Otitis

Causes of binocular vision impairment, diagnosing visual impairment, vision correction. Impaired binocular vision in adults Binocular vision is possible only if

What is amblyopia of the eye? This is a special state of the visual analyzer, caused by its prolonged inactivity. Due to functional inertia, the brain begins to ignore the visual signals it sends. In response to this, the eye begins to become lazy and stops doing its job. This ultimately leads to complete one-sided blindness.

Species

Depending on the cause, ophthalmologists distinguish several types of amblyopia of the eye. They need to be distinguished in order to understand the mechanism of development of the disease and determine treatment tactics.

Types of pathology:

Dysbinocular amblyopia. Develops in children with strabismus. Since the squinting eye always looks to the side, the child’s binocular vision is impaired and double vision appears. To eliminate visual discomfort, the brain begins to selectively suppress visual impulses. Over time, the eye begins to lose functional activity.
Anisometropic (refractive amblyopia). Occurs when there is a large difference in the refraction of the two eyes (3 or more diopters). The cause may be asymmetrical myopia, astigmatism or farsightedness, expressed to varying degrees. The mechanism of development of pathology is similar to the previous version.
Psychogenic. Both eyes in this case are completely healthy and fully functioning. Lazy eye syndrome develops due to neurological or neuropsychiatric disorders.
Obscurational amblyopia. It occurs due to clouding of the optical media of the eyeball, which prevents the passage of light rays. Due to long periods of inactivity, the eye loses its ability to see. Cataracts, corneal cataracts, and destruction of the vitreous body can lead to the development of obscurational amblyopia.

Degrees

Amblyopia is characterized by visual impairment that cannot be corrected. This means that glasses and contact lenses do not help the patient see well. Depending on the visual acuity of the affected eye, there are four degrees of amblyopia. A doctor can distinguish them after examining and examining the patient.

Low degree amblyopia. Characterized by a decrease in visual acuity to 0.8–0.4. At the same time, a person sees quite well and may not notice the first signs of the disease.
Moderate amblyopia. Vision drops to 0.3–0.2. The patient loses binocular vision, which is why surrounding objects seem flat and bulky to him. A person has difficulty assessing distances, which causes him a lot of difficulties in everyday life.
High degree of amblyopia. Visual acuity decreases to 0.1 or less. The patient practically cannot see out of one eye. The amblyopic eyeball deviates from its normal axis, resulting in strabismus.

When vision loss is less than 0.04, we are talking about very high amblyopia. The pathology has a poor prognosis and eventually leads to complete blindness of the eye. Unfortunately, it is impossible to restore normal vision to a person at this stage.

Reasons

Unlike most ophthalmological diseases (myopia, astigmatism, keratitis, retinitis, cataracts), amblyopia does NOT develop due to organic damage to the eye. The reason is inhibition of visual perception in the occipital lobe of the cerebral cortex.

If amblyopia has gone too far, it cannot be cured. And even surgical treatment of strabismus, removal of cataracts on an amblyopic eye, or elimination of another provoking factor will not help restore vision. That is why it is so important to identify the disease in time and prevent its further development.

Symptoms

A child with amblyopia usually does not notice the alarming symptoms of the disease or simply does not attach importance to them. Therefore, only the baby’s parents can identify the disease. To do this, you need to carefully observe the behavior and habits of their child.

Symptoms of amblyopia in a child:

lack of clear fixation of gaze on objects;
difficulties with orientation in unfamiliar places;
deviation or closing of one eye while reading or performing other activities;
poor vision in the affected eye, which can be detected by closing the other eye.

In adults with hysterical amblyopia, symptoms appear suddenly, after suffering stress or emotional shock. The patient suddenly notices a deterioration in central and peripheral vision. Unpleasant symptoms may persist for several hours, days or even months.

Refractive amblyopia grade 1–2 often affects people with high degrees of myopia and farsightedness who have refused to wear glasses for a long time. The disease develops gradually and affects both myopic eyes. Having decided to put on glasses or contact lenses, the patient discovers that the correction no longer helps him achieve one hundred percent vision.

Which doctor treats amblyopia?

Diagnosis and treatment of amblyopia is carried out by an ophthalmologist. For strabismus, ptosis, cataracts and severe corneal opacity, the patient usually requires the help of an ophthalmic surgeon or laser ophthalmologist. People with psychogenic amblyopia need to consult a neurologist or psychiatrist.

Diagnostics

To clarify the diagnosis, a thorough examination by an ophthalmologist and additional research methods are required. A full examination helps to identify the cause of the development of amblyopia and determine the tactics of its treatment.

Methods for diagnosing amblyopia.

