RU2150253C1 - Method for treating anisometropic refraction amblyopia - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying medicine and homeopathic preparations for improving cerebral blood supply, normalizing metabolic processes, relaxing cross-striated and smooth muscles, and magnetic therapy. Retina and optic nerve stimulation, laser stimulation of macular area of the retina, laser therapy of the ciliary muscle and pattern-stimulation are applied concurrently or after finishing the course. Then, ciliary muscle relaxation therapy is applied as follows. A lens of +6.0 diopters refractive power is set into a test rim and placed before patient eye. 10 min later the lens power is reduced by 0.5-1.0 diopters. The power reduction process is continued every 2-3 min until +0.5 diopters lens power is reached. The procedure is performed with concurrent vision load applied. The course being over and vision acuity reaching its maximum for the given patient, binocular and stereoscopic vision training is carried out with computer software applied. EFFECT: enhanced effectiveness of treatment; removed accommodation spasm; increased vision acuity; restoration of binocular and stereoscopic vision. 2 dwg, 2 tbl

Description

 The invention relates to medicine, namely to ophthalmology, and can be used to treat various forms of anisometropic refractive amblyopia, in the pathogenesis of which the leading role is played by accommodation spasm (complex myopic astigmatism, simple astigmatism, complex hyperopic astigmatism, mixed astigmatism).

 Currently, 1.9% of children suffer from refractive amblyopia, and there is a tendency to increase the number of children suffering from this disease. Amblyopia with astigmatic eye refraction is most difficult to treat. Anisometropic refractive amblyopia not only reduces visual acuity, but also a number of other visual disturbances are observed, primarily related to binocular vision disorders, which greatly complicates the correction of ametropia in such patients. Therefore, it remains relevant to develop new effective methods of treating anisometropic refractive amblyopia.

 A known method of treating anisometropic refractive amblyopia, comprising sequentially placing spherical or cylindrical positive lenses with a power of 3.0, 2.0, 1.0 and 0.5 diopters in a test frame. The patient with each glass for 10-15 minutes looks at the table to determine visual acuity until the initial vision is fully clarified. Every two days, the same glasses are used to train in the reverse order (M. D. Mammadov “The effect of orthoptic treatment of accommodation spasm on myopic anisometropia” / Final session of the AzNII Ophthalmology, June 16, 1978). But this method does not always give a positive effect in the treatment, since the effect is carried out only on the peripheral section of the visual analyzer.

 Closest to the proposed is a method of treating anisometropic refractive amblyopia, including percutaneous electrical stimulation, laser stimulation and pattern stimulation. (L.N. Bachaldina, O.A. Antipova, S.A. Nebera, I.N. Gutnik "Dynamics of visual functions in the treatment of amblyopia in children with astigmatic refraction" / Sat. Actual issues of balneology, physiotherapy and medical rehabilitation ". Irkutsk. 1997, pp. 172-173).

 However, this method is not effective enough, because It does not eliminate the main cause - spasm of the ciliary muscle.

 The aim of the invention is to increase the effectiveness of the treatment of anisometropic refractive amblyopia.

 This goal is achieved by the fact that the patient is given a course of treatment, including taking medications and homeopathic medicines that improve blood supply to the brain, normalize metabolic processes, promote relaxation of striated and smooth muscles and physiotherapy - magnetotherapy or induction magnetotherapy (magnetic field effect on optical-gyrophysical system). In parallel or after the end of this course of treatment, the patient is given a course of electrical stimulation of the retina and optic nerve, laser stimulation of the macular region of the retina, laser therapy and pattern stimulation. Then they conduct a course of treatment that relaxes the ciliary muscle: a lens with a power of + 6 diopters is placed in the test frame in front of the patient’s eye. After ten minutes, reduce the lens power by 0.5 - 1.0 diopters and continue to reduce the lens power every 2-3 minutes to a lens with a power of +0.5 diopters with simultaneous visual load (the patient looks at the Sivtsev-Golovin table and tries to consider the smallest possible optotypes). After the end of this course of treatment, with increasing visual acuity to the maximum for this patient (from 0.4 and above), binocular and then stereo-vision training is carried out using standard computer programs.

