RU2704781C1 - Method of training absolute eyes accommodation and device for its implementation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions relates to medicine. Method of training absolute accommodation includes a load on accommodative muscles of eyes and relaxation of accommodation. Load on accommodative eye muscles is performed monocularly with an eye up to emmetropy, with optotypes at distance of 5 meters with 14 negative lenses by an exponential increasing force for children from 5 to 10 years of age: -2.5D, -4.2D, -5.34D, -6.34D, -7.16D, -7.66D, -8.2D, -8.66D, -9.0D, -9.34D, -9.5D, -9.66D, -9.84D, -10.0D; from 10 to 30 years of age: -3.75D, -6.25D, -8.0D, -9.5D, -10.75D, -11.5D, -12.25D, -13.0D, - 13.5D, -14.0D, -14.25D, -14.5D, -14.75D, -15.0D, and for 40-year-olds and older: -1.25D, -2.1D, -2.67D, -3.17D, -3.58D, -3.83D, -4.1D, -4.33D, -4.5D, -4.67D, -4.75D, -4.83D, -4.95D, -5.0D. Each lens is exposed for 3-5 s, and if it is impossible to read the text through any lens, if exposed for more than 5 s, pass to relaxation of accommodative muscles with weak lenses, holding each lens in front of eye for 1–2 s, ending with training with a lens + 1.0D. Training is performed for each eye separately for not more than 1 minute once and daily, with increase in the glass force on the following day. Device for training of absolute accommodation of eye contains negative and positive lenses. Device consists of five hinged plastic plates, arranged on each, according to exponential law of force increase, three lenses of different diopters, which are made monolithically from optical polycarbonate by thermolysis with a plate. At that, for training of absolute accommodation the device has three versions of set with different values of force of lenses.

EFFECT: use of this group of inventions enables eliminating spasm of eye accommodation.

2 cl, 4 dwg

Description

The invention relates to medicine, namely to ophthalmology and is used to prevent the development and progression of myopia.

Known methods and devices for training accommodation, which use sets of lenses of various designs, prisms, graphic optotypes, computer programs, laser methods, electrical stimulation (1, 2, 3, 4,), etc. The individual effect of their use in the author’s methods is positive.

However, the progressive myopization of the entire population, reaching 25-30% in our country, and 65-85% in other countries, indicates the absence of methods for mass use, either a high price or their low efficiency.

The latter circumstance requires understanding in the structural features, functions of the ciliary body of the eye - directly of the muscle tissue that we train. This is a smooth muscle formation that has three muscle groups of fibers mutually perpendicular in direction (M. Brucke, M. Ivanov, M. Muler) (5). The cellular basis of muscles are myocytes developing from splanchnotome mesenchyme. In addition to contractile function, they participate in the secretion of type V collagen, elastin, proteoglycans, as they have a granular endoplasmic reticulum. Regeneration of smooth muscle tissue is carried out due to mitotic division of myocytes or conversion of myofibroblasts into smooth myocytes.

The mechanism of muscle contraction in smooth muscles differs from the striated muscle - biochemistry, time parameters, energy features. Excitation transmitted from a nerve fiber to a muscle of this type is transmitted ten times delayed with respect to the striated muscle. This is due to the different structure of proteins and biochemistry, where the main role is played by calcium ions. It has been established that before smooth muscle myosin can show its ATPase activity, it must be phosphorylated. Phosphorylation and dephosphorylation of myosin is also observed in skeletal muscle, but in it the phosphorylation process is not necessary to activate the ATPase activity of myosin. The starting moment for the contraction of the smooth muscle is the addition of the Ca ^{2+ ion} to calmodulin, while in the skeletal and cardiac muscle the starting moment is the addition of Ca ²⁺ to troponin (6).

Contractile stress per unit cross-sectional area in smooth and skeletal muscles is often the same (30-40 N / cm2), and with prolonged contraction, they can hold the same load. However, the energy expended by the smooth muscle, as measured by O2 consumption, is 100-500 times less. Unlike skeletal, most smooth muscles when stretched often behave not as more or less elastic, but as plastic or viscoelastic bodies (5).