The essence of the method

Results

Examination and history taking	The ophthalmologist carefully examines the patient and finds out when and after what alarming symptoms appeared.	During the examination, the doctor may notice a change in the position or limited movement of the eyeball
Visiometry	During the study, the specialist determines the visual acuity of each eye. First he does this without correction, then he selects positive or negative lenses	A typical sign of amblyopia is decreased visual acuity that cannot be corrected optically.
Definition of binocular vision	This is done using a color test. The doctor sits the patient at a distance of 5 meters from the device and puts glasses with colored filters on him.	A light test allows you to identify impaired binocular vision and determine the dominant (conditionally healthy) eye
Biomicroscopy	Involves examining the external structures of the eye using a slit lamp.	During the examination, the doctor may identify cataracts, corneal opacity or other pathology that caused the development of amblyopia
Determination of the type and angle of strabismus	The Hirschberg method or synaptophore can be used for diagnosis.	With normal vision, the reflex from the ophthalmoscope is located in the center of the pupils. In case of strabismus, it will blend closer to the iris
Ophthalmoscopy	The doctor examines the fundus of the eye using a direct or indirect ophthalmoscope	Biomicroscopy allows you to see pathological changes in the retina. It can be used to distinguish amblyopia from retinitis, chorioretinitis and other organic damage to the retina
Electrophysiological studies	There are several types of procedure: electroretinography, visually evoked potentials, multifocal electroretinography method	Provides an opportunity to assess the functional state of the retina and optic nerve

Treatment

Treatment of amblyopia begins with eliminating the factor that caused its development. A child with strabismus undergoes surgery on the extraocular muscles, people with cataracts have their clouded lens removed, and patients with corneal cataracts undergo photorefractive keratectomy.

If necessary, the patient is selected for vision correction (glasses or contact lenses). They should be worn in case of myopia, farsightedness and astigmatism. For therapeutic purposes, ophthalmologists can prescribe so-called hypercorrection. Its essence lies in the suppression of visual signals from the healthy eye. This allows you to return functional activity to the second eyeball.

In order to “stir up” the amblyopic eye and make it work normally again, the occlusion method is used. Its essence is to wear the bandage daily for 3-4 hours. Note that “turning off” requires a healthy eye, not a diseased one. This means that a child with amblyopia in the right eye needs to be patched on the left eye.

To restore the functional activity of the retina and optic nerve, electrical stimulation, photopulse therapy and laser stimulation are used. These techniques actively stimulate the lazy eye and restore its ability to see well.

Forecast

In children under 7 years of age, the disease responds quite well to treatment. This is due to the immaturity of the visual system and the incomplete formation of the eyeball. If treatment for amblyopia was started on time, there is a high probability of complete restoration of vision.

In adulthood, the disease most often develops due to untimely removal of cataracts. Within a few years, the patient completely loses his vision. Such amblyopia leads to irreversible impairment of the functional activity of the retina. Read more about age-related cataracts →

Prevention

The development of amblyopia can be avoided by timely treatment of dangerous ophthalmological diseases. These include refractive errors, cataracts, strabismus, large corneal cataracts, etc.

The sooner the cataract is removed or binocular vision is restored, the better the prognosis and the lower the risk of suffering from amblyopia.

What is lazy eye? This is a functional visual impairment that develops due to prolonged inactivity of the eyeball. Amblyopia most often affects children with strabismus, farsightedness and astigmatism. In adults, lazy eye syndrome can result from untimely surgical treatment of cataracts.

To combat amblyopia, the occlusion method is most often used. Its essence lies in wearing the bandage every day. The healthy eye is closed for 3–4 hours a day. To restore the functional activity of the retina and optic nerve, photopulse therapy, electrical and laser stimulation are used.

Useful video about amblyopia

How to determine binocular vision

The concept of binocular vision refers to the ability to clearly see images by two organs of the visual apparatus at once, that is, the eyes. This occurs due to the connection of the overall picture seen by the eyes in the cerebral cortex. It can also be called stereoscopic vision, which allows you to see the volume of an image, determine the distance directly between objects and how far or close each object is from a person. In a word, this is healthy vision.

But there is also monocular vision, in which one eye determines the shape, width and height of any thing, but it is impossible to check the distance. Therefore, stereoscopic vision is necessary for normal human life.

Binocular vision is completely absent at birth, but begins to develop from 2 months of age. However, it can be developed in any age category.

Conditions for the existence of binocular vision

Each visual organ should have vision of at least 0.3-0.4.
The position of the eyeballs should be parallel.
The lens, cornea and vitreous body must be transparent.
Fusion ability.
Both eyes should combine correctly when looking at a moving object.
When looking up close, the approach of the eyes should correspond to each other.
There should be no pathologies that impair the functionality of vision.