 Comparative analysis with the prototype showed that the proposed method of treatment differs from the known one in that an additional course of treatment is carried out for the patient, including the administration of drugs and homeopathic medicines, magnetotherapy, and laser therapy. The impact on the ciliary muscle with positive lenses is as follows: in front of the patient’s eye, put a +6 diopter lens into the test frame. After ten minutes, reduce the lens power by 0.5 - 1.0 diopters and continue to decrease the lens power every 2-3 minutes with simultaneous visual load.

 Thus, the proposed technical solution meets the criteria of the invention of "novelty."

 The analysis of patent and specialized literature showed that this method of treating anisometropic refractive amblyopia differs not only from the prototype, but also from other technical solutions in this and related fields. So, the authors did not find a way to treat anisometropic amblyopia, which would combine the treatment with the medicinal and homeopathic remedies we offer, physiotherapy, electrical, laser and pattern stimulation and relieve accommodation spasm according to the proposed scheme. No treatment method was found in which, at the first stage of treatment, an effect on the central nervous system was carried out. Namely, the complex effect of medicinal and homeopathic preparations and physiotherapy on the central nervous system and on the ciliary muscle makes it possible to reduce the focus of excitation in the brain, interrupt the flow of pathological impulses, relieve the uneven spasm of the ciliary muscle, and create more favorable conditions for acting directly on the visual analyzer. Electro, laser, pattern stimulation and laser therapy improve conduction processes and activate biochemical processes in retinal pigment epithelium, improve blood supply, metabolic processes in tissues, which also leads to the removal of accommodation spasm and more effective treatment of amblyopia.

 The relaxation of the ciliary muscle according to our scheme against the background of preliminary exposure to the central nervous system and the visual analyzer also leads to more effective removal of the accommodation spasm, and this, in turn, allows achieving better treatment results for amblyopia, in the pathogenesis of which there is an accommodation spasm.

 Thus, the proposed modes of the method according to the proposed scheme can increase the effectiveness of treatment in patients with anisometropic refractive amblyopia: increase visual acuity, translate astigmatic refraction into simple spherical or simple astigmatic, and therefore, it becomes possible to correct with glasses or contact lenses and the possibility of restoring binocular and stereo vision.

 This method of treatment can be used in ophthalmology departments of clinics and hospitals.

 Thus, the proposed method meets the criteria of the invention of "inventive step" and "industrial applicability".

The method is as follows: the patient undergoes a complete ophthalmological examination, including visometry, ophthalmoscopy (direct and reverse), scioscopy with a wide and narrow pupil, refractometry, studies of the nature of vision using a four-point color test and synaptophore, computer perimetry, ultrasound of the eyeball. The patient is examined by an endocrinologist and a neuropathologist. To clarify the neurological status spend
1) electroencephalographic study with registration of evoked visual cortical potentials;
2) rheoencephalographic research.

 All examinations are carried out in dynamics (before and after treatment).

 When diagnosed with anisometropic refractive amblyopia, treatment is carried out according to the proposed method, which consists of three stages.

 Stage 1 - effects on the central nervous system. Treatment is prescribed by a neurologist according to EEG, REG and clinical examination. As a rule, with anisometropia in patients, a focus of excitation is recorded on one side. The patient is prescribed medication and homeopathic medicines and physiotherapy. Drugs are selected individually: drugs are used that improve the blood supply to the brain (for example, nootropil, cinnarizine, piracetam, etc.), normalize metabolic processes (glycine, riboxin), help to relax smooth and striated muscles (for example, dibazole) and homeopathic medicines ( cuprum, magnesia phosphoric, conium, etc.). The course of treatment is 3 weeks - 1.5 months.

 In addition, the patient is prescribed magnetotherapy or induction magnetotherapy. Magnetotherapy is carried out using a pulsed low-frequency physiotherapeutic apparatus (INFITA) with the prefix OPTEMAGS. The impact of a pulsed low-frequency electromagnetic field is carried out through a spectacle frame and directly the emitter for 7-9 minutes once a day. The procedure is carried out 9-11 times.

 Induction magnetotherapy is carried out on the hardware-software complex IMEDIS. Electrodes impose a ring on the head area. The exposure is carried out for 30-35 minutes once a day 7-10 times.

