RU2614210C2 - Method for bifixation and stereoscopic vision recovery at early stages of concomitant strabismus conservative treatment, and visual fields separator for method implementation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method for bifixation and stereoscopic vision recovery at early stages of concomitant strabismus conservative treatment, which includes application of liquid crystal glasses, visual exercises to restore the fusional ability to merge on sinoptofore and/or visual fields separator, exercises to restore the binocular vision, according to the invention, preliminary inspection is conducted to reveal causality of strabismus with involvement of a neurologist and vertebrologist, therapeutic and rehabilitative measures to address the identified causes, the visual function is activated without strict separation of the right and the left eye visual fields, using liquid crystal glasses, partial blocking of objects visible by the better seeing eye and/or alternate blocking of the right and the left eye is provided, application of the direct occlusion is limited by 1 hour per day, and bifixation training on the visual fields separator starts at a distance of 5-7 cm from the eye, with development of fusional merging reflex with gradual distance increase up to 50 cm. The visual fields separator, which includes a separating bar and a transverse frame installed thereon for object placement, according to the invention, the transverse frame is movable along the separating bar.

EFFECT: group of inventions allows to increase the efficiency of concomitant strabismus treatment at an early age.

4 cl, 3 dwg

Description

The inventive method relates to medicine, in particular to methods for treating friendly strabismus.

Treatment of friendly strabismus with ametropia begins with the appointment of points. With a decrease in visual acuity of the squinting eye, special methods are used (pleoptics). These include turning off the better seeing eye (occlusion, local irritation with light from the central fossa of the retina, the use of negative sequential images that occur when illuminating the retina of the posterior pole of the eye with simultaneous covering with areas of the central fossa, visual exercises, etc.). In the absence of amblyopia or with persistent (during treatment) increase in visual acuity above 0.4, exercises are shown that help to restore fusional ability (orthoptics), which are mainly carried out at synoptophore. If the constant wearing of glasses for 6-12 months does not eliminate strabismus, resort to surgical intervention, which is best done at the age of 3-5 years. Two types of operations are used - enhancing and weakening the action of the oculomotor muscles. Strengthening of the action is achieved by shortening the muscles using resection or other methods. The weakening of the action of the muscle is obtained when it is transplanted (recession) or the intersection of the tendon. The system of strengthening or weakening the action of the oculomotor muscles during surgery depends on the strabismus angle. Orthoptic exercises are shown before and after surgery. After restoration of the symmetrical position of the eyes achieved as a result of conservative treatment or surgery, special (diploptic) exercises are performed to restore binocular vision http://dic.academic.ru/dic.nsf/enc_medicine/15080/%D0%9A%D0% BE% D1% 81% D0% BE% D0% B3% D0% BB% D0% B0% D0% B7% D0% B8% D0% B5.

At the same time, pleoptics is a type of treatment for amblyopia, which consists in obtaining visual acuity due to visual fixation, which allows the possibility of binocular vision. The main methods of treating amblyopia include: direct occlusion, penalization, treatment using a negative sequential image, local blinding irritation with light from the central fossa of the retina.

Orthoptics - restoration of lost binocular vision. As soon as orthophoria is established under the influence of treatment or surgery, with visual acuity of the amblyopic eye of 0.4 or higher, it is necessary to attach exercises to the development of binocular vision in the following sequence: disinhibition of scotoma suppression, creation of bifoveolar fusion, development of fusion and binocular vision. The orthoptic treatment system also includes electrostimulation of the oculomotor muscles and exercises for the development of eye mobility. Orthoptic exercises are permissible only with central fixation and are available to children aged 4-5 years and older (T. Birich, L. Marchenko, A. Chekina. Treatment of amblyopia in children with strabismus. Http://www.myglaz.ru/public/ ophthalmology / ophthalmology-0471.shtml). At the same time, to merge the fields of view, along with the synoptophore, field separators are used to separately view paired images with the right and left eye (see http://enc-dic.com/medicine/Razdelitel-Polej-Zrenija-24057.html and http: / /zrenue.com/kosoglazie/90-sodruzhestvennoe-kosoglazie/753-ortopticheskie-apparaty-i-uprazhneniia-sinoptofor-kheiroskop-biviziotrener-stereoskop.html).

