RU2559283C1 - Method for binocular vision recovery - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: positive spherical lenses 0.5 D are placed in front of each eye above Bargolini glasses; a lens force increases at a pitch of 0.5 D until binocular fusion disappears. Thereafter, negative spherical lenses 0.5 D are placed into a frame; the lens force increases at a pitch of 0.5 D until binocular fusion disappears. The patient seats successively at 3 and 5 meters, and the procedure is repeated. A fixation object is a laser speckle in a pulse mode set 5 units below a critical fusion frequency. The treatment is conducted once a day with correcting ametropy completely; the therapeutic course makes 10 days.

EFFECT: method enables recovering the binocular vision by separating adaptation and convergence.

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Description

The invention relates to medicine, namely to ophthalmology, and is intended to restore binocular vision with friendly strabismus.

Friendly strabismus is characterized by a deviation of one or two eyes from a common fixation point against a background of binocular dysfunction. This is characterized by the appearance of functional suppression, manifested in the form of a monocular or simultaneous nature of vision, a violation of bifoveal fusion during synoptophore research, a violation of the interaction of accommodation convergence and accommodation, a decrease in accommodation volume, a decrease in fusional reserves, and a decrease in the sharpness of stereo-vision.

Restoring binocular vision is one of the priority tasks in the treatment of friendly strabismus. It is implemented in orthoptic and diploptic treatment methods.

Diploptics is a system of treatment methods for friendly strabismus, focused on restoring binocular vision in conditions as close to natural as possible.

There is a method of uncoupling accommodation and convergence (the method of "dissociation"), which is intended for the development of binocular fusion in the face of an increasing load on the accommodation apparatus with negative lenses, as well as relaxation with positive spherical lenses under the control of binocular fusion at a distance of 33 cm in the conditions of raster separation of visual fields [ Dashyan S.B., Kashchenko T.P. Copyright certificate No. 1752383 dated May 29, 1990].

The disadvantage of this method is the possibility of its use only to a limited number of patients with unstable binocular vision, the recovery efficiency of which is 44%.

There is also a method of restoring binocular vision with friendly strabismus, based on the use of laser speckles acting on the accommodation apparatus (TP Kashchenko, TA Kornyushina, SL Shapovalov, NM Maglakelidze Patent for invention No. 2354337) .

The disadvantage of this method is the lack of binocular control during treatment, which is extremely important for the development of bifoveal fusion and binocular nature of vision.

The closest analogue is the method described in the article [Serdyuchenko V.I. A modified technique for conducting diploptic exercises with friendly strabismus // Ophthalmic Journal. 1982. - No. 6. - S. 336-339], based on the use of Bagolini raster glasses to control binocular fusion when developing a reflex of bifixation from different working distances.

The disadvantage of this method is that it does not affect the accommodation apparatus of the eye, without normalization of which it is impossible to achieve a full binocular vision.

The objective of the invention is to provide a method for restoring binocular vision, based on the separation of accommodation and convergence, by affecting accommodation from various visual working areas.

The technical result of the invention is the restoration of binocular vision, increasing the volume of accommodation of the eye, expanding the range of portable lenses from different working distances (0.33 cm, 1 m, 3 m and 5 m), expanding fusion reserves and increasing the severity of stereo-vision in patients with friendly strabismus.

The technical result is achieved in that in a method for restoring binocular vision, including the use of Bagolini glasses from a distance of 1 meter, 3 and 5 meters, placed in a test frame in front of each eye at 45 and 135 degrees on the Tabo scale, through which the patient looks at the fixation object, according to the invention, positive spherical lenses of 0.5 diopters are placed on top of Bagolini glasses in front of each eye, then, with a step of 0.5 diopters, the strength of the lenses is increased until the binocular fusion is lost, then negative spherical lenses are 0.5 diopters, increase their power in increments of 0.5 diopters until the binocular fusion is lost, the patient is sequentially dispensed at a distance of 3 and 5 meters, and the procedure is repeated, while using a laser speckle in the pulse mode as the fixation object, set 5 units below the critical fusion flicker frequency, treatment is carried out once a day with full correction of ametropia, the course of treatment is 10 days.

A theoretical prerequisite for the development of the proposed method was the observation of the authors in the treatment of patients with friendly strabismus at the age of 5-26 years. The method is carried out using laser speckle and Bagolini glasses from a distance of 1 meter. Bagolini glasses are placed in a test frame in front of each eye at 45 and 135 degrees on the Tabo scale. Through them, the patient looks at the laser speckle. The uncoupling effect of raster glasses is manifested by thin mutually perpendicular light bands passing through a common laser speckle. In the presence of binocular fusion against the background of laser speckle, the patient sees the figure of a cross. Symmetrically, in front of each eye, positive spherical lenses of +0.5 diopters are installed, creating conditions for the dissociation of convergence and accommodation, by relaxing accommodation. Then, in increments of 0.5 diopters, the power of the lens increases until the cross lines diverge, indicating a loss of binocular fusion. After that, negative spherical lenses of 0.5 diopters are installed in the frame, which promote dissociation by accommodation voltage, increase their strength in increments of 0.5 diopters until the binocular fusion is lost.

