Keratoconus in Children. Мodern Treatment Options

Objective: to evaluate the results of corneal collagen crosslinking in children with keratoconus.Patients and methods. Since 2017, 125 children aged 4 to 17 years have been under observation, who have applied to the Eye Microsurgery named after Academician S.N. Fedorov with complaints of reduced visual acuity and, in some cases, the inability to select optical correction. All patients were examined, including using high-tech methods (Sheimpflug camera, OCT). Based on the anamnesis and the data obtained, the diagnosis of keratoconus stage I–III was made. Corneal collagen crosslinking was performed in 30 patients with stage II–III.Results. The study included 30 eyes of 30 patients (21 (68 %) boys, 9 (32 %) girls) with a median age — 16 (15; 17) years (12 to 17 years), who underwent accelerated “epi-off” crosslinking. No intra-and postoperative complications were observed. 12 months after CXL, there was a slowdown in the progression of keratoconus in children (minimum corneal thickness before surgery 460.00 (445.00; 477.00), after surgery 457.00 (441.00; 477.00), p = 0.112; K1 before surgery 44.60 (43.20; 46.90), after surgery 44.60 (42.90; 46.50), p = 0.481; K2 before surgery 48.30 (47.30; 51.25), after surgery 48.20 (47.21; 49.20), p = 0.779; elevation of the posterior surface before surgery 25.00 (18.00; 42.00), after surgery 26.00 (21.00; 42.00), p = 0.074, and increased visual acuity (NCOZ from 0.30 (0.05; 0.40) to 0.30 (0.20; 0.40) (p = 0.039) and MCOZ from 0.60 (0.40; 0.80) to 0.60 (0.50; 1.00) (p = 0.010)).Conclusion. 1. Keratoconus is also found in the child population. 2. Timely cross-linking of corneal collagen can slow the progression of keratoconus in children

Regarding the Question of Postoperative Asthenopia

Relevance. It is well known that asthenopic complaints, such as increased visual fatigue when working at close range, lacrimation, eye pain and headache after corneal refractive operations in recent years are increasingly common at routine ophthalmological practice. They cause significant subjective discomfort in patients and reduce the satisfaction of the surgery. The pathogenesis of asthenopia is a violation of the coordinated work of the accommodation and binocular systems as a result of their overstrain with excessive visual loads.Purpose. To study the role of the lack of adequate optical correction before surgery in the development of asthenopia in patients with mild and moderate myopia after ReLEx SMILE surgery, as well as to evaluate the effectiveness of drug correction of this condition.Patients and methods. This study included 84 patients (128 eyes) who spend more than 8 hours at a computer due to their professional activity, without pathology of the visual organ that prevents keratorefractive operations, whose average age was 33.2 ± 1.9 years.Results and discussion. The ReLEx SMILE operations in all patients were carried out without complications with the achievement of uncorrected visual acuity equal to the preoperative values of the maximum corrected visual acuity in the period of 1 week and 1 month. In the group with a preoperative lack of adequate optical correction, signs of asthenopia were more often manifested than in patients using full eyeglass or contact correction before surgery. The appointment of the drug Mydrimax® allows to improve the subjective state of patients with asthenopia and leads to the normalization of functional parameters.Conclusion. Corneal refractive operations in patients with the lack of adequate correction of refractive disorders before surgery leads to a significantly significant increase in the initially impaired functional parameters compared to preoperative values, however, it does not reach normal values in most cases and is accompanied by a greater probability of developing postoperative asthenopia.

Possibilities of scleral lenses for visual rehabilitation of patients with corneal scars

Purpose. To analyze the efficacy and safety of SCL in patients with corneal cicatricial changes and other concomitant conditions. Material and мethods. The study included 19 patients (20 eyes) with cicatricial deformity of the cornea of various etiology, who were fitted with scleral contact lenses. Results and discussions. The use of SCL is possible in post-traumatic pathology, such as corneoscleral scars with or without aphakia, as well as after keratitis with an outcome in cicatricial deformity, cicatricial changes after a burn. A significant increase in visual acuity compared with spectacle correction has been proven. Depending on the topography of the scar, it is possible to select scleral lenses such as Oblate and Prolate, as well as with different versions of the support zone: both toric and quadratic. Conclusion. Scleral lenses can be successfully used for optical correction in patients with cicatricial changes in the cornea and other concomitant post-traumatic conditions of ineffectiveness of other methods of visual rehabilitation. Key words: cornea, lenses, vision correction, contact lenses, visual rehabilitation, scleral lenses, corneal scars, post-traumatic astigmatism, aphakia, keratitis, toric lenses, quadratic lenses, astigmatism, irregular cornea, regular cornea, regular astigmatism, irregular cornea, irregular astigmatism, prolate, oblate.

