RU2746651C1 - Method for selection of prismatic spectacles for children of preverbal age with concomitant squint - Google Patents

Abstract

FIELD: medicine; ophthalmology.

SUBSTANCE: to select prismatic spectacles for children of preverbal age with concomitant squint, an ophthalmological examination is performed, the strength of the prism corresponding to the size of the squint is determined, the prism is placed in the intended position on the spectacle lens, followed by an assessment of the correctness of the selection of prisms and the effectiveness of prismatic correction. The selection of prisms is carried out after a complete spectacle correction of ametropia. As prisms, elastic Fresnel prisms are used with the intended strength determined using a prismatic ruler by the absence of installation movements during the cover-uncover test. The prism corresponding in strength to the size of the squint is applied to one or both spectacle lenses with the base facing in the direction opposite to the direction of the squint. In amblyopia, the prism is applied to the spectacle lens of the better-seeing eye. At the same time, visual acuity, refraction before and after cycloplegia, and the correct selection of Fresnel prisms are evaluated on a Plusoptix refractometer. The effectiveness of prismatic correction is evaluated by the appearance of binocular and stereo vision of the child using the Stereo Fly test.

EFFECT: method reduces the duration of the selection of prismatic spectacles for children and increases the accuracy of the selection and the effectiveness of prismatic correction.

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Description

The invention relates to medicine, namely to ophthalmology, and can be used to select prismatic glasses for children of preverbal age with concomitant strabismus.

Concomitant strabismus is the most common type of strabismus in children. With concomitant strabismus, not only a cosmetic defect occurs, but also the sensory mechanisms that ensure the fusion of images perceived by each eye in the brain are disrupted, as a result of which normal binocularity and depth of vision are disrupted, the ability to accurately localize objects in space and navigate in it is lost.

Taking into account the causes and characteristics of different types of strabismus, a special type of treatment was identified - prismatic correction. To carry out this method, variants of glass prisms (prisms both in combination with a spherical component and without it) and elastic Fresnel prisms (Fresnel prisms) are used. However, the selection of prismatic glasses for children (up to 4 years old) is a certain difficulty. A small patient cannot always assess his feelings and accurately answer the doctor's questions (many patients do not speak yet). Their attentiveness, perseverance decreases, with prolonged examination. Therefore, undoubtedly, the doctor has difficulties in the selection of prismatic glasses in children of preverbal age - the age when the appointment of prismatic correction is most justified.

There is a known method of selection of prismatic glasses for children with friendly squint, including the use of a computer and liquid crystal glasses to separate the fields of vision of two eyes, and as tests, a text consisting of letters visible with different eyes is used, as well as a fixation disparity test (Ogle KN 1954. Fixation disparity Am Orthoptic J. 4: 35-39). The first of these tests establishes the accommodative - refractive balance, that is, the necessary spheres for each eye, and the second - the muscle balance, that is, the necessary prisms.

The disadvantages of this method are its limited functionality, since it is intended for children of verbal age (from 3-4 years old) in order to select a comfortable correction for near, as well as the need to use complex expensive equipment.

There is a method of selecting prismatic glasses for children with friendly strabismus, including conducting a standard ophthalmological examination to detect and correct ametropia, determining the angle of strabismus horizontally and vertically on a synoptophore, selecting the required prism using prisms from a set of spectacle glasses and a synoptophore device. With a prismatic correction on the device - the synoptophore, they achieve the disappearance of the setting movement when closing the eye and bifoveal fusion. The inability to eliminate the positioning movement or an increase in the angle of strabismus in prism glasses is a contraindication to the appointment of prisms. A second check is carried out on a color test, and in the absence of binocular vision on a color test, additional hardware orthopto-diploptic treatment is carried out while wearing elastic Fresnel prisms. (Modern ophthalmology, zrenue.com).

The disadvantages of this method are the impossibility of its use in children of preverbal age, the possibility of correcting only small angles of strabismus up to 30 diopters, the need for a qualified specialist to be present in a medical institution when working on a synoptophore and additional hardware orthopto-diploptic treatment.