The physiology of contractile function in smooth muscle elements is also different.

Neuromuscular transmission, through the exciting effect of adrenergic or cholinergic nerves, is electrically manifested in the form of separate waves of depolarization. Upon repeated stimulation, these potentials are summed up and, upon reaching the threshold value, an action potential arises. The inhibitory effect of adrenergic or cholinergic nerves is manifested in the form of individual waves of hyperpolarization, called inhibitory postsynaptic potentials (TPPS). With rhythmic stimulation, TPPS are summarized. Excitatory and inhibitory postsynaptic potentials are observed not only in muscle cells in contact with varicose veins, but also at a certain distance from them. This is due to the fact that postsynaptic potentials are transmitted from cell to cell through nexus or through diffusion of the mediator from the places of its selection. The development and disappearance of the electrotonic potential occurs exponentially (increases) and is determined by the parameters of the annoying current, as well as the properties of the membrane (its resistance and capacity). During the development of the electrotonic potential, the permeability of the membrane for ions practically does not change (7).

A distinctive ability of muscles is also accommodation, automation, plasticity and a tensile reaction, expressed in a reduction in counteracting this force.

Accommodation in physiology (lat. Accomodatio - adaptation) is the process of adaptation of excitable tissue to the gradually increasing strength of the stimulus, which manifests itself in a gradual increase in the threshold of irritation. The term "accommodation" was introduced into physiology by Nernst in 1908, although the phenomenon itself was observed by physiologists much earlier - du Bois-Reymond in 1848. Accommodation can develop under the influence of mechanical, thermal, electrical and other stimuli. Most often, linear and exponentially increasing electric currents are used to study it. The magnitude of the irritation threshold of excitable tissue (nerves, muscles) depends not only on the duration of the stimulus, but also on the steepness of the increase in its strength. The slower the increase in the strength of the electric current (or other stimulus), the greater the increase in the thresholds of stimulation, because during the increase in the strength of the stimulus in the fabric, changes develop that prevent the occurrence of excitation. If the slope of the current rise is less than the critical value, then the excitation does not occur at all, regardless of the magnitude of the current strength. The smallest slope of the current rise at which excitation occurs is an indicator of the accommodation rate (8).

Thus, in medical practice, electrical stimulation with exponential currents is used, where pulses with slowly increasing and relatively rapidly falling fronts are recognized as the most physiological (9). Stimulation frequency from 60 to 200 Hz - with this waveform is used in ophthalmology. The lower the ability of the muscle to accommodate, the more physiological for it will be impulses that slowly increase and fall relatively quickly. As such pulses, pulses with exponential fronts are used, through the electrodes of the surface and cutaneous type, and allowing in the process of visual loading to diagnose the accommodation apparatus in natural conditions for the subject (10).

A definitely significant factor in the contraction mechanism in smooth muscle is the “snap” phenomenon. As a result, the smooth muscle can be in a prolonged state of contraction in wide ranges from the initial length of the sarcomeres. This is explained by the fact that one of the light chains of each myosin head, called the regulatory chain, is phosphorylated by the action of myosine kinase. When this chain is not phosphorylated, cyclic attachment and separation of the myosin head with respect to the actin filament does not occur. But during phosphorylation of the regulatory chain, the head acquires the ability to re-bind to actin filament and to carry out the entire cyclic process of periodic “pull-ups” that underlie contraction, as in skeletal muscle. This ability of smooth muscles, evolutionarily allows you to reduce energy consumption by a hundred times, compared with striated muscles. The explanation of this mechanism is as follows. When both myosine kinase and myosine phosphatase are strongly activated, the frequency of the cycles of myosin heads and the rate of contraction are high. Then, when enzyme activation decreases, the cycle frequency decreases, but at the same time, deactivation of these enzymes allows myosin heads to remain attached to actin filaments for an increasingly long part of the cycle. Therefore, the number of heads attached to the actin filament at any given time remains large. Since the number of heads attached to actin determines the static force of contraction, the voltage is held, or “latched” (8).

