RU2757260C1 - Method for eliminating exophoria complicated by a-syndrome - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to ophthalmology. The method for eliminating exophoria complicated by A-syndrome includes the selection and use of corrective spectacle lenses, on the inner surface of the glasses of which elastic Fresnel prisms (EFP) are applied. The selection of the EFP of the desired force is carried out using a prismatic ruler, placing it in front of the patient’s eye with the base up, then shifting it down, towards the increasing force of the prism. At the same time, a prism is selected that ensures the absence of exotropia and diplopia when fixing a nearby object. Next, the EFP, corresponding in strength, is applied binocularly to the lower part of the spectacle lenses with the base facing up.

EFFECT: application of this invention will expand the functionality of the method, reduce its duration and increase efficiency.

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Description

The invention relates to ophthalmology and is intended to eliminate exophoria complicated by A-syndrome.

Exophoria is a form of intermittent divergent strabismus held latent by fusion mechanisms. A special place is occupied by exophoria, complicated by the horizontal Α-syndrome, which can be caused both by an abnormal structure and attachment of horizontal muscles, and by weakness of the lower rectus muscle - less adduction when looking down, strong upper rectus muscle (overstrain), more adduction when looking up , sagitalization of the superior oblique muscle. A distinctive and very important element of this pathology is the presence of binocular vision when looking straight and upward, the absence of vertical deviation in adduction and abduction. When looking down, the patient has an increase in the deviation angle, which is accompanied by discomfort, diplopia (double vision) and asthenopic complaints. Based on the etiology of this type of strabismus, surgical treatment is the main way to eliminate the A-syndrome. However, surgical treatment is not always possible to carry out quickly, therefore, the resulting exotropia and diplopia when looking down leads to the impossibility of working at a close distance, and reduces the patient's quality of life.

There is a known method of compensation (elimination) of exophoria, which consists in the fact that every day, at least 4 times a day, the following therapeutic exercise is carried out for 3-5 minutes: the patient sets the pencil vertically 15-20 cm from the eyes, after which he 15-20 sec looks into the distance and at the same time fixes attention on the double images of the pencil, then turns his gaze to the pencil (while merging its double images) and looks at it for 5-7 seconds, after which he again looks into the distance and repeats the cycle. With each cycle or before the next exercise, the pencil is moved to the eyes by 0.5-1 cm. These convergence training contribute to an increase in fusion reserves and, thereby, the capabilities of the visual system in blocking exophoria. (Treatment of functional myopia in children, 2000. No. 123 - pp. 58-63).

The disadvantages of this method are the limited functionality of the method, since it is used only with subcompensated exophoria without a syndrome, does not allow to eliminate diplopia.

A known method for eliminating exophoria by applying the method of binarimetry, based on the phenomena of physiological double vision and fusion of double images presented in free haploscopy. Binarimetry, acting on the processes of binocular synthesis, eliminates the imbalance of visual functions. With subcompensated exophoria, binarimetry is an effective method of treatment, it allows you to eliminate exophoria and, accordingly, diplopia. (Russian ophthalmology online "Binarimetry in the treatment of exophoria", No. 9034 2011-07-27T).

The disadvantages of this method is its low efficiency in exophoria with Α-syndrome, which does not allow solving the problem of eliminating exophoria and diplopia.

A known method for eliminating exophoria, which consists in the use of diploptic treatment for training convergent fusion using the apparatus "Forbis". After the correction of ametropia, the load is carried out with negative spherical lenses until the bifurcation of the object. The patient is asked to seek and monitor the presence of binocular fusion under negative lens loading conditions. The criterion for evaluating the effectiveness of treatment is the maximum power of the negative lens, at which binocular fusion is maintained without double vision. (Russian ophthalmology online "Orthopedic-diploptic treatment", No. 280 2017-09-15Т).

The disadvantage of this method is that it is applicable only in patients with subcompensated exophoria, but is not effective in patients with A-syndrome.

The closest to the claimed method - the prototype, is a method for eliminating exophoria using prismatic glasses, which consists in the fact that first the horizontal component of the eye deviation is 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 dpt, at which exophoria and diplopia disappear and binocular vision is restored. The resulting total force of the compensating prism is distributed approximately equally to both eyes. (Guidelines for the use of prismatic elements of spectacle correction, approved by the Ministry of Health of the USSR on 15.10.1987, order No. 11-49 / 6-23).