There is a known method of selecting prismatic glasses for the correction of paralytic strabismus, which consists in the fact that one elastic Fresnel prism of constant action is applied to the inner surface of the spectacle lens in front of the child's healthy eye, while wearing glasses is carried out daily for at least 2 hours, the course is 9- 12 months. Depending on the dynamics of the disease, the force of the prisms is reduced to compensate for the residual secondary angle of strabismus, and the direction, width and configuration of the prisms are reduced and shifted to the area of the glasses glass that corresponds to the direction of gaze where uncompensated double vision occurs. The criterion for the correct selection of prisms is the elimination of double vision, a compensatory forced position of the head. (Patent RU 2285510 C2, publ. 20.10.2006).

The disadvantages of this method are the impossibility of its use in children of preverbal age, limited use only in patients with paralytic strabismus to eliminate double vision and forced compensatory rotation or tilt of the head.

The closest prototype to the claimed method is a method for selecting prismatic glasses, which consists in the fact that first the horizontal and vertical components of the eye deviation are determined using a point light source and a Maddox cylinder, and then a prismatic compensator OKP-1 is installed in a universal spectacle frame. The prism compensator allows, by rotating the prism handle, to obtain the resulting prism in the range from 0 to 20 diopters, at which the diplopia disappears and binocular vision is restored. The resulting total force of the compensating prism is distributed approximately equally to both eyes. The criterion for the correct selection of prism glasses are the indicators of studies on a color instrument, the Bagolini test and a sample with a cover. With a correctly selected prism, the test with covering either does not reveal the setting movements of the eyes, or causes very slight movements. (Guidelines for the use of prismatic elements of spectacle correction, approved by the Ministry of Health of the USSR on October 15, 1987, order No. 11-49 / 6-23).

The disadvantages of this method are:

- limited functionality of the method, since it is applicable in children of verbal age, thereby reducing the efficiency of restoration of binocular vision, lengthening the period of preparation of the patient for surgery.

insufficient accuracy of selection, associated with the lack of a convincing assessment of the correctness of the selection of prismatic glasses, since the selection of the latter is carried out using a color device and Bagolini glasses, which is not always objective in children;

- the duration of the method, since the selection of the necessary prism takes a lot of time, perseverance, attentiveness of the child is required, therefore it is not always feasible even for children of preverbal age

- not applicable to children with insufficient intellectual development. The objective of the invention is to expand the functional

possibilities of the method, reducing the duration and increasing the accuracy of the selection of prismatic glasses.

EFFECT: expanding the functionality of the method, reducing its duration and increasing the accuracy of the selection of prismatic glasses and the efficiency of prismatic correction.

The task is achieved in the following way, which is as follows.

Before selection of elastic Fresnel prisms (ELF) for all children of preverbal age, a complete ophthalmological and strabismological examination is performed: visual acuity is determined using a Plusoptix remote refractometer without correction and with correction, refraction is determined before and after cycloplegia on a Plusoptix remote refractometer or by means of a skyoscopy, strabismus angle according to Girshberg in five diagnostic gaze positions, measure the volume of the monocular gaze field in eight diagnostic gaze positions, determine the nature of binocular vision, stereo vision according to the Stereo Fly test. Determine the horizontal or vertical fusion reserves using a prism ruler.

At the second stage, the SME of the required strength is selected, due to the absence of installation movements during the cover-ancaver test. The EPF, corresponding in strength to the magnitude of the strabismus, is installed in front of the child's eye with the base facing in the direction opposite to the direction of the strabismus. The angle of the SME application axis is expressed in degrees.

The selection of Fresnel prisms is carried out after spectacle correction of ametropia. Fresnel prisms are glued to one or both spectacle lenses. With amblyopia, a prism is glued to a spectacle lens better than the seeing eye. This eliminates the functional dominant in visual acuity, the squinting eye is included in the visual act and conditions are created for bifoveal stimulation, which is necessary for the formation of fusion.

The criterion for the correct selection of prisms are the indicators of research on the Plusoptix refractometer (Germany), with the help of which the symmetry of the location of the visual axes and the fixation of the child's eyes, as well as the absence of installation eye movements during the cover-ancaver test, are clearly evaluated.

Evaluation of the effectiveness of the EPF in patients of preverbal age is carried out using the Stereo Fly test, where the appearance of binocular, stereo vision in a child is visually assessed.

