Among all other deviations in terms of vision, refractive amblyopia (RA) is a common phenomenon. With this disease, objects and the whole environment are perceived by only one eye, the other is completely inoperative. At the same time, it is often children who are at risk, although the disease can also be in adults. Of the total number of ophthalmic diseases, amblyopia accounts for 2% (patients of any age).
In some cases, both eyes are affected immediately, and no deviations in terms of the anatomical structure of the eyeball are observed. And since this is more likely a childhood disease, then each parent needs to know its features and varieties.
General Amblyopia Information
The retina of the human eye is designed in such a way that it is able to fulfill its function only in case of irritation by the light flux. In this case, the main responsibility lies with its central part. It is in this place that rays are focused when refraction is within normal limits. From here, nerve impulses come into 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 blurry and blurry. In this case, the brain in order to compensate for fuzzy or distorted information reduces the flow of impulses due to inhibition processes. For this reason, the functionality of the visual department of the nervous system decreases - the severity decreases.
Neither with glasses nor with lenses is it possible to make corrections. It is important here to timely detect the pathology and begin to take appropriate measures. Otherwise, the nerve fibers that are responsible for signaling begin to lose functionality over time and may eventually stop working. Vision will begin to deteriorate even more, which ultimately threatens the development of serious complications.
Provocative factors
As for the reasons for the development of this pathology in adults or children, a rather versatile nature can be noted here. In this case, the disease may have a primary form or be of a secondary nature. But it is the initial stage of refractive amblyopia that often develops without reason. In reality, there are, of course, reasons, but it is still not possible to clearly identify them. This already significantly complicates the course of therapy.
The secondary form of the disease usually occurs against a background of a number of visual system disorders. The main provoking factors in this case include:
- Heredity.
- The presence of strabismus.
- Myopia or farsightedness.
- Decreased accommodation of the ocular apparatus due to a decrease in contractility of muscle tissue.
- Eye surgery.
- Visual injury.
- Early birth (up to 28 weeks).
- Constant eye strain (with long work at the computer).
- Prolonged stress.
With the timely detection of any pathologies of the visual system and the course of treatment, subsequently, the development of refractive disease can be avoided.
Disease severity
As we now know, the refractive form of the disease can be primary and secondary. The danger of the initial “phase” lies in the fact 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 incorrectly selected 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 - 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 is very high (≤0.05).
As a rule, the severity of amblyopia is proportional to the manifestation of another disease (if any). And as you can understand, the higher the stage of visual pathology, the lower the visual ability of the visual organ.
Symptomatology
Since, at the very beginning of the article, it was said that amblyopia of this species is a childhood disease, it is important for parents to know how it can manifest in their child. Often this can happen at an early age, when the baby is not yet able to complain about a decrease in visual acuity. In this case, the main symptom that should alert is the incorrect fixation of the eye. This can be seen when a child, looking at some object, as if looking through it.
Other signs of refractive amblyopia of the 1st degree can already be detected by an ophthalmologist:
- visual acuity is markedly reduced;
- the presence of monocular cataract;
- binocular vision is impaired.
Adults will be able to suspect visual pathology, based on the following symptoms. They may notice a decrease in eye sensitivity, while it is already impossible to distinguish between shades and brightness of the color gamut. It’s impossible to focus on a colored object. A person begins to see poorly near either far or in both directions. In addition, the eyes quickly tire, migraine appears.
But in addition to this, in patients with amblyopia you can also find visual signs of a refractive form: strabismus, drooping eyelids, nystagmus (eye movement is not controlled).
Diagnostics
Mild to moderate visual pathology is still being treated, but as for the other stages, therapy usually does not bring the desired results. Even in the maternity hospital, newborns are examined for the presence of pathology of the visual system. Thus, this examination allows you to timely identify any signs indicating refractive amblyopia of the 1st degree or any other severity.
If the parents suspect signs of a refractive illness in the child, it will not be amiss to visit a pediatric ophthalmologist for diagnosis. This procedure includes a whole range of activities.
First you need to examine the fundus. In this case, the doctor assesses the condition of the eyelids, the reaction of the pupil to the light flux, and also the location of the eyeball. To compile the overall clinical picture, the following activities are necessary:
- Checking visual acuity with and without glasses.
- Testing using a different shade.
- Carrying out a refractive test.
- Examination of the field of view of the patient.
For adult patients, the following procedures are performed:
- Biomicroscopy
- Goldman lens examination.
- The state of the lens and vitreous is assessed.
- Ultrasound examination (ultrasound).
With refractive amblyopia of moderate severity or more, a comprehensive examination is mandatory.
But in some cases, if necessary, doctors can prescribe a number of additional procedures such as tonometry or electroretinography.