2nd stage: in parallel with the course of treatment by a neurologist or after its completion, treatment is carried out by an ophthalmologist. All of the following procedures are performed daily, sequentially:
1) Electrical stimulation of the retina and optic nerve. Conducted by a Sunshine VSD-002 apparatus. The patient will determine the threshold of electrical sensitivity of the retina and electrical lability of the optic nerve. Depending on these indicators, a therapeutic stimulation mode is established: the current strength is from 100 to 250 μA, the amplitude is 12-18 mV. Stimulation is carried out 1 time per day for 12 minutes. The course of treatment is 9-13 procedures.

 2) Laser therapy (laser glasses). Conducted on the apparatus MAKDEL-00.00.09 - an infrared laser for the treatment of accommodation-refractive disorders of vision (approved for use by the Ministry of Health of the Russian Federation on 12/14/95). The effect is on the ciliary muscle. Therapy is carried out for 5-7 minutes, 1 time per day. The course of treatment is 9-13 procedures.

3) After a laser therapy session, monocular laser stimulation of the macular region with a helium-neon laser is performed using the MACDEL apparatus - 00.00.08.1. The apparatus has a flexible light guide system with a scattering nozzle, at the output of which a speckle structure is formed with a radiation power density of 10 ^-5 W / cm ² and a wavelength of 0.63 μm. The patient’s eye is 15 cm from the screen. Stimulation is carried out 1 time per day for 5 minutes. The course of treatment is 9-13 procedures.

 4) After the laser stimulation session, a pattern stimulation session is performed. A chess pattern is presented using a computer using a special computer program. Treatment is carried out monocularly, in daylight, the distance from the computer monitor to the patient’s eyes is 40-50 cm. Before treatment, the optimal stimulation parameters for a particular patient are determined (duration of presentation of the pattern, size of the pattern element). The stimulation pattern is carried out daily for 10-15 minutes with each eye. A course of 9-13 procedures.

 5) After the pattern stimulation, the following procedure is performed (“glass” atropine): spherical positive lenses with a force of +6.0 diopters (for 10 min) are sequentially inserted into the test frame and then the lens power is decreased by 0.5-1.0 diopters every 2-3 min to lens power +0.5 diopters. The procedure is carried out with simultaneous visual load - the patient looks at the Sivtsev-Golovin table from a distance of 5 m and tries to consider as small optotypes as possible. The procedure is carried out (if necessary) for each eye separately. The course of treatment is 9-13 procedures.

 Stage 3: with an increase in visual acuity to the maximum for a particular patient (from 0.4 and above), binocular and then stereo-vision training is performed using computer programs.

 A second course of treatment is carried out after 1-3 months. It includes: 1) laser therapy according to the above scheme for 3-7 days, 2) "glass" atropine according to the above scheme for 3-7 days. Upon receipt of the result achieved during the first course of treatment, the patient is trained in binocular and stereo vision.

 Example 1. Ryabinina Y., 9 years old. She complained of low vision in the distance of the left eye. Not treated.

 Objectively: vis 0.1 does not correct.

1.0
The nature of vision is monocular. Reserves of relative accommodation - 5.5D).

Степень астигматизма 5 дптр.Scoscopy

The degree of astigmatism is 5 diopters.

 Diagnosis: anisometropia, mixed astigmatism, reserves of absolute accommodation - 0, refractive amblyopia, accommodation spasm.

 The girl was examined by a neurologist. Diagnosis: condition after concussion, mild intracranial hypertension, VVD.

 Conclusion on the EEG: EEG is outside the normal range. Moderate diffuse changes are recorded without a clearly localized focus. On photostimulation and evoked potentials, flashes of slow waves in the temporal leads of amperes were recorded. 100 and above, mainly on the left (see the appendix to the description, Fig. 1).

 A course of treatment was carried out as described above.

1) Drug therapy for 1 month:
cinnarizine 0.0125 g - 3 times a day
glycine 1 tab - 2 times a day
dibazole - 0.02 g in the evening
2) Homeopathic remedies: cuprum 6 to 7 grains 1 time per day 1 month
3) Magnetotherapy using the INFITA apparatus with the OFTEMAGS prefix (magnetic glasses) 1 time per day for 7 minutes, 9 procedures.