It is recommended to constantly wear glasses with Fresnel prisms throughout the entire functional stage of treatment (from 6 months to 2 years after the onset of the disease). Evaluation of the results is carried out at intervals of 1, 2, 3 months and then every 3 months with the possible introduction of adjustments in the strength of the applied prisms.

The inventive method is intended for use in children from 1 year of age, which eliminates the possibility of the appearance of the vertical component of strabismus (primary hyperfunction of the inferior oblique muscle), reduce the time required to prepare a child for surgery, or achieve a state of orthophoria without surgery.

The defining differences between the proposed method and the prototype are:

- carry out the selection of the SME of the required force, using a prismatic ruler for the absence of installation movements during the cover-ancaver test, which allows to reduce the duration and increase the accuracy of selection, and therefore the effectiveness of using prismatic glasses;

- The SME, corresponding in strength to the magnitude of strabismus, is installed in front of the eye with a base facing in the direction opposite to the direction of strabismus, which makes it possible to create conditions for bifoveal fusion, which is necessary for the formation of fusion mechanisms and the formation of binocular vision in vivo;

- in case of amblyopia, the prism is applied to the spectacle lens of the better seeing eye, which makes it possible to eliminate the functional dominant in visual acuity and create conditions for bifoveal stimulation;

- the correctness of the selection of prisms is assessed using a Plusoptix refractometer, which makes it possible to increase the efficiency of the method due to the ability to visually assess the symmetry of the location of the visual axes and fixation of the child's eyes, as well as the absence of installation eye movements during the cover - ancaver test;

- Evaluation of the effectiveness of the EPF in patients is carried out using the Stereo Fly test, which allows you to visually assess the appearance of binocular and stereo vision in a child.

A search through the sources of scientific, technical and patent information did not reveal a method identical to the claimed one, and therefore, it can be concluded that the proposed technical solution meets the criteria of "novelty" and "inventive step".

The application of the proposed method is illustrated by the following examples.

Example 1.

Patient U., 2 years old. Diagnosis: partially accommodative esotropia with predominance of the right eye. Mild hyperopia in both eyes.

The parents complained of constant squint of both eyes (more often the right eye squints). Have noticed the appearance of strabismus from the 1st year. The child wears glasses all the time, they do occlusion in the 1: 1 mode all the time. Specialized kindergarten is not attended.

At the first stage, the child underwent a complete ophthalmological and strabismological examination. Refraction was assessed using a Plusoptix refractometer (under physiological conditions, monocular study mode):

OD + 1.0 cyl + 0.50axl55

OS + 0.25 cyl + 0.50 ax 88

with the help of skiascopy (after cycloplegia):

with Plusoptix refractometer (after cycloplegia, monocular mode of examination) OD + 2.0 cyl + 0.50 ax 150 OS 2.0 cyl + 0.50 ax85

An objective examination of the oculomotor system revealed the following:

Strabismus angle according to Hirshberg without glasses (w / o) Deviation value:

Strabismus angle according to Hirschberg in spectacle correction OU + 2.0D. Deviation value:

Mobility volume:

At the second stage, on the inner surface of the child's glasses in front of the left eye, an SME with a force of 25 dpt was applied (since the right eye squints more often, there is an uncompensated 1.0D hyperopia), the base of which was directed outward. The selection of the prism was carried out using a prism ruler for the absence of installation movements during the cover-ancaver test, as well as using the Plusoptix A12C pediatric refractometer, which made it possible to visually assess the central fixation of both eyes, the symmetrical arrangement of the child's visual axes. FIG. 1 shows data on a Plusoptix A12C refractometer in glasses with SME.

This prismatic correction made it possible to create conditions for bifoveal fusion in vivo and prevented the appearance of primary hyperfunction of the inferior oblique muscle. The child was dynamically monitored with a Plusoptix А12С refractometer after 1, 2, 3 months of constant wearing of prismatic glasses. The nature of binocular vision was determined, stereo vision was determined according to the Stereo Fly test - the absence of binocular vision.

During the follow-up examination of the child on a Plusoptix А12С refractometer in glasses with EEF after 6 months, a deviation of the left eye to the temple was noted. When performing the cover-ancaver test in glasses with SME, minus settings of -3-5 ° were noted in five diagnostic gaze positions. In this regard, it was decided to reduce the force of the prism to 20 pr. Diopters. This prism was applied to the inner surface of the glasses in front of the patient's left eye. After 3 months of constant wearing of glasses with EEF according to the Stereo Fly test, it was revealed that the patient had binocular, stereoscopic vision.