For the same purpose, liquid crystal glasses are used, the mechanism of action of which is based on the phase (in time) separation of the fields of view of both eyes with a frequency exceeding the critical frequency of flicker fusion (see Grigoryan A.Yu., Avetisov ES, Kashchenko T.P. ., Yachmeneva EI Bulletin of Ophthalmology. 1999.-N 1.-C.27-28. Bibl. 6 names.).

The creation of bifoveolar fusion is provided, for example, by attaching prisms to the eyes, the conditions of doubling are created, which serves as an incentive for fusion - bifoveal fusion of images. Diploptic exercises, as it were, revive the physiological ability of the eye to overcome double vision and thereby restore the mechanism of bifixation - the basis of normal binocular vision (http://www.glazmed.ru/lib/public19/oftalm0059.shtml).

Thus, a known method of restoring bifixation and stereoscopic vision in the early stages of conservative treatment of friendly strabismus, including at least one or more of the following:

• turning off the better seeing eye (occlusion),

• local irritation with light from the central fossa of the retina,

• the use of negative sequential images that occur when illuminating the retina of the posterior pole of the eye with simultaneous covering with areas of the central fossa,

• visual exercises, including exercises that contribute to the restoration of fusional ability (orthoptics), which are carried out on the separator of the field of view;

• after restoration of the symmetrical position of the eyes, special (diploptic) exercises are performed to restore binocular vision,

The specified method is selected as a prototype. http://dic.academic.ru/dic.nsf/enc_medicine/15080/%D0%9A%D0%BE%D1%81%D0%BE%D0%B3%D0%BB%D0%B0%D0%B7 % D0% B8% D0% B5.

But when implementing the method there are a number of problems.

Firstly, the effectiveness of treatment is directly related to the elimination of the causes of friendly strabismus, which include not only ophthalmic problems. So, disorders in the upper (cervical) spine often lead to the onset of the disease. The textbook (Kovalevsky EI Pediatric Ophthalmology. M. Medicine, 1970 - 152, 158) states the need for preliminary elimination of infections, tumors, injuries, etc. In addition, neurological causes are of great importance (Kaufmann Herbert, Heimo Stefffen, Strabusmis Thieme 2004,231). However, in the prototype method and in practice, these recommendations are often not implemented. There is no close practical connection between ophthalmologists and neurologists, vertebrologists.

Thus, the disadvantage of the prototype method is the lack of a preliminary examination of the child and the elimination of identified problems that caused or influenced the occurrence of friendly strabismus. The absence or incompleteness of treatment and rehabilitation therapy leads to a decrease in the effectiveness of treatment of friendly strabismus.

Secondly, as established by the authors, activation of visual functions with a strict separation of the visual fields of the right and left eye and prolonged use of occlusion (for 2 or more hours) reduces the effectiveness of treatment, since it can lead to the loss of compensatory mechanisms of fusion fusion, although in practice it is usually prolonged occlusion is used. So, in the book Kaufmann Herbert, Heimo Stefffen, Strabusmis Thieme 2004, 308-309 in the 1st year of life, partial occlusion is recommended from 1-2 hours a day to half a day, after the first year it is recommended to glue a better seeing eye for as many days as the child is years old. According to other sources, the leading eye is turned off for at least 4 months (Visual functions and their correction in children: A manual for doctors / Edited by S.E. Avetisov, T.P. Kashchenko, A.M. Shamshinova.- M .: Publishing House "Medicine", 2005 - 213). Prolonged occlusion can increase the central visual acuity of the amblypical eye, but completely destroys the fusion reflexes of the fusion.

Thirdly, the effectiveness of treatment is reduced due to the placement of the field separator at a constant distance from the eyes. The field of view separator - a device for separate viewing of paired images by the right and left eye - is used for the diagnosis and orthoptic treatment of strabismus (http://tolkslovar.ru/r8248.html). Separators with a distance from the eyes to the cross-member with images of 30 cm are usually used. But the child often cannot merge the images into one if the pictures are located at a great distance from the eyes and the squint angle is greater than 7 °. The child does not understand what he needs to do, how to achieve the merger of two images into one.

