Diagnosis of vision in children in the clinic "Excimer. Comprehensive ophthalmological examination of children and adolescents

Very often, children's strabismus is a consequence of poor vision and is accompanied by neurological pathology.

Approximately 50% of children remain farsighted, the rest become either nearsighted or retain normal vision. With farsightedness up to 3.0 diopters, due to the constant tension of the refractive media of the eye, in most patients, far-sightedness remains good, but near is satisfactory, therefore such farsightedness is called latent and many children do not use glasses, but experience discomfort when seeing far and near, periodic lacrimation, headache, the so-called asthenopic complaints. To reveal the power of latent farsightedness, modern pediatric ophthalmology uses cycloplegia of the eye to determine the required refraction.

• In the presence of asthenopic complaints, children should be examined for latent farsightedness.
• If it is detected, the doctor prescribes glasses and prescribes accommodation training on devices.
• Farsightedness, like myopia in childhood, is corrected with glasses or contact lenses.
• In the future, with age, the degree of hypermetropia in humans usually does not change.

Correction of children's ametropia

Farsightedness remains in a child if, for any reason, there is a delay in the growth of the eyeballs (excluding hereditary predisposition). Two reasons are distinguished: this is the presence of a very flat cornea, which has a significantly reduced refractive power. The second reason is the absence of the lens in the eye, as the most important part of the refractive optical system of the eye. Perhaps the congenital absence of the lens, as well as its removal, for example, after a severe injury. In our ophthalmological clinic, such children (regardless of age) undergo lens implantation operations. These operations help to preserve the eye as an organ of vision, prevent the development of amblyopia and contribute to the preservation or development of binocular functions.

Myopia correction, in our opinion, must be prescribed (the sooner the better) for children who have a threat of binocular vision impairment. The total number of myopic people on the planet is approaching one billion people. Children are especially susceptible to this disease. The problem of myopia is recognized as one of the main problems in modern ophthalmology.

Until recently, measures to combat myopia were mainly reduced to improving the social and hygienic conditions of visual work and improving the health of children. In myopia, to prevent its progression, it is necessary to prescribe glasses that would allow visual work to be performed near with significantly reduced accommodative-convergence loads.

If a child is assigned the maximum distance correction, then when working near, such glasses cause the work of accommodation, which leads to further progression of myopia. In our clinic, in order to prevent the progression of myopia in children, we widely use individually tailored training regimens for the treatment of myopia and its progression.

The so-called sphero-prismatic BSPO glasses are widely used in pediatric ophthalmology - the upper zone is designed for distance vision, and the lower, sphero-prismatic, reduces the load when working near, i.e. there will be no conditions for the progression of myopia. The proportion between accommodation and convergence is preserved - the basis of normal binocular vision.

Our clinic uses special tests that allow timely identification of children of the "risk group" for myopia - it is they who, first of all, need to be prescribed unloading optics to prevent the progression of myopia.

Astigmatism, as a rule, is a congenital condition of the optics of the eye, associated with the lack of sphericity of the cornea and (or) the lens during intrauterine formation of the eyeball. In addition to the congenital features of the eyeball, the causes of astigmatism can be: eye injuries, surgical interventions on the eyeball, corneal diseases. Due to this, light rays at different points of the curved cornea or lens will be refracted differently, with different strengths and form a fuzzy image on the retina. To correct astigmatism, special cylindrical glasses and contact lenses are used. Surgical methods of vision correction, including those with astigmatism, can be recommended mainly after reaching the age of 18. However, with anisometropia, amblyopia, the issue of vision can be resolved earlier.

Amblyopia is low visual acuity with a normal anatomical condition of the eye, most often one eye. The cause may be strabismus, ignoring the wearing of glasses with low visual acuity (poor correction of astigmatism), clouding of the optical eye media (leukoma, cataract), corneal clouding, keratoconus, ptosis, etc. If the optics of the eye is not disturbed in a child, then a good, clear image of the surrounding objects falls on the retina, and gradually the vision begins to perceive small details of the world around. If for some reason the image does not reach the retina, due to poor optics (myopia, hyperopia, astigmatism, etc.) or due to poor illumination of the place where a small child is permanently located, the visual analyzer remains underdeveloped, and subsequently it is able to distinguish objects only at the level of clarity that was available to him from the very beginning. Amblyopia can develop at any age, even in the elderly.