It was recommended to continue wearing glasses with SME with dynamic observation once every three months.

Example 2.

Patient A., 1 year old. Diagnosis: Non-accommodating esotropia with predominance of the left eye. Mild hyperopia in both eyes.

The parents complained of a permanent squint of the left eye. Have noticed the appearance of strabismus from 3 months. The child does not wear glasses, they do occlusion in the 1: 1 mode all the time. She does not attend specialized kindergarten.

At the first stage, the child underwent a complete diagnostic examination. Refraction was assessed using a Plusoptix A12C refractometer (physiological conditions, monocular study mode)

OD + 0.50 cyl + 0.25 ax 68

OS + 0.50 cyl + 0.5 ax 15

with the help of skiascopy (after cycloplegia):

with a Plusoptix А12С refractometer (after cycloplegia, monocular mode of examination): OD + 1.0 cyl + 0.50 ax 52 OS 0.75 cyl + 0.5 ax 10

An objective examination of the oculomotor system revealed the following:

Strabismus angle according to Hirshberg Deviation value:

Mobility volume:

Considering the large strabismus angle, limitation of abduction of both eyes, the ineffectiveness of occlusion and non-accommodating esotropia, it is recommended to carry out surgical treatment of strabismus in order to reduce the strabismus angle, increase eye mobility, to prepare the patient for functional treatment. The child underwent OU recession of the medial rectus muscle 5 mm.

Deviation value after surgery:

Mobility after surgery:

At the second stage, glasses with simple lenses were prescribed to the child, while an SME with a force of 15 pr.dopters was applied to the inner surface of the glass in front of the right eye, an SME with a force of 20 pr.dopters was applied in front of the left eye, the base of which was directed outward.

The selection of the required prism was carried out using a prism ruler for the absence of installation movements during the cover-ancaver test, as well as using a Plusoptix A12C refractometer, which made it possible to visually assess the central fixation of both eyes, the symmetrical arrangement of the visual axes of the child's eyes. FIG. 2 shows the data of the Plusoptix А12С refractometer in glasses with SME.

Prismatic correction of strabismus with fitted prismatic glasses made it possible to create conditions for bifoveal fusion, which is necessary for the formation of fusion mechanisms, thereby forming binocular vision in vivo. The child was dynamically monitored with a Plusoptix А12С refractometer after 1, 2, 3 months of constant wearing of prismatic glasses. The nature of binocular vision was determined, stereo vision was determined according to the Stereo Fly test - the absence of binocular vision. The strabismus angle without glasses according to Hirschberg remained the same + 15 ° in five diagnostic gaze positions.

It was recommended to continue wearing the EEF with dynamic observation once every three months.

The use of the proposed method will improve the accuracy of the selection of prismatic glasses in children, as well as expand the age range of the child (starting at 12 months), which, in turn, will reduce the time of functional treatment to prepare the child for surgery and prevent the occurrence of the vertical component of strabismus.

Claims (2)

1. A method of selecting prism glasses for children of preverbal age with concomitant strabismus, including an ophthalmological examination, determining the strength of the prism corresponding to the magnitude of the strabismus, installing the prism in the desired position on the spectacle lens, followed by assessing the correct selection of prisms and the effectiveness of prismatic correction, characterized in that the selection of prisms is carried out after full spectacle correction of ametropia, elastic Fresnel prisms of the required force are used as prisms, determined using a prism ruler for the absence of installation movements during the cover-ancaver test, a prism corresponding to the strength of the strabismus is applied to one or both spectacle lenses with the base facing in the direction opposite to the direction of strabismus, in case of amblyopia, the prism is applied to a spectacle lens of a better seeing eye, while visual acuity, refraction before and after cycloplegia, as well as the correct selection of Fresnel prisms are assessed on a Pluso refractometer ptix, and the effectiveness of prismatic correction is judged by the appearance of binocular and stereo vision in the child using the Stereo Fly test. 2. A method according to claim 1, characterized in that a Plusoptix A12C pediatric refractometer is used.

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