After this course, the following procedures were carried out (performed daily sequentially):
1) Electrical stimulation of the retina and optic nerve - 1 time per day for 12 minutes Course - 9 treatments
2) Laser therapy of the ciliary muscle - 1 time per day for 5 minutes. 9 treatments.

 3) Laser stimulation of the macular region - 1 time per day for 5 minutes, 9 procedures.

 4) Stimulation pattern (right eye) - 1 time per day for 10 minutes, 9 procedures.

 5) Relaxing ciliary muscle therapy (“glass atropine” on the right eye): put a spherical lens with a power of +6.0 diopters for 10 min into the test spectacle frame, then reduce the lens power by 0.5 diopters every 2 min and bring the lens power to +0.5 diopters.

су1 + 1.0 ax 90^o = 0.85
1.0
Скиаскопия

Степень астигматизма 1.0 дптр.After 9 sessions of "glass" atropine:
Vis 0.4 sph + 3.0 dptr

cy1 + 1.0 ax 90 ^o = 0.85
1.0
Scoscopy

The degree of astigmatism is 1.0 diopters.

 Repeated EEG: there is a positive trend - a decrease in the focus of slow waves while maintaining it in the right occipital leads (see the appendix to the description, figure 2).

су1 + 1.0 ax 90^o = 0.7
1.0
Была проведена лазертерапия в течение 3 дней по вышеописанной схеме и "стеклянный" атропин в течение 3-х дней по вышеописанной схеме.At the control examination 1 month after treatment:
Vis 0.4 sph + 3.0 dptr

cy1 + 1.0 ax 90 ^o = 0.7
1.0
Laser therapy was performed for 3 days according to the above scheme and “glass” atropine for 3 days according to the above scheme.

Степень астигматизма 0.5 дптр.After the second course of treatment:
Vis 0.6 sph + 3.0 diopters = 1.0
1.0
Scoscopy

The degree of astigmatism is 0.5 diopters.

 After the first and second courses of treatment, binocular and stereo vision were trained using standard computer programs.

 Conclusion: after the treatment, mixed astigmatism was converted to spherical refraction, the degree of astigmatism decreased to 0.5 diopters (which corresponds to physiological astigmatism that does not require additional correction), visual acuity without correction of the right eye is 0.6, with correction 1.0. Accommodation reserves increased to the age norm.

 Example 2. Orlenko M., 11 years old. He complained of low vision in the distance in both eyes. He was treated for 3 years in a clinic.

су1 - 3.25 ax 180^o = 0.5
0.3 sph - 0.75 дптр =1.0
Рефрактометрия: OD sph -0.5 дптр

су1 -3.75 ax 3^o
OS sph -0.75 дптр

cyl - 0.25 ax 178^o
Характер зрения - одновременный.Objectively: Vis 0.15 sph - 0.5 diopters

Su1 - 3.25 ax 180 ^o = 0.5
0.3 sph - 0.75 diopters = 1.0
Refractometry: OD sph -0.5 diopters

Su1 -3.75 ax 3 ^o
OS sph -0.75 dptr

cyl - 0.25 ax 178 ^o
The nature of vision is simultaneous.

 Reserves of absolute accommodation - 0.5D.

 The degree of astigmatism OD = 3.5 diopters.

 The degree of astigmatism OS = 0.25 diopters.

 Diagnosis: anisometropia. OD - complex myopic astigmatism, refractive amblyopia. OS - myopia of the 1st degree, the degree of absolute accommodation - 6.0.

 The patient was examined by a neurologist. Diagnosis: VVD.

 Conclusion on the EEG: EEG is outside the normal range. Mild diffuse changes are recorded. During hyperventilation, generalized outbreaks of synchronized D waves are recorded with an emphasis in the right posterior temporal and left central dark leads. There are signs of stem structure dysfunction.

 A course of treatment was carried out as described above.

1) Drug therapy for 3 weeks:
Nootropil 0.4 g - 3 times a day
glycine 1 tab - 2 times a day
dibazole - 0.0125 g in the evening
2) Homeopathic remedies: magnesia phosphoric 6, 7 grains 1 time per day, 1 month
3) Induction magnetotherapy on the hardware-software complex IMEDIS. The exposure was carried out 1 time per day for 30 minutes, 7 times.