It should be noted that when the visual acuity of one eye is lower than 20%, which is often found in amblyopia, binocular vision is impaired, which is the ability of both eyes to combine the individual images they see into a single perceived picture. Binocular vision, accordingly, serves as a very important mechanism in the process of human adaptation to the environment, as it is a three-dimensional reflection of reality. It defines the depth, its volume. Monocular vision, that is, vision with one eye in the absence of the second or with a significant decrease in its vision, displays the world around only in two planes. It is very important that in the event of a violation of binocular vision, the ability to correctly assess the distance to the object is lost, the sense of distance disappears.

Correction of children's strabismus

It is very important in a person's life to have binocular vision, and it is formed in early childhood. Therefore, each child should be consulted by an ophthalmologist to identify and eliminate the possible causes of the appearance and development of a "lazy eye", for example, in the case of congenital cataracts. The earlier treatment for amblyopia is started, the higher the child's vision may eventually be. If the child is started and the treatment of amblyopia is not started on time, then he gets used to looking with one eye and this state of visual functions is determined only in school years at annual medical examinations at school. Sometimes, even with a diagnosis of abliopia, parents are in no hurry to start treatment or take it lightly, and therefore the time so important to start treatment is missed.

It is best to correct amblyopia before the age of 5-7 years; after the completion of the formation of the visual analyzer, i.e. after 10-12 years, it is difficult to correct the visual defect. Very often these children develop strabismus. So if a child sees the same way with each eye, i.e. a clear image of objects falls on the retina, then the eyeballs will move simultaneously, and if the vision of one eye is reduced, i.e. the eye is amblyopic, then the muscles do not have a normal tone, they are innervated differently, the eyeballs work out of sync, strabismus is visually noted.

It should be especially noted that strabismus is not just a cosmetic defect, it can be considered as a disease of the child's nervous system, leading to severe visual impairment. Basically, there are two main types of strabismus: concomitant and paralytic. There may be an alternating deviation of the eyes from the fixed object. Such strabismus is called alternating.

At the OkoMed clinic, doctors conduct a thorough examination of all patients and, if necessary, prescribe special medical glasses in combination with exercises on devices. The sooner treatment is started, the more likely it is to restore vision, eliminating the cause and preventing the development of a violation of binocular functions.

Asthenopia is a complex of phenomena associated with a feeling of inconvenience when reading and visual work near, headaches that cause fatigue, reduced performance, an increase in the number of errors, worsening mood.

As a rule, asthenopic phenomena occur due to a mismatch between the state of the ocular muscular apparatus and the tasks that it must perform in the process of visual function, or, more simply, weakness of the eye muscles.

Many children, as well as adults, especially with prolonged visual stress, quickly get tired, which usually happens in children with high refractions - high farsightedness, anisometropia (a large refractive difference of more than 2 diopters between the two eyes). Some older people have the same phenomena in distance vision - in this case, glasses can be effectively helped.

Such patients are recommended a course of special exercises on devices that prevent the decrease in binocular functions, the development of amblyopia, and the correction of diplopia. If necessary, the selection of special spectacle correction, including prismatic. This complex of treatment can be temporary - as a result of exercises, massage, sphero-prismatic glasses, it can be reduced or gradually canceled.

Concomitant strabismus - in the world at least 2.5% of children suffer from this disease. There are the following types of concomitant strabismus: monolateral (always mows only one eye), alternating (mow alternately one or the other eye). Concomitant strabismus is not only an external unpleasant defect. At the same time, such a person does not have normal binocular and stereoscopic vision, does not perceive the three-dimensional arrangement of objects, and cannot work in industries associated with moving parts. Many specialties are closed to him.

Currently, in the world practice, the most widely used surgical methods for correcting strabismus. However, as statistics show, the percentage of functional success in this case is low - very few patients receive normal binocular vision. In the vast majority, there is only a slight decrease in the angle of strabismus, or only a temporary effect. It should be said that the operated eye muscles sharply lose their efficiency. Therefore, in postoperative patients, the percentage of functional success in the treatment with our method is much lower.

In our clinic, we use a treatment regimen for patients with binocular vision impairment, selected individually for each patient. After a thorough examination of the patient - eye refraction, all biometric parameters, examination of the fundus and checking the functionality of the eyes - the doctor prescribes a treatment that boils down to:

• To the selection and recommendations of wearing spectacle correction, sometimes sphero-prismatic, the selection of near-contact correction (treatment is aimed at increasing visual acuity and reducing double vision);
• Appointment of special home workouts;
• Course pleoptoorthoptic treatment according to an individual scheme.

One of the important features of the organ of vision is the ability to clearly see objects located at different distances from the eye - accommodation. The main means of accommodation of the eye is the lens, its ability to become convex or flat under various loads on the eyes. The ciliary muscles of the eyes take an active part in this process. The farther the object under consideration is located from the eye, the more the lens must flatten, the closer the object, the more convex the lens must be in order for the image to be clear. This is the mechanism of accommodation.