However, in the ciliary body, this can lead to the clinical syndrome of “persistent accommodation spasm”, the development of dentate and smooth tetanus. The reason for this is considered to be the primary weakness of the accommodating muscle and its prolonged tension when working at close range (3).

All methods of accommodation training focus on gradual loads on the accommodation muscle, with alternating various parameters (strength and value of glasses, change in angular distances, intensities and frequency of electric current, radiation, time of procedures), however, the final goal of training is not determined. It should also pursue age-related maximum accommodation reserves that exceed the usual load when reading at 3.0 D (working distance close to 33 cm) 3-4 times. So, for 6-10 years of age they are 8-10.0 D, at 20 years old - 12-15.0 D, at 30 years old - 10-12.0 D, at 40 years old - 4-8.0 D, and at 50 years old - 0 - 3.0 D (5).

There are conflicting data on the need for accommodation training. So, in the work of V.I. Pospelova and O.V. Petrushenko (11), in which 295 children from 5 to 13 years of age and 127 with myopia in 127 children, the volume of absolute accommodation (OAA) averaged 12.0 D with a spread of these values from 3.5 D to 28, 5 D, which was expressed by the authors' doubt in the appropriateness of training for accommodation with myopia, since with it OAA was greater than with emmetropia and hyperopia.

Given the above circumstances, the most physiological method of accommodation training should be such a regime when the muscle is loaded and relaxed at the highest possible speed close to the exponential law. This training method has not previously been used in ophthalmology. This is consistent with clinical observations. So according to the wwq website. GLAZAMECL / RU the accommodation stress time for near is 0.64 s, and the relaxation time is 0.56 s. (LOVENSTEN O. 1958. CEMPBELL F. 1958). It is also shown that the effectiveness of training to achieve maximum accommodation ability increases in 50% of cases with an increase in the speed abilities of the ciliary muscle, i.e. the speed of presentation of stimuli (5 sec.) in front of the eye (12).

The closest way to the proposed technical solution is a method of exerting a load on the accommodating muscles of the eyes with the help of negative lenses increasing in strength, to submaximal values, and accommodation relaxation, with the help of increasing plus lenses, to its submaximal relaxation (1).

In FIG. Figure 1 shows a training schedule for accommodating eye muscles, where the abscissa represents the training time in minutes, and the ordinate shows the strength and value of the presented lenses in diopters. As can be seen from the graph, the descending line 1 has a linear dependence of the increase in lens power stretched for 15 minutes, and the ascending line 2 also has a monotonously linear dependence extended for 15 minutes.

However, when applying this method:

- not envisaged the desire to achieve maximum accommodation voltage. The patient does not know their true values before the start of training, and at each age they have a fairly high scatter in absolute values;

- during the monotonous set of maximum negative lenses, the accommodation of the eye, due to prolonged tension, stops increasing due to patient fatigue, and this can lead to the development of a “snap” mechanism, thus, long-term training does not contribute to relaxation of the ciliary muscle, which creates conditions for the development of a spasm of accommodation directly from the procedure;

- the method does not have clear data on the specific values of the submaximal load, since it is individual and the final result of the training is not known, the patient has to spend more time on each glass, reaching 50-60 seconds in practice for one diopter increasing in strength, and the total the time of one workout increases significantly;

- the method cannot give the maximum training effect, since it is carried out simultaneously on both eyes from a distance of 30-35 cm, and this limits the strength of the accommodation tension due to the influence of convergence and dysbinocular physiological interactions in the visual perception, and upon reaching submaximal values of the lenses, diplopia, asthenopia , doubling of the presented test objects, which reduces the concentration, the patient’s attention, lengthens the working time and training procedures, and due to different refraction, and various reserves of acc dations eyes requires individual adjustment of the windows, that the practice or ignored, or a selection of lenses complicates the patient;

- the method is difficult to implement with a large flow of patients, requires an office, equipment, maintenance of medical staff;

