was 0.9 (with a correction of 1, 0). The child was examined 3 months after treatment, visual acuity remained at the achieved level.

 Example 2. Child C. 5.5 years. Entered the children's eye sanatorium DGKB N 1 East. N-48 N with a diagnosis of primary strabismus, permanent, friendly, non-accommodating, convergent monolateral, amblyopia of a high degree of the right eye. Visual acuity before treatment: 0.1 on the right eye (with 0.1 correction), 0.8 on the left eye (with 1.0 correction). The stimulation of the right eye. The treatment was carried out in a bright room using a television monitor located at a distance of 1 m from the child, stimulating with high-contrast chess fields. Within 3 minutes, chess fields with a mesh size of 220 angles were presented. min, reversing with a frequency of 9 Hz, then presented for 3 min chessboard with a mesh size of 14 angles. min, reversing with a frequency of 3 Hz, such a 6 min cycle was repeated again. In the course of treatment, including 12 sessions, ophthalmological monitoring of the state of visual functions was carried out. After completing the treatment, visual acuity: on the right eye increased from 0.1 (with 0.1 correction) to 0.2 (with 0.3 correction), visual acuity in the left eye 0.8 (with 1.0 correction). The child was examined 3 months after treatment, visual acuity remained at the achieved level.

 Example 3. Child P. 5 years. Entered the children's eye sanatorium DGKB N 1 East. b-ni N 31 with a diagnosis of strabismus primary constant friendly non-accommodating convergent monolateral, amblyopia of a weak degree of the right eye. Visual acuity before treatment: 0.3 on the right eye (with a correction of 0.5), 0.7 on the left eye (with a correction of 0.9). The stimulation of the left eye. The treatment was carried out in a bright room using a television monitor located at a distance of 1 m from the child, stimulating with high-contrast chess fields. For 3 minutes, chess fields with a mesh size of 110 angles were presented. min, reversing with a frequency of 8 Hz, then presented for 3 min chessboard with a mesh size of 7 ang. min, reversing with a frequency of 2 Hz, such a 6 min cycle was repeated again. In the course of treatment, including 12 sessions, ophthalmological monitoring of the state of visual functions was carried out. After completing the course of treatment, visual acuity: on the left eye increased from 0.3 (with a correction of 0.5) to 0.6 (with a correction of 0.8), visual acuity in the right eye was 0.7 (with a correction of 0.9). The child was examined 3 months after treatment, visual acuity remained at the achieved level.

 According to the proposed method, 30 children were treated. The control group consisted of 20 children aged 5–6 years with amblyopia of various origins. All patients in the control group received pleoptic treatment (method, prototype) optimal optical correction, direct occlusion, a child 15 20 min in a dark room from a distance of 1 m looks at the TV monitor screen, where the spatial grid is presented, the size of the chess grid depends on the initial visual acuity , the frequency of reversal is 11 Hz, 9 14 daily sessions. An increase in visual acuity in the control group by an average of 0.2 (from 0.1 to 0.3) was observed in 57% of children. As a result of applying the method of treatment of amblyopia that we proposed, an increase in visual acuity by an average of 0.2 (from 0.1 to 0.3) was observed in 74% of children, a follow-up period of 3 months. during which visual acuity was maintained at the achieved level.

 Thus, the proposed method provides: increased visual acuity (prototype 57% of the proposed method 74%); expansion of indications for the use of the method according to the age of the child due to the unnecessary determination of the size of the chess grid, depending on visual acuity.

Claims (1)

 A method of treating amblyopia with the correct fixation by exposing the visual analyzer to reversible chess fields, characterized in that the stimulation is first carried out by chess fields with cells measuring 55-220 angles. min with a frequency of reversal of 7 9 Hz, and then fields of size 3.5 14 ang. min, reversing with a frequency of 1 to 3 Hz in conditions of light adaptation.