Features of the treatment of visual pathology
The refractive pathology of the visual apparatus, if it appeared, does not go away by itself. And the sooner it is revealed, 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. At the same time, a comprehensive and purely individual approach to each patient is required.
Only after eliminating the cause can we talk about the full treatment of the disease. For children and adults, general treatment regimens are usually used:
- Drug treatment.
- Corrective therapy through optics.
- Pleoptic correction.
- Surgical intervention.
Here it is worthwhile to understand that the course of treatment will benefit only in case of timely access to medical care. In children, the initial or moderate degree of refractive amblyopia is completely cured. In adults, everything is a little different - the task of therapy is to maintain vision at a certain level, not allowing it to decline.
Corrective therapy through optics
As a rule, doctors prescribe wearing glasses or lenses, based on the severity of the disease. It is only worth considering that the effectiveness of this therapy is high if the cause of the development of amblyopia is hyperopia, astigmatism or myopia.
Optical instruments are selected for the patient depending on the diopter. At the same time, they must be worn constantly. Thanks to optics, a clear image is created, due to which stimulation of visual functions occurs.
The technique usually takes effect 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.
Drug treatment
When a diagnosis is made - mild refractive amblyopia in children under 4 years of age, the doctor may prescribe the use of a number of drugs. For this, a drug containing atropine is buried in a healthy visual organ. As a result, his visual acuity is reduced, which allows to stimulate the functionality of the affected eye.
In addition, irrigation therapy is used. In this case, a combination of different drugs is introduced into the eye through a special catheter. In this case, the doctor selects the composition of the complex again individually for each patient. The procedure itself is performed under the influence of anesthesia for children. As for adult patients, local anesthesia is used.
Also, the doctor may recommend taking medications containing lutein.
Pleoptic correction
What is refractive amblyopia 03-04, we have now found out (corresponds to an average degree). But what other ways can you fix this? The answer right in front of your eyes is pleoptic therapy. In fact, the treatment of eye disease using this technique is almost the same as when using medications. That is, the visual acuity of a healthy 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 healthy 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, as in children older than 6 years the situation can only worsen.
An active or perceptual technique for the treatment of refractive amblyopia (1 degree or more) is reduced to the implementation of special exercise programs:
- Rotation of eyeballs in a circle - to start in one direction, then in the other.
- Transfer of both eyes to the bridge of the nose.
- Look into the distance, and then sharply move your eyes to the lower left corner.
These exercises should be performed before tears appear. But in addition to a range of recreational activities, special computer programs are used.
Therapy in this case is carried out in medical institutions. The point here is simple - for example, among numerous items you need to find one, endowed with certain qualities, which distinguishes it from the rest. The choice is made using a computer mouse.
Surgical intervention
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 proper refraction.
To correct high-grade refractive amblyopia caused by strabismus, a procedure is performed to change the position of the muscle structure. This operation is performed under the influence of local anesthetics.
In any case, the patient is discharged after a short hospital stay (1-2 hours). The recovery period after laser exposure is up to 3 hours. After the procedure for correcting strabismus, it takes a little longer - up to a week.
Home treatment
In order to successfully combat amblyopia in children, in addition to the wellness activities carried out in specialized institutions, it is necessary to resort to home therapy. Classes according to the Goncharova-Kuppers method are considered no less effective than professional medical care.
A matte light bulb of 60 watts is screwed onto the 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 healthy organ should be covered with a bandage during the exercise or covered with a hand.
Therapy of refractive amblyopia in children at home is carried out as follows. The child sits 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 bright object (a white sheet of paper suspended on the wall) and hold it until the silhouette from the black circle is clearly distinguished.
If the stain disappears, the child needs to repeat everything. That is, look again at the black circle, and after 30 seconds, turn your eyes to a bright object. The procedure should be performed three times during the day in one session, no longer required. The duration of all 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 cap of black paper is put on top, in which a circle with a diameter of 30-50 mm is cut in the center. The hole is closed with a piece of red glass or a film.
The patient also takes a sitting position at a distance of 40 cm from the light source. Look at the closed hole should be delayed for 180 seconds. Here you need an assistant who, during these three minutes, must turn the lamp on and off with an interval of 2 seconds. The procedure must be performed daily for 3 months.
In conclusion
Refractive amblyopia is a serious ophthalmic problem. If you do not take any measures at the slightest suspicion of the presence of such a pathology, subsequently such negligence may threaten partial or complete loss of vision. It is unlikely that anyone will be able to please such a not promising prospect.
For this reason, the sooner the correct diagnosis is made, the better the prognosis for a successful outcome of the therapy. Just do not forget that 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.