The disadvantages of this method are:

- limited functionality of the method, since it is applicable only in patients with sub (de) compensated exophoria to eliminate double vision in the direct gaze position, it is inapplicable for patients with exophoria in combination with A-syndrome;

- insufficient efficiency associated with the impossibility of eliminating the A-syndrome and, accordingly, diplopia, since this method allows to eliminate double vision in the direct gaze position, does not take into account the change in the deviation value when looking down or up;

- the duration of the method, since the selection of the necessary prismatic correction takes a lot of time, perseverance, attentiveness of the child is required, therefore it is not always feasible.

The objective of the invention is to expand the functionality of the method, reduce the duration and improve the efficiency of eliminating exophoria complicated by the A-syndrome.

EFFECT: expanded functionality of the method, reduced duration and increased efficiency of elimination of exophoria complicated by A-syndrome.

The task is achieved by the proposed method, which is as follows.

Before treatment, all patients undergo a complete ophthalmological and strabismological examination: visual acuity is determined using a Plusoptix distant refractometer or according to the Golovin-Sivtsev table without correction and with correction, refraction is determined before and after cycloplegia on a Plusoptix distant refractometer, autorefractometer or by means of skyoscopy strabismus angle according to Hirschberg in five diagnostic gaze positions, determine the nature of binocular vision, stereo vision both far and near by color test and Stereo Fly test.

At the second stage, the selection of elastic Fresnel prisms (Fresnel) of the required force is carried out using a prismatic ruler. The prism ruler is placed in front of the patient's eye with the base up, then it is shifted downward, towards the increasing force of the prisms, in order to determine the force of the prism, at which the patient will not need to move his gaze down (the installed prism will do this for him), that is exotropia is not provoked and, accordingly, there is no diplopia. The criterion for the correct selection of prisms is the absence of exotropia and diplopia when fixing a close object. Next, the SME, corresponding in strength, is installed binocularly in the lower part of the spectacle lens with the base facing up.

It is recommended to use glasses with Fresnel prisms close up before performing the surgical stage of treatment.

Justification of the proposed method. When the prism is installed with the base up, the image on the retina is displaced towards the base of the prism. The image seen by the patient is virtual, and the virtual images are displaced towards the top of the prism. In order for the patient not to lower his gaze, not to provoke the onset of exotropia, the selected prismatic correction is installed in the lower part of the spectacle lens. Thus, when trying to look down, the patient's gaze falls into the lower part of the glasses, where the prisms are installed, they induce the displacement of the image perceived by the patient downward. As a result, the patient does not develop exotropia and, accordingly, there are no complaints of double vision.

The inventive method is intended for use in patients with exophoria complicated by Α-syndrome, as one of the stages preceding the surgical stage of treatment, which makes it possible to eliminate the patient's main complaint - double vision, thereby improving the quality of life.

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

- carry out the selection of the EPF of the required force using a prismatic ruler, which allows to reduce the duration of selection, while selecting a prism that ensures the absence of exotropia and diplopia when fixing a near object, which allows the use of prisms in patients with A-syndrome;

- the selected prisms are applied to the lower part of the spectacle lenses with the base up, as a result, the installed prism induces a downward movement of the perceived image, thus excluding an increase in the strabismus angle, which makes it possible to increase the efficiency of the method by eliminating the A-syndrome and diplopia when looking down;

- 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 change in the deviation value and fixation of the patient's eyes (i.e., how many degrees the gaze is lowered) when looking down.

A search on 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., 10 years old. Diagnosis: Subcompensated exophoria complicated by A-syndrome. Acquired axial myopia of weak degree of both eyes.

Parents complained of intermittent strabismus (usually noticed near), the child noticed the appearance of double vision when reading. The patient wears glasses all the time.

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

OD - 2.5 cyl - 0.5 ax 150

OS - 2.0 cyl - 1.50 ax 170

The visual acuity was determined according to the Orlova table:

OD 0.1 s sph - 2.0 = 1.0

OS 0.1 s sph - 2.0 = 1.0

with a Plusoptix refractometer (after cycloplegia, binocular examination mode)

OD - 2.0 cyl - 0.5 ax 154

OS - 2.0 cyl - 1.50 ah 178

An objective examination of the oculomotor system revealed the following:

Strabismus angle according to Hirschberg in glasses (w / o)

Deviation value:

When carrying out a cover test, the patient is diagnosed with exophoria in four main directions of gaze. However, when looking downward, the strabismus angle increases, that is, the A-syndrome is determined. This is the reason why the patient complains of double vision.