- the application of the method requires expensive equipment (a set of test lenses, skioscopic rulers, a lot of finished frames with glasses, hardware), which makes it impossible for home and individual use;

- the method is difficult to implement for people of different ages - schoolchildren and preschoolers, students, adults, elderly people, who, due to their employment, cannot often visit specialized rooms (for example, a nurse is required to treat 3 to 5 patients; treatment of 1 patient takes an average of 30-40 minutes, and in one 8-hour working day, the office can take no more than 80 people, and in 1 month - a full course of treatment can be done for no more than 160-200 patients. for 1 year 1 nurse in Only 1,200 people can be treated in an ophthalmology room, and with the prevalence of myopia of 25-30% in Russia, regular treatment with this method of training becomes unrealistic, and with the availability of a standard - 1 office per 10,000 people, it turns out a 10-fold shortage of the ophthalmological service for such kind of activity).

There are standard skyscraper lines LSK-1 (13), consisting of two frames with positive and negative lenses from 1.0 to 9.0 D and having engines, respectively, with positive and negative lenses, with a force of 0.5 D and 10.0 D Rulers are made of metal with glass lenses inserted into them. The rulers cost 11-18 thousand rubles.

The skyscopic ruler is known (14). The ruler is made of plastic with seven windows for lenses of unknown strength. The price list of the company on the site www.armed.ru does not contain any data on the lines.

The above sources do not allow for eye accommodation training due to the mismatch of the lens kit with the exponential law, are not accessible to the mass consumer, roads are not manufactured in large industrial volumes.

Closest to the proposed technical solution is a device consisting of a metal or plastic frame, two rows of opposite lenses of 10 pieces in each row, a slider with additional six lenses, which allow varying widely the dioptricity of the RU 325002 system (15).

However, the device has a bulkiness (500 × 50 × 15 mm), weight (250 g), cost (from 12000-18000 r). The device is difficult to use, because you have to be distracted by the selection of a combination of lenses necessary for training accommodation of the eye.

The task was to eliminate the spasm of eye accommodation, reduce the time of the procedure, increase the tension power of eye accommodation, eliminate diplopia, asthenopia, double test objects, ease of training for patients of different ages, affordable individual use of the device at home and significantly reduce the cost of dialing.

The task is achieved by a single daily training of eyes adjusted to emmetropi with 14 minus lenses of exponentially increasing strength for age groups: from 5-10 years from -2.5 D to -10.0 D, for 10-30 years from -3 , 75 D to -15.0 D, for 40 years of age and older from -1.25 D to -5.0 D, and when the maximum tolerated lens is reached, the strength of the lenses is reduced linearly and relaxation of the ciliary muscle with the last glass in + 1.0 D. The procedure is performed daily, once, for each eye separately., No more than 1 minute per eye, with an increase in st kla the next day.

The implementation of the proposed exponential method for training absolute accommodation of the eyes is carried out by a device consisting of five plates fastened fan-shaped, with 3 lenses of different strengths located on each. In total, there are 15 lenses in the device, distributed by numbers and the exponential law of negative lenses growth. There are 3 device options for three age groups: for 5-10 years of age, a set of lenses from +1.0 D, -2.5 D to -10.0 D; for 10-30 year olds from +1.0 D, -3.75 D to -15.0 D and for forty years of age and older, a set of lenses from +1.0 D, -1.25 D to -5, 0 D.

The proposed exponential method for training absolute accommodation is as follows.

The patient is corrected to emmetropia. Before the eye of the trainee, the proposed device is placed with negative lenses in increasing strength, having a diopter increment obeying the exponential law. The second eye is covered with a palm.

