Amblyopia - Causes, symptoms and treatment. MF.

Amblyopia - reduction in visual acuity of one or both eyes, which can not be corrected optically, occurs for no apparent reason( primary) or due to a lack of normal conditions for retinal function( secondary).

Causes of amblyopia

Cortical inhibition underlies the development of pathology, which "turns off" the visually impaired eye from the visual process, preventing the development of diplopia( doubling).

Primary amblyopia occurs when the development of the eyeball during the intrauterine period is disturbed.
Causes of secondary amblyopia development depending on the form:

- obscuring( due to long-term opacities of the optical media of the eye, more often the lens).
- postobscuration( amblyopia, which persists after elimination of the cause that caused the obscuration).For example, after replacing the lens with the intraocular lens, the visual acuity does not improve
- the stenosis( appearing in the mowing eye).In these cases, the cortex suppresses the image from one eye so that there is no diplopia, and eventually the neurons do not conduct a nerve impulse to the brain.

- refractive( at different degrees of refraction in the two eyes, when there is a big difference between them, and inadequate correction of ametropia).
- achromatic( associated with underdevelopment of cones, so there is a color blindness).Only two-sided.
- combined.

Symptoms of amblyopia

Refractive amblyopia has an asymptomatic course. It is revealed during examination( medical examination) more often in children 3-7 years. It occurs with hypermetropic anisometropia, astigmatism, high myopia. With myopic anisometropia is less common, becauseThe worst eye is used to view near. Amblyopia develops the next refraction: hyperopic difference of both eyes than 0.5 diopter, astigmatic diopter-over 1.5 in any meridian, more than 2.0 diopters myopic.

amenotropic amblyopia develops in the absence of different refraction in both eyes, but the high degrees of myopia( over 8 diopters bilaterally), hyperopia( greater than 5 diopters on both sides) and astigmatism( more than 2.5 dpt in any meridian).It is found mainly in children under 7 years of age, rarely accompanied by strabismus.

of obscure amblyopia occurs in the absence of the normal functioning of the retina of factors, for example, ptosis, corneal opacity, cataract, vitreous hemorrhage.

The parasitic develops in the presence of strabismus. There are several options. A healthy eye fixes the image in the central fossa region, and mowing either in the same way or not centrally, sometimes or permanently, or generally with no fixation.

degrees of amblyopia depending on visual acuity:

- low( 0,4-0,8)
- average( 0,2-0,3)
- high( 0,1-0,05)
- very high( more than 0,04)

The manifestations of amblyopia are different, possibly asymptomatic. Reduced visual acuity( there is no improvement in correction), color perception and dark adaptation are violated, strabismus arises( convergent, divergent, etc.).May be organic causes, such as ptosis( full or partial omission of the century), cataract( cataract), corneal dystrophy, hemophthalmus( vitreous hemorrhage).

Diagnosis of amblyopia

The following research methods are needed for diagnosis:

- visual acuity determination with correction and without. Children who do not know letters, use tables with pictures( eg, eagles table)
- perimetry, if possible
- definition of color perception using polychromatic tables Rabkin

Polihromoticheskie table

Rabkin - dark adaptation is determined to Adaptometry
- tonometry
- Biomicroscopy
- Determination of the angle of strabismus by the method of Hirschberg - normally the reflex from the ophthalmoscope is located in the center of the pupil. With strabismus asymmetric
- definition of the type and angle of strabismus on synoptophora

Synoptophore

- refractometry with full cycloplegia( preferably atropinization within 3-4 days)
- skiascopia - refraction determination by characteristic movement of the shadow in the pupil area
- transfusion study to determine the transparency of eye environments
- eye day examination with the Goldman lens
-Electroretinography for the determination of the functional state of the retina
- the critical frequency of confluence of flashes - examine the states of neurons. The indicator is the minimum number of flashes of light, which is perceived as a single whole
- eye ultrasound - examine the state of the eye's media with opacity and the length of the anterior-posterior segment of the eye( important for refractive errors)
- computed tomography, magnetic resonance therapy, neurologist consultationto exclude the pathology of the nervous system

Treatment of amblyopia

Treatment is impossible without an ophthalmologist, and untimely treatment of amblyopia leads to persistent loss of visual functions.

First, the optimal correction for is selected, in older children contact or night lenses can be used, laser correction, especially with anisometropia( different refraction of both eyes).Eliminate the cause of acclimation amblyopia( eyelid plasty in ptosis, photorefractive surgery with corneal opacities, phacoemulsification and IOL implantation in cataract, resorption therapy or vitrectomy with hemophthalmia).

For abbysmatic amblyopia, is used for passive and active pleoptics of .

Pleoptika

Passive is realized by occlusion of the leading eye( visual acuity is increased in the mowing), and then variable occlusion for the transition of strabismus to alternating( with the image on the central fossa from one eye to the other).After that, the methods of active pleoptics are used. With adequate correction, close the lead and stimulate the retina of the mowing eye( light, laser, electrical impulses and special computer programs).Pleoptic treatment is carried out 3-4 times a year to achieve the desired effect.

Hardware treatment is the primary treatment for amblyopia. For example, training on Amblycore, while depending on the activity of the cerebral cortex, recorded with electroencephalography, the characteristics of the image on the computer change.

Amblykor

Also used ASO stimulation of ( through color light pulses), KEM, PS-1, Mosaic PS-2, Panorama, etc.

In children who do not suffer occlusion, the method is used with atropine .A wide pupil sharply reduces visual acuity, thereby causing the amblyopic eye to "work."Atropine is digested 1-2 times a week and it is ensured that mydriasis is permanent.

Widely used methods of physiotherapy - vibromassage, reflexotherapy.

Treatment is completed after achieving approximately the same visual acuity of both eyes. If there is strabismus, then it is removed surgically.

The forecast of amblyopia in adults is unfavorable, children need adequate treatment with full correction.

Doctor ophthalmologist flying T.Z.