How is vision determined?

To determine binocular vision today, there are many tests with and without special devices. The equipment divides the field of vision in each individual eye using color filters or Polaroid devices. The most popular is the 4-point color test for studying binocular vision CT 1.

In this case, light filters of different colors (green and red) in the form of glasses are placed in front of a person’s eyes. Then you need to focus your gaze on a special round-colored screen. It contains 4 luminous circles: 2 green, 1 red, 1 white. If a person has binocular vision, then he will see all four circles, but the white circle will seem to him the color of the filter that is put on the more dominant eye. If there is no stereoscopic vision, then the patient will see only 2-3 circles or 5 (with simultaneous vision).

Hardware-free testing

There are many more ways to conduct binocular vision testing without the use of equipment. This testing can also be done at home:

Treatment methods

Binocular vision cannot be treated, but its absence is undoubtedly. As a rule, strabismus is most often observed, so all measures should be aimed exclusively at treating this pathology. But even without strabismus and other diseases, you can learn to develop binocular abilities. For this, there are special exercises for binocular vision:

How and why does amblyopia (lazy eye syndrome) develop in adults? How to treat the disease?

Amblyopia is a common ophthalmological pathology, which is expressed in the inability (complete or partial) of the left or right eye.

The development of the disease is not associated with any anatomical disorders or defects in the tissues of the eyeball and can be corrected with timely treatment.

What is eye amblyopia?

Amblyobia is also known as lazy eye syndrome and dull eye syndrome. In the ICD-10 catalog, the pathology is designated by code H53.0.

With this disorder, visual images are perceived by the brain only from the side of the healthy eye.

Therefore, vision turns from binocular volumetric to monocular.

At the same time, a person cannot correctly estimate the size of observed objects and the distance to them.

In addition, amblyopia can lead to a noticeable decrease in vision, and if correction is not done in time, even loss of vision is possible.

Features and symptoms of the disease in adults

The disease develops gradually in adulthood and is asymptomatic in the initial stages, although after a while the following signs of amblyopia may be observed:

double vision;
increased lacrimation;
lack of a positive effect when trying to wear contact lenses or glasses (decreased visual acuity is not corrected with the help of such optics);
difficulties in orienting in space;
the problematic eye involuntarily squints and closes under more or less severe stress;
the eyes quickly get tired even with short-term concentration of vision on small objects or in the process of performing work that requires extreme focusing of vision;
peripheral and central vision is significantly reduced after suffering stress for several hours or days.

Reasons

The reasons for the development of amblyopia can be:

Sometimes amblyopia can develop for no apparent reason if a person has a genetic predisposition to the disease.

Diagnostics

It is possible to identify such a disease and prescribe the correct treatment only through a comprehensive examination.

During the examination, the specialist performs direct and indirect ophthalmoscopy, and also determines the field of view and determines the presence or absence of refractive errors.

During the diagnosis, the transparency of the lens is also determined by examining this element in transmitted light.

If opacity is confirmed, an additional ultrasound of the eye is prescribed.

In difficult cases, the patient may be prescribed electroretinography and tonometry procedures, and if a neurological etiology of amblyopia is suspected, the patient may be referred for examination by a neurologist.

Types of amblyopia in adults

There are several types of lazy eye syndrome, each of which has its own characteristics and symptoms:

Degrees of the disease

Regardless of the type, amblyopia can be classified into varying degrees. The first and second degrees are weak, and in such cases visual acuity is 0.5-0.9 units.

The third (medium) degree is characterized by a sharpness of 0.3-0.4 units. The fourth and fifth degrees are high and very high, respectively (0.05-0.2 in the first case and below 0.05 units in the second).

Treatment of amblyopia in adults

if strabismus is present, eliminate it;
correction of refractive errors;
doing eye exercises regularly;
in rare cases - surgical intervention;
hardware therapy.

In the hysterical form of the disease, psychotherapeutic methods and treatment with sedative medications can additionally be used.

By the way, no other form of amblyopia can be treated with medication.

Pathology of the obscuration form is treated only by surgical intervention.

At the same time, starting treatment in the early stages sometimes makes it possible to completely restore vision lost during the progression of the disease.

Occlusion method

The occlusion method often helps get rid of the disease: in 7 out of 10 cases it helps.

The essence of the technique is that the patient wears special glasses, instead of one of the lenses of which an opaque “plug” is used, located on the side of the healthy eye.

Instead of such glasses, special lenses can also be used, one of which is opaque.

The simplest option is to put a bandage on the pathological eye, but in modern medicine this method is not used due to its unaesthetic nature.