The binocular nature of vision was determined by a color test from 5 meters, and by the Stereo Fly test, the absence of near binocular vision was determined.

At the second stage, on the inner surface of the glasses, which the child had, in front of both eyes, an SME with a force of 8 pr. Diopters was applied, the base of which was directed upward. The selection of the prism was carried out using a prism ruler, with the help of which the absence of exotropia and diplopia was achieved when fixing a near object, as well as using the Plusoptix A12C pediatric refractometer, which made it possible to visually assess the change in the magnitude of deviation and fixation of the patient's eyes (i.e., how many degrees the gaze is lowered) ) when looking down. Fig. 1. glasses are presented, on the lower part of which the SME is applied with the base facing up.

This prismatic correction made it possible to create conditions for moving the perceived image downward, thus eliminating the possibility for the patient to lower his gaze on his own, thereby eliminating the appearance of exotropia and Α-syndrome. The inventive method made it possible to eliminate the main complaints and improve the patient's quality of life.

Surgical treatment was recommended to eliminate exophoria with A-syndrome.

Example 2.

Patient U., 13 years old. Diagnosis: Subcompensated exophoria complicated by A-syndrome. Moderate axial acquired myopia in both eyes.

Parents complained of intermittent strabismus (usually noticed near), as well as the appearance of double vision when reading. The patient wears glasses all the time.

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

OD - 4.5 cyl - 0.5 ax 100

OS - 4.0 cyl - 0.5 ax 90

The visual acuity was determined according to the Orlova table:

OD 0.09 s sph - 4.5 = 1.0

OS 0.09 s sph - 4.0 = 1.0

with a Plusoptix refractometer (after cycloplegia, binocular examination mode)

OD - 4.0 cyl - 0.5 ax 99

OS - 3.75 cyl - 1.50 ax 92

An objective examination of the oculomotor system revealed the following:

Strabismus angle according to Hirschberg in glasses (w / o)

Deviation value:

When carrying out a cover test, the patient is diagnosed with exophoria in four main directions of gaze. However, when looking downward, the strabismus angle increases, that is, the A-syndrome is determined. This is the reason why the patient complains of double vision.

The binocular nature of vision was determined by a color test from 5 meters, and by the Stereo Fly test, the absence of near binocular vision was determined.

At the second stage, on the inner surface of the child's glasses, in front of both eyes, an SME with a force of 10 diopters was applied, the base of which was directed upward. The selection of the prism was carried out using a prism ruler, with the help of which the absence of exotropia and diplopia was achieved when fixing the near object, as well as using the Plusoptix А12C pediatric refractometer, which made it possible to visually assess the change in the deviation value and the change in the fixation of the patient's eyes when looking down.

This prismatic correction made it possible to create conditions for moving the perceived image downward, thus excluding the patient's ability to lower his gaze on his own, thereby eliminating the appearance of exotropia and A-syndrome. Surgical treatment was recommended to eliminate exophoria with A-syndrome.

The use of the proposed method will expand the functionality of the latter, reduce the duration, increase the efficiency in eliminating exophoria complicated by the A-syndrome, which in turn will improve the quality of life of patients, eliminate their main complaint before surgical treatment.

Claims (3)

1. A method for eliminating exophoria complicated by A-syndrome, including the selection and use of corrective spectacle lenses, on the inner surface of the glasses of which elastic Fresnel prisms (Fresnel) are applied, characterized in that the selection of the EEF of the required force is carried out using a prismatic ruler, setting it in front of the eye the patient with the base up, then shifting it down, towards the increasing force of the prism, while selecting such a prism that ensures the absence of exotropia and diplopia when fixing the near object, then the SME corresponding in strength is applied binocularly to the lower part of the spectacle lenses with the base facing up ... 2. The method according to claim 1, characterized in that before treatment, the patient undergoes a complete ophthalmological and strabismological examination. 3. The method according to claim 1, characterized in that the correctness of the selection of the SME is assessed using a Plusoptix refractometer.

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