Among all other visual impairments, refractive amblyopia (RA) is not uncommon. With this disease, objects and the entire environment itself are perceived with only one eye, while the other is completely inoperative. At the same time, children are often at risk, although adults can also have the disease. Of the total number of ophthalmic diseases, amblyopia accounts for 2% (patients of any age).
In some cases, both eyes suffer at once, and there are no deviations in terms of the anatomical structure of the eyeball. And since this is more of a childhood disease, each parent needs to know its features and varieties.
Amblyopia overview
The retina of the human eye is designed in such a way thatwhich is able to perform its function only in case of irritation with a light flux. In this case, the main responsibility lies with its central part. It is in this place that the rays are focused when the refraction is within the normal range. From here, nerve impulses enter the brain, as a result of which everything that we see with our eyes is formed.
Refractive amblyopia is characterized by a violation of the refractive power of the eye (refraction). For this reason, the image is formed fuzzy and blurry. In this case, the brain, in order to compensate for fuzzy or distorted information, reduces the flow of impulses due to the processes of inhibition. For this reason, the functionality of the visual part of the nervous system decreases - sharpness decreases.
Neither glasses nor lenses can correct. It is important to detect pathology in a timely manner and begin to take appropriate measures. Otherwise, the nerve fibers that are responsible for signal transmission begin to lose functionality over time and may eventually stop working completely. Vision will begin to deteriorate even more, which, ultimately, threatens the development of serious complications.
Provoking factors
As for the reasons for the development of this pathology in adults or children, a rather versatile character can be noted here. In this case, the disease can have a primary form or be secondary. But it is the initial stage of refractive amblyopia that often develops for no reason. In reality, the reasons, of course, are present, but it is not yet clear to recognize them.seems possible. This already significantly complicates the course of therapy.
The secondary form of the disease usually occurs against a background of a number of disorders of the visual system. The main provoking factors in this case include:
- Heredity.
- Presence of strabismus.
- Myopia or farsightedness.
- Decrease in the accommodation of the eye apparatus due to a decrease in the contractility of muscle tissue.
- Eye surgery.
- Injury to the visual organ.
- Early delivery (before 28 weeks).
- Constant eye strain (when working at the computer for a long time).
- Prolonged stress.
With the timely detection of any pathologies of the visual system and the course of treatment, the development of refractive disease can subsequently be avoided.
Severity of disease
As we now know, the refractive form of the disease can be primary and secondary. The danger of the initial "phase" is that it develops for no apparent reason, as mentioned above. The reason for the appearance of the secondary stage of refractive amblyopia in both eyes or one is almost any of the existing diseases, which was also mentioned. But even the wrong glasses can also serve as a provoking factor.
However, amblyopia of this variety can have several degrees of severity (diopters are indicated in brackets):
- I is the weakest (0, 8-0, 9).
- II –weak (0.5-0.7).
- III – medium (0, 3-0, 4).
- IV - high (0.05-0.2).
- V - very high (≦0, 05).
As a rule, the severity of amblyopia is proportional to the manifestation of another disease (if any). And how can you understand that the higher the stage of visual pathology, the lower the visual ability of the visual organ.
Symptomatics
Since, as it was said at the very beginning of the article that amblyopia of this variety is a childhood disease, it is important for parents to know how it can manifest itself in their child. Often this can happen at an early age, when the baby is not yet able to complain of a decrease in visual acuity. In this case, the main symptom that should alert is incorrect fixation of the eye. This can be seen when a child, looking at an object, seems to be looking through it.
Other signs of grade 1 refractive amblyopia can already be detected by an ophthalmologist:
- visual acuity is markedly reduced;
- presence of monocular cataract;
- binocular vision is impaired.
Adults will be able to suspect visual pathology based on the following signs. They may notice a decrease in the sensitivity of the eyes, while it is no longer possible to distinguish between shades and brightness of the color range. I can't focus on some colored object. A person begins to see poorly near or far, or in both directions. In addition, the eyes quickly get tired, migraines appear.
But apart from thatin patients with amblyopia, visual signs of the refractive form can also be detected: strabismus, eyelid drooping, nystagmus (eye movement is not controlled).
Diagnostics
Mild and moderate visual pathology is still being treated, but as for other stages, therapy usually no longer brings the desired results. Even in the maternity hospital, newborns are examined for the presence of a pathology of the visual system. Thus, this examination allows you to timely identify any signs that indicate refractive amblyopia 1 degree or any other severity.
If parents suspect a child has signs of a refractive disease, it will not be superfluous to visit a pediatric ophthalmologist for a diagnosis. This procedure includes a whole range of activities.
First you need to examine the fundus of the eye. In this case, the doctor evaluates the condition of the eyelids, the reaction of the pupil to the light flux, as well as the location of the eyeball. To draw up an overall clinical picture, the following activities are necessary:
- Checking visual acuity with and without glasses.
- Testing with different shades.
- Performing a refractive test.
- Examining the patient's visual field.
For adult patients, the following procedures are performed:
- Biomicroscopy.
- Goldman lens examination.
- The condition of the lens and vitreous body is assessed.
- Ultrasound examination (ultrasound).
Whenrefractive amblyopia of moderate severity or more, a comprehensive examination is mandatory.
But in some cases, if necessary, doctors may prescribe a number of additional procedures such as tonometry or electroretinography.
Features of the treatment of visual pathology
Refractive pathology of the visual apparatus, if it has appeared, then by itself it does not go away. And the sooner it is discovered, the better. In this case, the main goal is to eliminate the provoking factors of amblyopia. That is, it is necessary to treat myopia, hyperopia, astigmatism. This requires a comprehensive and highly individual approach to each patient.