Unlike children, when treating adults, this method is not as effective, so if amblyopia does not disappear after three months, the method is considered untenable.

Hardware treatment

The most effective method is hardware treatment, during which video-computer auto-training is performed, eye stimulation using blinding irritation of the retina or the use of sequential images.

This technique was first used more than half a century ago, but modern hardware treatment is not too different from the method developed in the 50s of the 20th century.

During the hardware treatment of amblyopia, the following procedures are performed:

exploitation of grain fields;
use of flash lamps;
electrical stimulation of the visual pathways.

This also includes activation of metabolic processes and stimulation of the functions of the optic nerve, which are responsible for stimulating conduction functions.

As a result of such treatment, in most cases it is possible to restore the accommodative properties of the eye and binocular vision.

Exercises and gymnastics

In the early stages of the development of the disease and in some forms of amblyopia, treatment may be limited to ophthalmic exercises that help normalize processes in the pathological eyeball.

It is enough to perform a set of exercises only once a day, but it is advisable not to miss a single day.

This type of treatment does not produce immediate results and may take months before noticeable improvements occur.

For adults, such a gymnastic complex looks like this:

Useful video

In this video you will see how amblyopia is treated in adults:

The sooner treatment for amblyopia is started, the higher the likelihood of a favorable treatment outcome.

But in order for the therapy to be successful, it is important to notice warning signs in time and undergo examination by a specialist who will develop the optimal course of treatment and, if necessary, adjust it.

Considering that it becomes more and more difficult to correct such violations with age, there is no point in delaying the adoption of appropriate measures.

A person’s ability to simultaneously see with both eyes and obtain a three-dimensional view of surrounding objects is called binocular vision. If this ability is impaired, it affects the sharpness, clarity and other features of visual perception. Special exercises will help restore binocular vision in adults.

How does binocular vision work?

With normal binocular vision, each human eye receives a separate image, after which the brain converts them into a single three-dimensional image. For a number of reasons, the eyes of adults can work separately, and then the merging of two images into one does not occur. This negatively affects the acuity of visual function and makes it difficult to adequately perceive the distance between objects and evaluate them in three-dimensional perspective.

Binocular vision disturbances can occur if there is a large difference in the optical power of the right and left eyes, the eyeballs are located asymmetrically, the functioning of the nervous system or eye muscles is disrupted, and pathological changes are observed in the retina, cornea or lens.
The most common ophthalmopathologies that accompany binocular vision disorders are strabismus and amblyopia.

Is it possible to restore binocular vision?

Today in ophthalmology there are two main methods of restoring healthy binocular vision: orthoptics and diploptics.

Orthoptic treatment is aimed at improving the joint functioning of the eyes as a single organ of vision. To achieve this goal, special exercises are used to stimulate the eyes to connect two pictures together.
Diploptics is a technique for restoring vision, the essence of which is to cause the patient to experience double vision of the object of perception. This method stimulates a person’s ability to independently restore binocular stereoscopic vision. To perform diploptic exercises, the level of strabismus should not exceed 7 degrees.

The final stage of treatment for binocular vision disorders is special therapeutic exercises for the eyes, the task of which is to increase the mobility of the eyeballs.

How to restore binocular vision at home?

Restoring binocular vision at home can only be done if such therapy has been prescribed by an ophthalmologist. After diagnosis, the specialist decides whether standard therapy will help you or whether serious surgical treatment will be required.

Often, binocular vision disorders can be treated either on an outpatient basis in the clinic or at home, following the doctor’s instructions. As a rule, they include wearing special glasses, performing a set of exercises and procedures aimed at restoring balance between the eyes.

Effective exercises to restore binocular vision

Regular training of binocular vision is an important condition for its restoration. There are several training systems that were developed by specialists in the field of ophthalmology - Kashchenko, Bates, etc. Only an ophthalmologist during an in-person examination can select the optimal set of exercises for a particular patient.

Basic eye training is carried out in a clinical setting using special equipment. But, in addition to hardware treatment, experts recommend performing special gymnastics at home as an additional measure.
Below we present several exercise options that are often prescribed to restore binocular vision in an adult and are suitable for home use.

Simple exercises at home

Draw a vertical line 10 cm long and 1 cm wide with a marker on a sheet of paper. Attach the sheet to a well-lit wall at eye level and move one meter away from it.
Now tilt your head so that you see the drawn line in a single copy, that is, it does not double before your eyes. After the double image merges into one, begin to slowly move your head down, without taking your eyes off the strip. Continue until the image begins to double in size.
Repeat the same steps from the very beginning, only moving your head up, and then alternately to the sides. You need to do this exercise at least three times a day for five minutes. In the same way, you can train binocular vision by using any small object instead of a drawn line.