The eye of the trained eye should fix the optotypes from a distance of 5 meters with an angular resolution of 1 minute (font size 7.0 × 1.35 mm). You can use an analogue of the Sivtsev-Golovin table (focus on the 10th line), or use a TV, but rather its creeping line. In total, 14 lenses of increasing strength are used: for 5-10 year olds (-2.5 D, -4.2 D, -5.34 D, -6.34 D, -7.16 D, -7.66 D, - 8.2 D, -8.66 D, -9.0 D, -9.34 D, -9.5 D, -9.66 D, -9.84 D, -10.0 D); for 10-30 year olds (-3.75 D, -6.25 D, -8.0 D, -9.5 D, -10.75 D, -11.5 D, -12.25 D, -13 , 0 D, -13.5 D, -14.0 D, -14.25 D, -14.5 D, -14.75 D, -15.0 D); for forty years old and older (-1.25 D, -2.1 D, -2.67 D, -3.17 D, -3.58 D, -3.83 D, -4.1 D, -4, 33 D, -4.5 D, -4.67 D, -4.75 D, -4.83 D, -4.95 D, -5.0 D). When reaching the maximum tolerated lens, the lens power is reduced linearly, and with the last glass of +1.0 D, the ciliary muscle is relaxed. At the same time, 3-5 seconds of procedural time are spent on each lens. If it is impossible to read the text from any glass for more than 5 seconds, they go downward to weaker lenses and always end with a plus glass (+1.0 D).

The procedure is performed daily, once, for each eye separately and not more than 1 minute per eye. The next day, increase the strength of the glass. To achieve the age level of accommodation, individual training is required, which can vary from a few days to 2-3 weeks. In the future, accommodation indicators of the eyes are checked once a week, the age norm is supported by additional training (up to 10 years of age: -10.0 D, from 10 to 30 years of age: -15.0 D, and after 40 years: -5.0 D).

In FIG. 2 shows a graph of the exponential training of absolute accommodation of the eye muscles. The abscissa axis represents the absolute accommodation training time in seconds, and the ordinate axis represents the strength of the proposed lenses in diopters, where 3 is the descending curve according to the exponential law, and 4 is the ascending curve with a linear relationship. As can be seen from the graph, curve 3 corresponds to the growth gradient of negative lenses in the following sequence: - 3.75 D, -6.25 D, -8.0 D, -9.5 D, -10.75 D, -11.5 D, -12.25 D, -13.0 D, -13.5 D, -14.0 D, -14.25 D, -14.5 D, -14.75 D, -15.0 D. Ascending part of the graph reflects a linear relationship at the end of which the patient is offered to use a lens +1.0 D.

As can be seen from FIG. 2, the curve of the growth of lens power in diopters retains an exponential pattern, and the procedure time (in comparison with Fig. 1) is reduced by 50-60 times.

In FIG. 3 shows the proposed device for training absolute accommodation of the eyes, where 5 is a plate, 6 is a lens, 7 is a rod retainer, fastening plates with lenses.

Each plate has 3 optical lenses of different diopters located in it, made with it in one piece of optical polycarbonate, by injection molding in a mold, with a certain pressure and temperature regime. Five plates of the device are fixed by a rod with a retainer that performs the function of the axis of rotation, allowing them to be laid out in a convenient form, like a fan. The plate size of the device (165.0 × 12.5 × 2.0 mm). The size of the device when folded (165.0 × 12.5 × 21.0 mm) and weight 30 g. A total set of five plates covers the entire exponential range for training accommodation. The device has 3 variants of a set with different values of lens power.

The first option is recommended for children 5-10 years old and has the following set of lenses: +1.0 D, -2.5 D, -4.2 D, -5.34 D, -6.34 D, -7.16 D, -7.66 D, -8.2 D, -8.66 D, -9.0 D, -9.34 D, -9.5 D, -9.66 D, -9.84 D, -10 , 0 D. The second option has values corresponding to the lens numbers on the plate: +1.0 D, - 3.75 D, -6.25 D, -8.0 D, -9.5 D, -10.75 D , -11.5 D, -12.25 D, -13.0 D, -13.5 D, -14.0 D, -14.25 D, -14.5 D, -14.75 D, - 15.0 D. With this kit you can train accommodation from 10 to 30 years of age. The third version of the device is recommended for forty years of age and older, with a set of lenses: +1.0 D, -1.25 D, -2.1 D, -2.67 D, -3.17 D, -3.58 D , -3.83 D, -4.1 D, -4.33 D, -4.5 D, -4.67 D, -4.75 D, -4.83 D, -4.95 D, - 5.0 D.