Only after eliminating the cause, we can talk about the full treatment of the disease. For children and adults, general treatment regimens are commonly used:
- Drug treatment.
- Correction therapy through optics.
- Pleoptic correction.
- Surgery.
Here it is worthwhile to understand that the course of treatment will only be beneficial if you seek medical help in a timely manner. In children, the initial or average degree of refractive amblyopia is cured completely. In adults, things are a little different - the task of therapy is to maintain vision at a certain level, preventing it from declining.
Corrective Therapy Through Optics
As a rule, doctors prescribe glasses or lenses based on the severitydiseases. Just keep in mind that the effectiveness of this therapy is high if the cause of amblyopia is farsightedness, astigmatism or myopia.
Optical devices are selected for the patient depending on the diopter. However, they must be worn at all times. Thanks to the optics, a clear image is created, thereby stimulating visual functions.
Method usually comes into force at the time of detection of visual pathology. But after adapting to the effects of optics, the specialist selects a different type of correction for the patient.
Medicated treatment
When making a diagnosis of mild refractive amblyopia in children under 4 years old, the doctor may prescribe the use of a number of drugs. To do this, a preparation containing atropine is instilled into a he althy visual organ. As a result, his visual acuity is reduced, which allows him to stimulate the functionality of the affected eye.
In addition, irrigation therapy is being used. In this case, a combination of different drugs is injected into the eye through a special catheter. At the same time, the doctor selects the composition of the complex again on an individual basis for each patient. The procedure itself is performed under the influence of anesthesia in relation to children. For adult patients, local anesthesia is used.
Your doctor may also recommend lutein-containing medications.
Pleoptic correction
What is refractive amblyopia 03-04, we have now found out (corresponds tomedium degree). But what other ways can you improve the situation? The answer is right in front of your eyes – pleoptic therapy. In fact, the treatment of an eye disease using this technique is almost the same as when using medications. That is, the visual acuity of a he althy eye is artificially reduced in order to stimulate the functionality of the affected organ. The technique happens:
- Passive pleoptics.
- Active pleoptics.
In the first case, the he althy eye is closed with a bandage or glasses are used, in which one of the glasses (in the appropriate place) is opaque. Therapy takes a long time (from 6 to 12 months). Only the technique, also called direct occlusion, is relevant only in relation to children under the age of six, since in children older than 6 years the situation can only get worse.
Active or perceptual treatment for refractive amblyopia (grade 1 or more) involves specific exercise programs:
- Rotation of the eyeballs in a circle - first in one direction, then in the other.
- Transferring both eyes to the bridge of the nose.
- Look into the distance, then sharply shift your gaze to the lower left corner.
These exercises should be done before tears appear. But in addition to the complex of recreational activities, special computer programs are used.
Therapy in this case is carried out in medical institutions. The essence here is simple - for example, among the numerous items you need to find someone endowed with certain qualities that distinguish him from the rest. The selection is made with the computer mouse.
Surgery
For adult patients, surgery is prescribed when amblyopia is caused by strabismus, astigmatism, myopia, hyperopia. In case of low visual acuity, laser correction is performed. The essence of the operation is to change the thickness of the cornea, which allows you to give it the necessary shape for correct refraction.
To correct high-grade refractive amblyopia caused by strabismus, a procedure is performed to reposition the muscle structure. This operation is performed under the influence of local anesthetics.
In any case, the patient is discharged after a short stay (1-2 hours). The recovery period after laser exposure is up to 3 hours. After the strabismus procedure, it takes a little longer - up to a week.
Treatment at home
To successfully deal with amblyopia in children, in addition to he alth-improving activities carried out in specialized institutions, it is necessary to resort to home therapy. Classes according to the Goncharova-Küppers method are considered no less effective than professional medical care.
A matte light bulb with a power of 60 watts is screwed onto a table lamp and a circle with a diameter of 6-10 mm is glued from a material that does not transmit light. The procedure should be performed in a darkened room (twilight effect), and a he althy organ duringexercises should be covered with a bandage or covered with a hand.
Therapy of refractive amblyopia in children at home is carried out as follows. The child sits down on a chair (the distance to the light source is 50 cm), and he should peer into the dark circle on the lamp for 30 seconds. After that, you should look at any light object (a white sheet of paper hanging on the wall) and hold it until the silhouette is clearly distinguished from the black circle.
When the spot disappears, the child needs to repeat everything. That is, look again at the black circle, and after 30 seconds, look at a light object. The procedure should be performed three times during the day in one session, no more is required. The duration of the entire therapy is 1-3 months.
Another technique involves a similar but slightly different option. A table lamp with high power (100 watts) is taken, a black paper cap is put on top, in which a circle with a diameter of 30-50 mm is cut out in the center. The hole is closed with a piece of red glass or film.
The patient also takes a sitting position at a distance of 40 cm from the light source. The gaze at the closed hole should be held for 180 seconds. Here you need an assistant who, during these three minutes, must turn the lamp on and off at intervals of 2 seconds. The procedure must be carried out daily for 3 months.
As a conclusion
Refractive amblyopia is a serious ophthalmic problem. If no measures are taken at the slightest suspicion of the presence of such a pathology, subsequently such negligence may threaten with partial or complete loss of vision. It is unlikely that such a rosy prospect will please anyone.
For this reason, the sooner a correct diagnosis is made, the better the prognosis for a successful outcome of the therapy. Just do not forget that the treatment is most effective at the initial stage or moderate severity of the disease, and therefore it is better not to take everything to the extreme.