Effective Focusing Exercises

Option 1.

Place a visual object on the wall and move away from it at a distance of two meters. Extend your hand in front of you and raise your index finger up. It should be located in the same visual axis with the object on the wall.
First, focus your attention on a visual object and observe it through your fingertip. It will seem to you that your finger is splitting into two. Then change your focus and focus it on the tip of your finger. Now you should see the hand as a solid image, and the object on the wall will split into two.
Keep in mind that the clearest image will be on the side of the eye with the best vision. Sometimes you can train with one eye closed so that the other one works at maximum efficiency at this time.
This exercise needs to be repeated several times. Alternately switching focus from near to far objects trains binocular vision, and over time you will notice that the image clarity increases.

Option 2.

Take a bright drawing and first examine it in detail in its entirety. Then select a small element of the image and try to concentrate on it, outline its outline with your eyes, examine the inside, without paying attention to the main background. Then do the same thing, but choose an even smaller element to focus on.

Looking at stereograms is useful for binocular vision

A useful exercise for adults with impaired binocular vision would be to look at stereoscopic pictures. When you peer into stereograms, internal encrypted pictures appear before your eyes, the image becomes three-dimensional, which helps to restore binocular vision.

Full bilateral vision is necessary for surgeons, jewelers, and pilots. Sometimes impaired binocularity causes strabismus. Deviations in eye function can be identified independently in several ways.

Mechanism and conditions for binocular vision

Monocular vision is seeing an object with one eye. It evaluates object parameters such as shape, width and height. However, it will not be possible to get an idea of the relative position of objects.

Looking with both eyes provides a complete perception of things. Stereoscopic vision determines the distance between objects. It also expands the field of vision and increases visual acuity.

The formation of binocular vision is based on the fusion reflex. It is a physiological phenomenon - the combination of two reflections of an object from the retinas into one picture in the cerebral cortex. In this way, a stereoscopic image is formed. If the images do not merge, they say that binocular vision is impaired. .

For the correct formation of a vision of objects, the following conditions are necessary:

objects on the retina match in shape and size;
the picture appears on equivalent areas of the retina, if the images appear on asymmetrical points, then double vision appears;
good degree of transparency of the lens, vitreous body and cornea;
synchronized movement of visual muscles;
position of the eyeballs in the same horizontal and frontal plane;
visual acuity in the range of 0.3–0.4.

Impaired binocular vision leads to distortion of the real vision of objects. This negatively affects people who are associated with precise professions.

How to check?

For any eye pathology, you must visit an ophthalmologist. Using precision equipment, a specialist will conduct a binocular vision study. There are several tests available for self-checking at home.

Kalfa test

Binocular vision is determined using two long pencils or knitting needles. One pencil is placed in a horizontal plane, and the other is held vertically. You need to connect them at an angle of 90 degrees or hit the tip of a pencil.

Normal stereoscopic vision will allow you to easily complete the task. With monocular vision, a person will not cope with it and will miss.

Sokolov's experience

To perform the test, you will need a folded sheet of paper or a paper towel roll. A man looks straight through a round hole. The hand is placed in front of the second eye near the end of the tube. If stereoscopic vision is normal, a hole in the palm is visible, and an object is visible in the distance.

If the point is not in the center of the hand, then they speak of simultaneous vision. In this case, the pictures in the brain do not merge. When conducting a test for stereoscopic vision, you need to take into account that the objects in question must be 4–5 meters from the eyes.

Reading with a pencil

The reader places an object such as a pencil or pen between the book and his eyes. The distance from the nose should be 15 cm. If stereoscopic vision is without deviations, the pencil does not interfere with reading. The brain superimposes two images from both eyes and produces an overall picture.

With monocular vision, the subject cannot read the closed part of the newspaper. The reason for the deviation of stereo vision is that the brain receives information from only one eye.

Four point color test

Binocular vision is best determined by the four-point color test. Diagnosis is carried out using a machine in the ophthalmology department. The operation of the device is based on dividing the visual fields of the eyes using color filters. In special glasses, green glass is placed in front of the left pupil, and red glass in front of the right one.

The deviation is set depending on what color is perceived. With binocular vision, a red and green filter is visible, and a colorless filter takes on a mixed tint. Simultaneous vision is characterized by seeing five points. With monocular vision, the color of the light filter in each eye is determined.

Binocular vision and strabismus

The problem occurs when the eye axis deviates from the point of fixation with the second organ. With this position of one or two eyeballs, the two images do not merge in the brain. One of the pictures is excluded. Externally, the disorder is manifested by the incorrect position of the eyeball in the orbit.