As a prototype for the inventive device, a traditional separator of the field of view is selected, which consists of a curved bar measuring 30x7 cm, separating the field of view of one and the second eye, and a transverse frame of 10x7 cm in size for objects. The frame has two round holes and manholes for inserting paired drawings and changing the distance between them from 40 to 60 mm (see http://zrenue.com/kosoglazie/90-sodruzhestvennoe-kosoglazie/753-ortopticheskie-apparaty-i-uprazhneniia- sinoptofor-kheiroskop-biviziotrener-stereoskop.html).

When using this device, the transverse frame is at the same distance from the eyes, in addition, the child has to hold the divider in his hand.

The objective of the present invention is to remedy these disadvantages, namely: increasing the effectiveness of the treatment of friendly strabismus at an early age, facilitating the child's understanding of the front-line task and simplifying the use of the device.

This problem is solved due to the fact that in the method of restoring bifixation and stereoscopic vision in the early stages of conservative treatment of friendly strabismus, including the use of liquid crystal glasses, visual exercises to restore fusion ability to merge on the synoptophore and / or separator of visual fields, exercises to restore binocular view, according to the invention, a preliminary examination is carried out to identify causal relationships of the appearance of strabismus with the involvement of by a neurologist and vertebrologist, treatment and rehabilitation measures to eliminate the identified causes, activation of visual functions are carried out without hard separation of the visual fields of the right and left eye, using liquid crystal glasses provide partial blocking of visible objects of the better seeing eye and / or alternate blocking of the right and left eye in the presence of a competitor, they limit the use of direct occlusion to 1 hour per day, and the bifixation training on the field of view separator begins at a distance Research Institute 5-7 cm from the eye to the development of reflex diffusive fusion with a gradual increase in the distance of 50 cm.

This problem is solved due to the fact that the implementation of the proposed method is additionally implemented within the framework of the visual school with the involvement of parents.

In addition, this problem is solved due to the fact that in the separator of the field of view, including the separating bar and mounted on it with a transverse frame for placing objects, according to the invention, the transverse frame is mounted to move along the separating bar.

The field of view separator is equipped with a base for installation on a supporting surface.

Thus, the obligatory preliminary examination to identify the cause-effect relationships of the appearance of strabismus with the involvement of a neurologist and vertebrologist, as well as therapeutic and rehabilitation measures to eliminate the identified causes make it possible to more effectively treat friendly strabismus.

In addition, these measures provide the opportunity for timely implementation of directly ophthalmic therapeutic actions: the use of liquid crystal glasses, which provide partial blocking of visible objects better than the seeing eye and / or alternate blocking of the right and left eyes in the presence of a competitor (better seeing eye), visual exercises to restore fusional the ability to merge, exercises to restore binocular vision, which excludes their unproductive effects per child.

The specified features of the effect of liquid crystal glasses without hard blocking provide enhanced work of the visually impaired eye without turning off a competitor (clearly seeing eye).

Limiting the use of direct occlusion to 1 hour per day prevents the loss of compensatory fusion mechanisms, which also positively affects the effectiveness of treatment.

Training bifixation on the separator of visual fields starting from the minimum distance from the eyes with a gradual increase in the distance to 50 cm allows the child to quickly master the mechanism of the fusion reflex of fusion, which also increases the effectiveness of treatment.

The addition of the traditional treatment carried out within the medical institution with procedures performed by the child with the help of the parents at home, allows to increase the duration of the procedures and increase their effectiveness.

The combination of the claimed features provides a joint technical result: the child begins to see well much faster and psychologically painlessly than with traditional methods, and all the signs are in a causal relationship with the specified result, while the child becomes more calm and assiduous. At the same time, the child more easily understands the tasks before him and therefore actively participates in the training process.

The implementation of the frame in the separator of the field of view of the movable ensures the implementation of the claimed method. In addition, placing the separator on a base mounted on a support surface frees the child or the adult helping him from having to hold the device in his hands.

The claimed invention is used within the existing visual school for the treatment of friendly strabismus, it can also be widely used in domestic and foreign health care, which confirms compliance with the criterion of "industrial applicability".

Conducted patent studies showed that the claimed combination of features is not known, therefore, the proposed technical solution meets the criterion of "novelty." Revealed from the prior art solutions do not contain signs that match the distinguishing features of the claimed invention, therefore, the latter meets the criterion of "inventive step".