In parallel with this course, the following procedures were carried out (performed daily sequentially):
1) Electrical stimulation of the retina and optic nerve - 1 time per day for 12 minutes Course - 13 treatments
2) Laser therapy - 1 time per day for 7 minutes. 13 treatments.

 3) Laser stimulation - 1 time per day for 5 minutes, 13 procedures.

 4) Stimulation pattern (right eye) - 1 time per day for 15 minutes, 13 procedures.

 5) Relaxation of the ciliary muscle therapy (“glass atropine” on the right eye): a spherical lens with a power of +6.0 diopters for 10 min was placed in a test spectacle frame, then the lens power was decreased by 1.0 diopters every 3 min and the lens power was adjusted to +0.5. 13 sessions were conducted.

After the course of treatment:
Conclusion of a neurologist (data from repeated EEG): there is a positive microdynamics in terms of increasing the organization and index of alpha activity of the background rhythm.

Optometrist's conclusion:
Vis OD 0.2 sph - 0.75 diopters - 0.85
OS 0.4 sph -0.5 diopters = 1
Refractometry: OD sph -0.5 diopters
OS sph-0.75 dptr
Diagnosis: 1st degree myopia in both eyes. Amblyopia of the 1st degree of the right eye.

 After the course of treatment, binocular and stereo vision were trained using standard computer programs.

At the control examination 3 months after treatment - visual acuity did not change: OD - 0.85 (with correction)
OS - 1.0 (with correction)
The degree of astigmatism: OD - 0 diopters
OS - 0 diopters
Accommodation reserves correspond to the age norm:
OD-12 diopter
OS-15 Dptr
Spasm of accommodation removed.

The proposed method was used in the treatment of various forms of anisometropic refractive amblyopia in 61 patients (86 eyes). The age of patients is from 5 to 15 years. Patients were divided into 4 groups:
1) with complex myopic astigmatism (23 eyes)
2) with complex hyperopic astigmatism (27 eyes)
3) with mixed astigmatism (26 eyes)
4) simple myopic astigmatism (10 eyes)
The results of the treatment of these patients (by the proposed method) are presented with table 1. Table 2 presents the results of treatment of the proposed method and the prototype method in comparison.

After 3 months, visual acuity with correction decreased:
In the 1st group, by 0.1-0.15 in 35% of cases
In the 2nd group, by 0.2-0.25 in 27% of cases
In the 3rd group by 0.15-0.2 in 31% of cases
In the 4th group, by 0.1-0.15 in 20% of cases
After 3-7 days of treatment according to the proposed method, visual acuity was restored to the results achieved after the 1st course of treatment in all patients.

 As can be seen from tables 1-2, the proposed method for the treatment of anisometropic refractive amblyopia can increase visual acuity in patients suffering from various forms of amblyopia, relieve spasm of accommodation, reduce the degree of astigmatism, increase the reserves of absolute accommodation to the age norm in 95% of cases.

 In 72% of patients, astigmatic refraction was converted to simple spherical refraction, in 15%, the degree of astigmatism did not exceed 1.0-1.25 diopters, and in 2%, the degree of astigmatism was 1.25-1.75 diopters, which made it possible to apply correction with glasses and contact lenses, and it was possible to restore binocular vision.

 Thus, the proposed method is effective in the treatment of anisometropic refractive amblyopia, in the pathogenesis of which there is a spasm of accommodation.

 The proposed method is recommended for use in clinical practice.

Claims (1)

 A method of treating anisometropic refractive amblyopia by percutaneous electrical stimulation of the retina and optic nerve, laser stimulation of the macular region of the retina, pattern stimulation and training of binocular and stereoscopic vision, characterized in that they additionally carry out a course of treatment, including taking medications and homeopathic medicines that improve blood supply to the brain, normalizing metabolic processes that contribute to the relaxation of striated and smooth muscles, the effect of lower with a frequency magnetic field on the optic-pituitary system, the effect of infrared laser radiation on the ciliary muscle and relaxation of the ciliary muscle as follows: a lens with a power of + 6.0 diopters is placed in front of the patient’s eye, after 10 minutes they reduce the lens power by 0.5 - 1.0 diopters and they continue to reduce the power of the lens every 2 to 3 minutes to a lens with a power of +0.5 diopters, while the procedure is performed with simultaneous visual load.

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