There are several types of strabismus associated with binocularity:

Explicit secondary form . Occurs when there is clouding of the lens, diseases of the retina or optic nerve.
Imaginary strabismus . Develops due to an abnormality in the structure of eye tissue. Binocular vision testing does not reveal any pathology. The patient sees well in both eyes.
Hidden deviation of the eyeball . Associated with a violation of the symmetry of the eye muscles. It appears when a person looks at an object without fixing his gaze. Although the organ is sometimes deviated, visual function is not impaired.

May be periodic. The provoking factor is nervous tension, fear, excessive physical effort.

Treatment

The imaginary and hidden form do not need correction. The clarity of vision of the deviated eye with an obvious secondary form decreases over time, so treatment should be started as early as possible.

If a binocular vision study has confirmed obvious strabismus, several types of eye function restoration are used:

stimulation of binocularity;
usage , ;
hardware treatment (diploptics and orthoptics) to improve vision acuity;
eye exercises under the supervision of a methodologist;
surgical intervention.

The operation is performed to get rid of a cosmetic defect. As a result, one of the extraocular muscles weakens. In this case, restoration of binocularity is impossible.

To maintain a three-dimensional perception of the world under heavy visual load, you need to do eye exercises. It is important to eat right and be outdoors often. If you have problems with your vision, you should not put off visiting an ophthalmologist.

Useful video about binocular vision

Binocular vision is the ability to form a single image from the images of two eyes. Simultaneous vision with both eyes has a number of advantages: the field of vision expands; due to the amplification of the signal in the central part of the visual analyzer, visual acuity in the presence of binocular vision is approximately 40% higher than with monocular vision; the ability to assess the relative distance of objects in space appears (stereoscopic vision).

Binocular vision is a subtle physiological function provided by the coordinated movement of both pelvises, maintaining a constant direction of their visual axes to the point of fixation and the merging of two images into a single visual image (fusion).

It should be pointed out that convergence, i.e. the change in the angle between the visual lines depending on the position of the point of fixation in relation to the eyes is closely related to accommodation. There is a certain relationship between these quantities. Thus, with convergence to a fixation point located 1 m from the eyes, accommodation is 1.0 D, with convergence at 33 cm, accommodation is 3.0 D. Fusion and vergence eye movements (which include convergence) are interconnected: it is possible turning the visual line of one eye inward or outward (for example, using a prism) to a certain limit without disturbing the fusion - these are the so-called fusional reserves.

Binocular vision disorders often manifest themselves in the form of strabismus, i.e. deviation of the visual axis of one of the eyes from the joint point of fixation. Strabismus is classified as concomitant when the eyes deviate at the same angle in different directions of gaze, and as paralytic if the deviation of the eye in any direction of gaze increases, decreases or disappears, as is observed, for example, with paresis of the eye muscles. Based on the direction of deviation of the eye, there are three main types of strabismus: convergent, divergent and vertical. Based on whether one eye is constantly deviated or both eyes are alternately deviated, monolateral and alternating strabismus are distinguished. The degree of strabismus is determined by the angle of deviation of the oblique pelvis and is measured in degrees. Finally, a distinction is made between visible and hidden (heterophoria) strabismus. In the first case, one eye is constantly deviated from the point of fixation. With heterophoria, deviation of one of the eyes is detected only when the vision of both eyes is separated (for example, the closure of one pelvis). In the case of heterophoria, deviation of the pelvis outward is designated by the term exophoria, and in case of deviation inward - esophoria. With hidden strabismus, visual disturbances are rarely observed. Only a small part of the population has a state of ideal muscular balance - orthophoria; the majority have one or another degree of muscular imbalance, i.e. heterophoria, but, as a rule, with preservation of binocular vision.

Optical, including contact, correction for impaired binocular vision largely depends on the type and degree of obliquity. Thus, with convergent strabismus or esotropia, hypermetropia is more often observed, which leads to increased accommodation and, consequently, to excess convergence. With divergent strabismus (exotropia), myopia is usually noted. It should be noted that with monolateral strabismus, a persistent decrease in visual acuity of one eye is often observed - amblyopia.

Treatment of binocular vision disorders is aimed at naming amblyopia, eliminating cosotasis, restoring the ability to merge images in two pelvises, i.e. to fusion.