The essence of the claimed device is confirmed by the drawings, where in FIG. 1 is a perspective view of a field separator; FIG. 2 is a view of the dividing strip of the claimed device, FIG. 3 is a photograph of a field separator.

The inventive method of restoring bifixation and stereoscopic vision in the early stages of conservative treatment of friendly strabismus using the example of an existing visual school is as follows.

An examination is carried out of children who have revealed friendly strabismus by a neurologist and vertebrologist, who each in their area check the child and, if possible, establish a diagnosis, which resulted in strabismus.

If the doctor vertebrologist has identified abnormalities in the upper cervical spine, then treatment and rehabilitation measures are prescribed to restore physiology and eliminate the negative impact on the balance of the eye muscles of the identified disorders.

At the same time or sequentially, a neurologist carries out an examination of the child. It identifies possible neurological causes of strabismus. If any, then appropriate treatment and rehabilitation therapy is prescribed.

After carrying out all the prescribed treatment and preventive procedures and improving the condition of the upper cervical spine and the psychosomatic state of the child, correction and treatment-and-training therapy of visual functions begins. At the same time, within the framework of the visual school, the existing methods are also widely used.

The visual school is equipped with the following equipment: SINF-1 synoptophore (made in Kharkov), Oculus synoptophore (Germany), slit lamp, autorefractometer (Huvitz), skoscoric rulers, a set of test eyeglass lenses and prisms, tables and table light for visual acuity tests for both near and far, an Riester direct electric ophthalmoscope, MEKO diagnostic computer programs using liquid crystal glasses, LOT laser speckle for stimulating central vision (Moscow), ESOM-COMET electrical stimulator, and SECTOR 1 color-rhythm stimulation (T. Teterina), vacuum infrasound massager E.I. Sidorenko, LED ophthalmological apparatus O.P. Pankova, amblyotrener, bivisotrener, visual field separator for generating and fixing the fusion, muscular trainer perimetric ophthalmic complex, computer, MEKO training programs (Constructor, Ural Federal District, OKSIS) using liquid crystal glasses, a complex of medical training computer programs with blue-red glasses.

For each child, a survey is carried out:

- visometry;

- study of the volume of movement of the eyeballs;

- determination of the nature of strabismus (accommodative, non-accommodative);

- direction of strabismus;

- determination of the strabismus angle according to Hirschberg;

- determination of the strabismus angle at the synoptophore (OUK - objective strabismus angle, CMS - subjective strabismus angle), determination of functional scotoma, the presence of fusion fusion;

- determination of the nature of vision using a four-point test;

- refractometry in cycloplegia (skioscopy);

- ophthalmoscopy.

In the process of treatment, liquid crystal glasses were used with partial blocking of visible objects of the better seeing eye and / or alternating blocking of the right and left eyes. Visual exercises were carried out to restore the fusion ability to merge at the synoptophor and / or the separator of the visual fields. In addition, exercises were conducted to restore binocular vision.

Since bifixation and binocular vision are absent in friendly strabismus, the main emphasis in medical treatment therapy in the visual school was aimed at creating conditions and opportunities for earlier start of classes to restore bifixation and subsequent development of stereoscopic vision. This had a very positive effect on the timing of the child’s recovery and the quality of the result.

One of the main features of the visual school is that the parents of children attending the visual school are involved in the healing process. And the responsibility for recovery lies also with the parents. They also become responsible for the rehabilitation of the child during the recovery period.

After the first examination of the child in the visual school, he was given homework, which he should do at home with his parents, this is a gymnast for the eyes, visual-concentration exercises for the amblyopic eye while wearing occlusion, it was recommended to consult and conduct classes with an occupational therapist (defectologist). In the visual school, the duration of one lesson was 1.5 - 2.0 hours, game pauses of 5-7 minutes are included here, the duration of classes for one exercise did not exceed 10-15 minutes. The course of treatment was 10 days. Before conducting classes to stimulate central vision, children received an infrasonic vacuum massage (improving trophic functions of the eye muscles and posterior segment of the eye). Then, electric or laser (LOT) stimulation, after which classes were held on computer programs (Flower, Eye, Tic Tac Toe, Spider,). After computer classes, classes were conducted on (-) lenses to increase RA. When, after conducting pleoptic therapy, the central visual acuity increased, and the difference between the vision of the right and left eyes did not exceed 15-20%, we went on to the bifixation classes, after eliminating the functional scotoma (a session on synoptophore). After obtaining simultaneous and then binocular vision, we proceeded to the development of stereoscopic vision. After a ten-day course, certain results were achieved. The children were given homework with their parents, so that they would be engaged already under the control of their parents at home, and then the parents themselves were responsible for stabilizing the positive results. The course of treatment was repeated after 3 months. Treatment courses and homework continued until the child reached simultaneous or stereoscopic vision in severe cases of simultaneous and alternating.