After the patient is seated sequentially at a distance of 3 and 5 meters, and the procedure is repeated. Laser speckle is presented in a pulsed mode. The pulse mode is set 5 units below the previously determined critical flicker fusion frequency. Treatment is carried out with a complete correction of ametropia. The course of treatment was 10 days.

As the studies of the authors showed, the treatment of patients with friendly strabismus according to the method of dissociation against the background of observing laser speckles with raster separation of the field of view led to an increase in the range of portable spherical lenses from 5 meters from 8.72 diopters to 23.48 diopters when studying from 3 meters from 11.24 diopters to 24.79 diopters and when examined from 1 meter from minus 14.68 diopters to 30.99 diopters, as a result, the volume of absolute accommodation increased: on the double eye from 3.82 ± 0.5 diopters to 6.08 ± 0.68 diopters, on the better seeing eye from 6.13 ± 0.5 diopters to 7.63 ± 0.68 dpt p, i.e. decreased anisoaccomodation; the number of people with binocular vision increased during the study from a distance of 5 m - from 0% to 71.4%, from a distance of 3 m - from 7.1% to 85.7%, and from a distance of 1 m - from 31.1% to 97.6%; the number of persons with the simultaneous and monocular nature of vision decreased, the thresholds for stereo vision decreased from 1500 ± 500 ug. sec to 503 ± 157 arcsec Fusion reserves expanded from 12.6 ± 6.69 ° to 18.5 ± 0.92 °.

The treatment method is based on the separation of accommodation and convergence by affecting accommodation (presenting positive and negative spherical lenses) from different working distances (5 m, 3 m and 1 m) under the control of binocular vision (soft raster separation) in patients with bifoveal fusion and functional scotoma, with a monocular and simultaneous nature of vision (i.e. with the absence of binocular vision).

Clinical example 1. Patient S.P. 14 years old, before treatment, the strabismus angle averaged minus 10 °; when examining at a distance of 33 cm with different types of separation of the field of view, the range of transported lenses was reduced and was only in the plus zone during relaxation, the range of transportable lenses from 5 meters was 3 diopters, from 3 meters and 1 meter - 5 diopters; from all working distances during anaglyph separation, the character of vision was simultaneous, the amount of accommodation was reduced in both eyes, there was anisoacommodation of 7.75 diopters, fusion reserves were limited at 10 °, and the visual acuity was 3000 angular seconds.

After the treatment according to the invention, the strabismus angle decreased to minus 6 °; when researching at a distance of 33 cm, binocular vision appeared, the range of transferred lenses ranged from +6.0 diopters to - 8.0 diopters; the range of portable lenses in the study from 5 meters expanded to 11 diopters, from 3 meters to 15, and 1 meter to 17 diopters, the nature of vision became binocular when examined from all working distances; the volume of accommodation in both eyes increased, aniso-accommodation decreased to 5.0 diopters; fusion reserves increased to 22 °, the acuity of stereo vision increased to 400 arc seconds.

Clinical example 2. Patient Sh.E. 7 years, before treatment, the strabismus angle averaged + 3 °, at a distance of 33 cm, the range of transferred lenses with polaroid and color separation of the visual fields was, respectively, from +1.0 to +6.0 and from +3.0 to + 6.0; in the study during anaglyph separation, the nature of vision from all working distances was simultaneous; the volume of accommodation was reduced in both eyes, there was aniso accommodation of 1.0 diopters; fusion reserves were limited at 8 °; the threshold for stereo vision was 140 arc seconds. After the treatment according to the invention, the strabismus angle was not corrected with spectacle correction, when examined at a distance of 33 cm, the volume of transferred lenses was from 6.0 to minus 8.0 with polaroid and color separation of the visual fields, the nature of the vision became binocular when examined from all workers distances, the volume of accommodation in both eyes increased, aniso accommodation disappeared; fusion reserves increased to 23 °, the acuity of stereo vision increased to 60 arc seconds.

Claims (1)

A method for restoring binocular vision with friendly strabismus, including the use of Bagolini glasses from a distance of 1 meter, 3 and 5 meters, placed in a test frame in front of each eye at 45 and 135 degrees on the Tabo scale, through which the patient looks at the fixation object, characterized in that positive spherical lenses of 0.5 diopters are placed on top of Bagolini’s glasses in front of each eye, then, with a step of 0.5 diopters, the strength of the lenses is increased until the binocular fusion is lost, then negative spherical lenses are mounted in the frame lenses are 0.5 diopters, increase their power in increments of 0.5 diopters until the binocular fusion is lost, the patient is sequentially dispensed at a distance of 3 and 5 meters, and the procedure is repeated, while using laser speckle as the object of fixation in the pulse mode set 5 units below the critical frequency of flicker fusion, treatment is carried out once a day with full correction of ametropia, the course of treatment is 10 days.