Elimination of strabismus usually begins with optical correction of existing ametropia. In the presence, for example, of convergent strabismus and hypermetropia, the lens power should be close to the value determined using objective refractive methods. Plus glasses eliminate excess accommodation, reduce convergence and thereby eliminate the so-called accommodative component of strabismus. With divergent strabismus, which is often accompanied by myopia, on the contrary, minus glasses help to strengthen the usual weakened tone of accommodation and thereby enhance convergence and reduce the angle of strabismus. There is even a method for treating divergent strabismus through hypercorrection with minus glasses. With heterophoria, correction is carried out in case of its decompensation, i.e. impairment of binocular vision. When treating amblyopia, complete correction of the amblyopic eye is also required.

However, spectacle correction does not always provide the appropriate effect due to the often insufficient correction of astigmatism. In addition, children and adolescents are often embarrassed to wear glasses and take them off secretly from their parents, while constant spectacle correction is a prerequisite for the treatment of strabismus and amblyopia.

Contact correction in the presence of astigmatism is preferable in the treatment of binocular vision disorders: it provides complete correction of existing astigmatism, in addition, the lenses are more aesthetic, since they are practically invisible. It should also be taken into account that with anisometropia, complete correction of existing ametropia is possible with the help of contact lenses, while with a significant difference in refraction in both eyes, one has to be content with only tolerable spectacle correction (with the difference in the powers of both spectacle lenses usually not exceeding 2.0 D ).

Therefore, in the eye with greater ametropia, spectacle lenses with a lower diopter power are used, which leads to a decrease in the already reduced vision in the amblyopic eye.

When treating amblyopia, the most common method is occlusion of the better eye. In this case, they use eye sealing, special occluders and np., which are often poorly tolerated by children.

An effective method of occlusion using cosmetic contact LENSES with a shaded pupillary zone or lenses with high plus or minus refraction is proposed. This method ensures complete exclusion of the better-seeing eye from the act of vision; it is aesthetic, since the lens is invisible on the pelvis.

The so-called penalization method is also used, in which artificial anisometropia is created in the patient, as a result of which the vision of the dominant, better-seeing eye deteriorates, and the amblyopic eye becomes the fixing eye. For this purpose, two main types of this treatment are used, depending on the type of strabismus, the degree of amblyopia, the age of the child and other factors:

Penalization for near, when the amblyopic pelvis becomes fixative for near, and the dominant eye for distance. In this case, against the background of mydriasis, a complete correction of the leading pelvis for distance and hypercorrection of the amblyopic eye is carried out;

Penalization for distance, when, against the background of mydriasis, hypercorrection of the leading pelvis and complete correction of the amblyopic eye for distance are carried out.

There are other methods of penalization. This type of treatment for amblyopia and strabismus leads to the connection of the amblyopic eye to active visual work in conditions where the dominant eye also takes part in the act of vision, which reduces the likelihood of a decrease in visual acuity, which is sometimes observed with occlusion.

However, the use of glasses for penalization is not always effective, since this deteriorates the vision of the leading pelvis, and therefore children often look over the glasses or take them off. Contact lenses have advantages over glasses - they cannot be easily removed, and in some cases they can be used to perform penalization without mydriasis.

Thus, in many cases of binocular vision disorders and amblyopia, the use of contact lenses allows one to obtain good results ^Sivaev A.A. et al., 1998).

28-11-2011, 15:35

Description

Binocular vision called the ability to form a single image from the images of two eyes. Simultaneous vision with both eyes has a number of advantages: the field of vision expands; due to the amplification of the signal in the central part of the visual analyzer, visual acuity in the presence of binocular vision is approximately 40% higher than with monocular vision; the ability to assess the relative distance of objects in space appears (stereoscopic vision).

Binocular vision is the ability to form a single image from the images of two eyes.. Simultaneous vision with both eyes has a number of advantages: the field of view expands; due to the amplification of the signal in the central part of the visual analyzer, visual acuity in the presence of binocular vision is approximately 40% higher than with monocular vision; the ability to assess the relative distance of objects in space appears (stereoscopic vision).

Binocular vision- a subtle physiological function provided by the coordinated movement of both eyes, maintaining a constant direction of their visual axes to the point of fixation and merging two images into a single visual image (fusion).

It should be pointed out that convergence, i.e. the change in the angle between the visual lines depending on the position of the point of fixation in relation to the eyes, is closely related to accommodation. There is a certain relationship between these quantities. Thus, with convergence to a fixation point located 1 m from the eyes, accommodation is 1.0 D, with convergence at 33 cm, accommodation is 3.0 D. Fusion and vergence eye movements (which include convergence) are interconnected: it is possible turning the visual line of one eye inward or outward (for example, using a prism) to a certain limit without disturbing the fusion - these are the so-called fusional reserves.