In FIG. 4 shows a plate 5, with optical lenses 6 located therein and a retainer rod 7. In FIG. 5 shows a side view of the device in the folded state, where are 5 plates of the device and -7 is a latch.

The use of the device is as follows.

The device is laid out like a fan and placed before the eye of the trained lens, according to their numbering. At first, the effect on the eye with a lens will be a fuzzy image, but by the end of 3 - 5 seconds it should recover. Then they move to a stronger lens until a clear image of the optotype appears. Further, the strength of the lens is increased until, after 5 seconds of its exposure to the eye, by any diopter, the eye has reached a clear image of the optotype. Immediately go to weaker lenses, holding each in front of the eye for 1-2 seconds. Finish training with a lens (+1.0 D) - for maximum relaxation of eye accommodation.

The strongest negative glass with which there was a clear image speaks of the power of absolute accommodation of the eye. If this glass does not meet the age norm, exercises are carried out daily. The same thing is done with the second eye. Upon reaching the age norm, and this may take 2-3 weeks of exercise, the training course is completed. In the future, at least 1 time per week, supportive training is carried out, despite normal age-related indicators of absolute accommodation.

This technique has been tested on 142 volunteers (students 20-23 years old). The studies were performed at the outpatient department of the eye microsurgery clinic at Stavropol State Medical University. The subjects were divided into groups: mild myopia - 48 people, mild hyperopia - 12 people, emmetropia - 64 people, accommodation spasm - 18 people. For the representativeness of studies, cases were selected where the maximum accommodation reserves did not exceed -5.0 D. Each group was divided into two subgroups: in one subgroup, accommodation training according to Avetisov-Matz was carried out, and in the other by the proposed device using an exponential method.

As a result of 2-week exercises, it was found that the average time of daily training on Avetisav-Mats, to achieve maximum accommodation reserves of -15.0 D, was 31.5 minutes, whereas, according to the proposed method, no more than 1.0 minutes. The recovery of these values during training according to Avetisov-Matz was 12.5 days, and according to the exponential law - 6 days. The most difficult groups were subjects with spasm of accommodation and hyperopia, where training was required for more than 2 weeks, respectively 22 and 17 days. All subjects noted the simplicity of training according to the proposed exponential method, the subjective absence of symptoms of overload (double vision, fatigue, pain in the eyes), as was observed by the Avetisova-Matz technique.

Thus, an almost 2-fold reduction in the number of days to reach age-related stocks of accommodation and a 6-10-fold reduction in the conduct of the training procedure itself was found. Using the proposed device allows the massive use of the exponential training method, at almost any age. The low cost of the device is achieved by performing one technological operation - hot pressing. The cost of the device is 70% dependent on the cost of the material and today is 75-80 rubles per product, which is ten times less than the known devices, and its low weight (30 g) and the small size of the folded device (165 × 12.5 × 21 mm) are not burdensome for a schoolboy, student, employee.

Due to the massive "endemicity of myopia", reduced training time, ease of carrying out the technique in outpatient and home settings and low cost, the device is much in demand among ophthalmologists, the population, and also possibly among residents of near and far abroad.

Information sources:

1. Avetisov E.S., Matz K.A. A method of training the ciliary muscle (A.S. 353719 1972).

2. Patent RU 2421122 C1 Mironov A.A. A method of training relative accommodation.

3. Avetisov E.S. Myopia. M .: Medicine, 1999.288 p.

4. Valkova I.V., Nuremberg O.YU. Prevention of the occurrence of myopia by electro-puncture stimulation of a weakened accommodation apparatus. Eye protection for children and adolescents. Sat scientific tr M., 1984. S. 49-52

5. Accommodation: A Guide for Physicians / Ed. L.A. Katargina. - M: April, 2012.S. 48.

6. Remezov, A.N. Medical and biological physics [Text] / A.N. Remezov. - M.: Higher School, 1999 .-- 616 p.

7. Khodorov B.I. The problem of excitability. L., 1969.S. 184.

8. Fundamental and clinical physiology / Ed. A.G. Kamkina, A.A. Kamensky. - M.: Academia, 2004 .-- 1072 p.

9. Shvets E.Ya. Electrostimulator of the eye muscles with exponential modulated pulses [Text] / E.Ya. Shvets, L.L. Verevkin, A.P. Posunko et al. // Radio Electronics Informatics Management. - 2003. - No. 1. - S. 24-26.