In this case, the activation of visual functions was carried out without a hard separation of the visual fields of the right and left eyes. Liquid crystal glasses in accordance with a specially designed program provided partial blocking of visible objects better than the eye and / or alternate blocking of the right and left eyes. A child with such glasses in a playful form trains a poorly seeing eye in the presence of a competitor (a good seeing eye). Amblyopic eye training was carried out with careful preservation of compensatory fusion mechanisms. Direct occlusion by limiting the use of direct occlusion to 1 hour. The training of bifixation on the remote field of view separator was carried out starting from a very close distance of 5-7 cm from the eyes individually for each child. Then we proceeded to training the fusion fusion reflex at close range with a gradual increase in distance to 50 cm, which leads to the restoration of increased divergence for convergent strabismus or convergence for divergent strabismus. The development of a fusion reflex enables early acquisition of stable binocular vision and the possibility of developing stereoscopic vision.

One of the main features of the visual school is that the parents and children attending the visual school are involved in the healing process. And the responsibility for recovery lies also with the parents. They also become responsible for the rehabilitation of the child during the recovery period.

Classes are held with parents on the problems of their child, the stages of treatment and the possibilities of their active participation in the treatment process. Parents are required to participate in the healing process. Parents are taught the rules for conducting additional classes using the comprehensive MEKO program and using the remote field of view separator. The duration of therapy with playing pauses up to 2 hours in a medical facility and an additional up to 1.5 hours a day at home. The child, in addition to the course of treatment for 10 days, receives regular homework. The increase in training time provides an earlier restoration of binocular vision and the possibility of developing stereoscopic vision, which is an indicator of complete recovery.

Active involvement of parents in the medical process allows them to broaden their horizons regarding this disease, to more correctly understand the difficulties of their child, and how much this requires persistent, consistent, painstaking work. The family is becoming more united. And a significant proportion of the hard work that ensured the restoration of vision in their child belongs to the parents.

The proposed separator of the field of view includes a base 1, on which the separating strip 2 is fixedly mounted. On the separating strip 2 symmetrically and with the possibility of movement along the strip 2 there is a transverse frame 3 with holes 4 for placing objects.

Claims (4)

1. A method of restoring bifixation and stereoscopic vision in the early stages of conservative treatment of friendly strabismus, including the use of liquid crystal glasses with partial blocking of visible objects by the better seeing eye or alternately blocking the right and left eye, visual exercises to restore fusion ability to merge at a synoptophor or a separator of visual fields , exercises to restore binocular vision, characterized in that pre-conduct inspection for I identify the cause-effect relationships of the appearance of strabismus with the involvement of a neurologist and vertebrologist, treatment and rehabilitation measures to eliminate the identified causes, activation of visual functions are carried out without strict separation of the fields of vision of the right and left eye, partial blocking is performed in the presence of a competitor, restrict the use of direct occlusion to 1 hours a day, and the bifixation training on the field of view separator begins at a distance of 5-7 cm from the eyes with the development of the fusion reflex of fusion with the gradual a marked increase in distance to 50 cm. 2. A method of restoring bifixation and stereoscopic vision in the early stages of conservative treatment of friendly strabismus according to claim 1, characterized in that it is additionally implemented within the framework of the visual school with the involvement of parents. 3. The separator of the fields of view, including the dividing bar and mounted on it a transverse frame for placing objects, characterized in that the transverse frame is mounted to move along the dividing bar. 4. Divide the fields of view according to claim 3, characterized in that it is equipped with a base for installation on a supporting surface.

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