Binocular vision disorders often manifest themselves as strabismus, i.e. deviation of the visual axis of one of the eyes from the joint point of fixation. Strabismus is classified as friendly, when the eyes deviate at an equal angle in different directions of gaze, and as paralytic, if the deviation of the eye in any direction of gaze increases, decreases or disappears, which is observed, for example, with paresis of the eye muscles. Based on the direction of deviation of the eye, there are three main types of strabismus: convergent, divergent and vertical. Based on whether one eye is constantly deviated or both eyes are alternately deviated, monolateral and alternating strabismus are distinguished.

The degree of strabismus is determined by the angle of deviation of the squinting eye and is measured in degrees. Finally, a distinction is made between visible and hidden (heterophoria) strabismus. In the first case, one eye is constantly deviated from the point of fixation. With heterophoria, deviation of one eye is detected only when the vision of both eyes is separated (for example, one eye is closed). In the case of heterophoria, outward deviations of the eye are called exophoria, and inward deviations are called esophoria. With hidden strabismus, visual disturbances are rarely observed. Only a small part of the population has a state of ideal muscular balance - orthophoria; the majority have one or another degree of muscular imbalance, i.e. heterophoria, but, as a rule, with preservation of binocular vision.

Optical, including contact, correction for impaired binocular vision largely depends on the type and degree of strabismus. Thus, with convergent strabismus or esotropia, hypermetropia is more often observed, which leads to increased accommodation and, consequently, to excess convergence. With divergent strabismus (exotropia), myopia is usually noted. It should be noted that with monolateral strabismus, a persistent decrease in visual acuity of one eye is often observed - amblyopia.

Treatment of binocular vision disorders is aimed at naming amblyopia, eliminating the angle of strabismus, restoring the ability to merge images in two eyes, i.e., fusion.

Elimination of strabismus Usually they begin with optical correction of existing ametropia. In the presence of, for example, convergent strabismus and hypermetropia, the lens power should be close to the value determined using objective refractive methods. Plus glasses eliminate excess accommodation, reduce convergence and thereby eliminate the so-called accommodative component of strabismus. With divergent strabismus, which is often accompanied by myopia, on the contrary, minus glasses help to enhance the usual weakened tone of accommodation and thereby enhance convergence and reduce the angle of strabismus. There is even a method for treating divergent strabismus through hypercorrection with minus glasses. With heterophoria, correction is carried out in case of its decompensation, i.e. impairment of binocular vision. When treating amblyopia, complete correction of the amblyopic eye is also required.

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However spectacle correction does not always allow to obtain the appropriate effect due to the often insufficient correction of astigmatism. In addition, children and adolescents are often embarrassed to wear glasses and take them off secretly from their parents, while constant spectacle correction is a prerequisite for the treatment of strabismus and amblyopia.

Contact correction in the presence of astigmatism preferable in the treatment of binocular vision disorders: it provides complete correction of existing astigmatism, in addition, the lenses are more aesthetic, as they are practically invisible. It should also be taken into account that with anisometropia, complete correction of existing ametropia is possible with the help of contact lenses, while with a significant difference in refraction in both eyes, one has to be content with only tolerable spectacle correction (with the difference in the powers of both spectacle lenses usually not exceeding 2.0 D ).

Therefore, in the eye with greater ametropia, spectacle lenses with a lower diopter power are used, which leads to a decrease in the already reduced vision in the amblyopic eye.

During treatment amblyopia The most common method is occlusion of the better eye. In this case, they use eye patches, special occluders, etc., which are often poorly tolerated by children.

An effective method of occlusion using cosmetic contact lenses with a shaded pupillary zone or lenses with high plus or minus refraction is proposed. This method ensures complete exclusion of the better seeing eye from the act of vision; it is aesthetic, since the lens is invisible on the eye.

Penalization for near, when the amblyopic eye becomes fixating for near, and the dominant eye for distance. In this case, against the background of mydriasis, complete correction of the dominant eye for distance and hypercorrection of the amblyopic eye is carried out;

Penalization for distance, when, against the background of mydriasis, hypercorrection of the dominant eye and complete correction of the amblyopic eye for distance are carried out.

There are other methods of penalization. This type of treatment for amblyopia and strabismus leads to the connection of the amblyopic eye to active visual work in conditions where the dominant eye also takes part in the act of vision, which reduces the likelihood of a decrease in visual acuity, which is sometimes observed with occlusion.

However, the use of glasses for penalization is not always effective, since this deteriorates the vision of the dominant eye, and therefore children often look over the glasses or take them off. Contact lenses have advantages over glasses - they cannot be easily removed, and in some cases they can be used to perform penalization without mydriasis.

Thus, in many cases of binocular vision disorders and amblyopia, the use of contact lenses allows one to obtain good results (Kivaev A.A. et al., 1998).