10. Patent RU 2154974 2000, V. Sheludchenko; Kolotov M.G.

11. Pospelov V.I., Petrushenko O.V. Absolute accommodation with different eye refractions in children // Actual issues of the clinic, diagnosis and treatment in ophthalmology.

12. E.N. Iomdina, S.M. Bauer, K.E. Kotlyar. Biomechanics of the eye: Theoretical aspects and clinical applications. Moscow 2015 p. 23.

13. Scioscopic rulers LSK-1, passport t ZhZ.890.000 PS, OJSC Kharkov Plant TOCHMEDPRIBOR, Kharkov.

14. Booklet: ARMED Group of Companies, exhibition MSOO-2005 from March 9 to 12, 2005

15. A.S. No. 325002 The scope line. V.A. Roslyakov 1972

Claims (2)

1. A method of training absolute accommodation of the eye, including the load on the accommodating muscles of the eyes and relaxation of accommodation, characterized in that the load on the accommodating muscles of the eyes is monocular with the eye adjusted to emmetropia, with optotypes at a distance of 5 meters, 14 negative lenses in exponentially increasing force for children from 5 to 10 years of age: -2.5 D, -4.2 D, -5.34 D, -6.34 D, -7.16 D, -7.66 D, -8.2 D, -8.66 D, -9, 0D, -9.34D, -9.5D, -9.66D, -9.84D, -10.0D; from 10 to 30 years of age: -3.75 D, -6.25 D, -8.0 D, -9.5 D, -10.75 D, -11.5 D, -12.25 D, -13.0 D, - 13.5 D, -14.0 D, -14.25 D, -14.5 D, -14.75 D, -15.0 D and for 40-year-olds and older: -1.25 D, -2.1 D, -2.67 D , -3.17 D, -3.58 D, -3.83 D, -4.1 D, -4.33 D, -4.5 D, -4.67 D, -4.75 D, -4.83 D, -4.95 D , -5.0 D, and each lens is exposed for 3-5 s, and if it is impossible to read the text through any lens, when exposed for more than 5 s, they proceed to relax the accommodating muscles with weak lenses, holding each lens in front of the eye for 1- 2 s, ending with lens training + 1.0 D, while training is carried out for each eye separately for no more than 1 minute spot and every day, with an increase in glass strength for the next day. 2. A device for training absolute accommodation of the eye, containing negative and positive lenses, characterized in that it consists of five plastic plates fastened by a hinge, with each of them, according to the exponential law of increase in strength, with three lenses of different diopters, made integral from optical polycarbonate by thermo-casting a plate, and for absolute accommodation training, the device has three types of dialing with different lens power values, so for children from 5 to 10 years of age: + 1.0D, -2.5D, -4.2D, -5, 34D, -6.34D, -7.16D, -7.66D, -8.2D, -8.66D, -9.0D, -9.34D, -9.5D, -9.66D, -9.84D , -10.0 D; from 10 to 30 years of age: + 1.0 D, -3.75 D, -6.25 D, -8.0 D, -9.5 D, -10.75 D, -11.5 D, -12.25 D, - 13.0 D, -13.5 D, -14.0 D, -14.25 D, -14.5 D, -14.75 D, -15.0 D and for 40-year-olds and older: + 1.0 D, -1.25 D , -2.1 D, -2.67 D, -3.17 D, -3.58 D, -3.83 D, -4.1 D, -4.33 D, -4.5 D, -4.67 D, -4.75 D , -4.83D, -4.95D, -5.0D.

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