Under unfavorable conditions, the ciliary muscles spasm, i.e. continue to remain in an abbreviated form when the eye has already ceased to fix a closely located object. As a result, distance vision is impaired. This condition is called accommodation spasm or may have another name - just like with myopia, the refractive power of the eye increases significantly. As a rule, spasm is characteristic of adolescent children and young people. The revealed spasm of accommodation necessarily requires prompt treatment, since untreated spasm leads to the appearance and growth of true true myopia.

Children's ophthalmology in the clinic "OkoMed"

The clinic "OkoMed" provides a complete diagnosis and subsequent therapeutic or surgical treatment of identified diseases. An individual treatment program is drawn up for each child. Ophthalmologists work here, who have extensive practical experience working with children, understand the psychology of a child's personality, which makes the treatment most effective and comfortable.

As a result of a course of treatment (10-15 sessions), visual acuity increases by 15-20% in 85% of cases, the accommodation margin increases by 3-4 diopters. In children who work a lot with a computer, visual performance increases, complaints of visual discomfort and decreased vision disappear.

We carry out the correction of ametropias - there is a large selection of frames for both the smallest patients and adolescents. The clinic has a contact correction room, a large selection of soft contact lenses, in case of astigmatism, in addition to spectacle correction, we use toric contact lenses.

In case of progressive myopia, strabismus, congenital cataract, surgical treatment is performed in the clinic. The clinic provides assistance to patients who apply for an emergency condition that does not require hospitalization.

After a thorough examination of the child, parents receive answers to all their questions about the state of his eyes and recommendations for the future. In childhood, it is much easier to cope with various diseases of the visual system, or you can simply prevent them from developing.

The clinic successfully treats diseases:

• congenital and acquired myopia (nearsightedness);
• hypermetropia (farsightedness);
• spasm of accommodation;
• astigmatism;
• amblyopia;
• cataracts;
• glaucoma;
• various types of strabismus;
• pathologies of the optic nerve and retina.

In our clinic, optimal conditions have been created not only for examination, but also for the rest of children.

Prices for pediatric ophthalmology services

Hardware treatment for children with impaired binocular vision and retinal pathologies - 10 sessions from 15,000 rubles.
It is carried out only for patients treated at the OkoMed ophthalmological clinic, after the appointment of the attending physician.

Regular visits to the ophthalmologist are just as important as regular visits to the pediatrician. Unfortunately, a cursory examination of an ophthalmologist in a clinic, kindergarten or school is not always able to give a complete picture of the health of children's eyes. You are lucky if you do not have vision problems. But this does not guarantee that your child's vision will be one hundred percent. And vice versa, myopia one of the parents may not affect the condition of the child's eyes. But it is better to get rid of doubts and go with all questions to specialists.

IOL-master measures the length of the eyeball. This parameter allows you to clarify the causes of many refractive errors. After all, with myopia, the eyes are often elongated, and with farsightedness - on the contrary, "short".

Also, a modern device of a new generation "IOL-master" makes it possible to simultaneously measure the length of the eye, the curvature of the cornea, the depth of the anterior chamber. In the clinic of pediatric ophthalmology, the IOL-master device is indispensable during the examination of small patients with myopia.

"IOL-master" provides "sparing" diagnostics, which will not cause discomfort to the child. A feature of the IOL-master device is that absolutely precise fixation is not required from children. This is a stress-free technique with minimal light exposure. Particular attention is paid to the verification of binocular functions. This is not only about such a visual impairment as strabismus, but also about binocularity (that is, the ability to create “one picture” from those that each eye sees separately). There are also more subtle parameters, such as depth of field. "Incorrect" work of the visual system reduces the quality of vision. In case of violation of fine binocular functions, it is urgent to carry out their restoration.

Modern examination necessarily involves examination with a dilated pupil. New generation drugs are used to dilate the pupil. Unlike atropine, they are harmless and easily tolerated. Even if a more in-depth diagnosis with a dilated pupil is needed, a 3-day examination will be enough for the doctors of the children's department of the Excimer clinic.

In the children's department of the Excimer clinic, diagnosis is the first and very important stage of treatment. Specialists of the children's department of the Excimer Clinic have the opportunity to detect eye disease at the earliest stage and start its treatment when it has not yet had a significant impact on the function of the eye. It is impossible to determine the disease, its cause, prescribe the necessary method of treatment without a thorough diagnosis.

Cost of basic services