A novel strategy for degree design in amblyopia with anisometropia and ametropia

Objective To propose a novel strategy for degree design in amblyopia with anisometropia and ametropia. Methods 28 patients with refractive amblyopic eye visual acuity ranging from 20/666 to 20/29 (45 eyes) were provided with optical correction followed by the maximum plus to maximum visual acuity (MPMVA) and amblyopic training. After which, the patients were supposed to test acuity improvement at the 3-month, 6-month, and 12-month visit. Results At the initial 3-month visit and 6-month visit, visual acuity improvement from the spectacle-corrected baseline acuity averaged 1.5 ± 1.00 lines and 2.0 ± 1.10 lines respectively. Moreover, the data demonstrated that the age and baseline acuity both inversely related to the visual acuity improvement (P = 0.093, P < 0.001, at 3-month visit; P = 0.080, P < 0.001, at 6-month visit). And it showed there are no relationship between type of anisometropia and ametropia and acuity improvement at 3-month visit (P = 0.315), while they were relevant at 6-month visit (P = 0.025). Conclusion From another point of view, we proposed a new notion to reveal secret of amblyopia. The study directed by the principle based on the new notion showed that getting the degree to MPMVA and following by amblyopic training in amblyopia with anisometropia and ametropia can improve visual acuity effectively.

An Open Labelled Comparative Clinical Study to Evaluate the Effect of Go-Ghrita Tarpana and Triphala-Ghrita Tarpana on Antero-Posterior Diameter in Axial-Myopia

Background and Objective: Axial-myopia is characterized by blurriness of vision for distance caused by increased in A-P diameter. Usual treatment for myopia is optical correction by optical glass and contact lens. To restore distance vision, surgical intervention like, LASIK is adopted, which has complications like dry eye syndrome and astigmatism. The Ayurvedic approach of the disease mainly concentrates on treating the disease and preventing the progression of the disease. There are many hypothetical theories regarding mode of action of Tarpana on Myopia and Timira. In this study, an attempt is made to observe the effect of Tarpana on A-P diameter of eyeball and to know the difference between Tarpana by plain Go-Ghrita and Triphala Ghrita. Materials and Methods: 20 patients of Group A, were treated with Go-Ghrita Tarpana (two sittings of 7 days each, with the gap of 14 days) and in Group B, 20 patients were treated with Triphala-Ghrita Tarpana (two sittings of 7 days each, with the gap of 14 days). Results: The data of both the groups were collected according to the objective and subjective parameters and analyzed using the most appropriate statistical test (repeated measures of ANOVA, Bonferroni Test and Mann- Whitney U Test). The efficacy is statistically significant within the group at P <0.001and statistically insignificant between the groups at P >0.05 among all the parameters. Interpretation and Conclusion: On comparison of Go-Ghrita Tarpana with Triphala-Ghrita Tarpana, both have an equal effectiveness on distant vision, Optical correction and A-P diameter.

Epidemiology of Myopia in Children of the Russian Federation and Analysis of Its Control Methods

The increasing prevalence of myopia is observed all over the world, and Russia is no exception. In this regard, obtaining new data on its epidemiology among children and assessing methods of its control in real clinical practice are highly topical matters.Purpose. The purpose of this work was to assess the current issues of the epidemiology and treatment of progressive myopia in children in various regions of the Russian Federation.Materials and methods. We conducted a prospective multicenter epidemiological observational questionnaire study. This study involved 106 doctors from 53 regions of Russia and 2931 parents of myopic children.Results. 50% of the surveyed doctors noted that the manifestation of myopia is diagnosed in children aged 10–12 years, while 43% noted the same in children aged 7–9 years. According to 74.5% of doctors, the degree of the newly diagnosed myopia ranges from –1.25 to –3.00 diopters, 25.5% of doctors reported that it is below –1.0 diopters. The majority of doctors (73.6%) assess accommodation in myopic children, considering it one of the progression factors. 52.9% of ophthalmologists prescribe optical correction in cases when monocular distance visual acuity amounts to 0.6 (decimal scale) or lower values, while 29.2%, 16% and 1.9% of the surveyed ophthalmologists prescribe optical correction in cases when monocular distance visual acuity amounts to 0.7, 0.8 and 0.9 respectively.The following optical methods for juvenile myopia control are recommended by the doctors: orthokeratology contact lenses (53.8%), spectacles for full correction (51.9%), peripheral defocus-inducing (bifocal) soft contact lenses (18.9%), while 4.7% of the surveyed doctors utilized other methods of myopia control, which were not indicated in the questionnaire.Conclusion. In most cases, manifestation of myopia is diagnosed in children aged 7–12 years. Its degree ranges from –1.25 to –3.0 diopters, which indicates its late diagnosis; optical correction is prescribed mainly in cases when monocular distance visual acuity is 0.6 or lower; most ophthalmologists assess accommodation in myopic children, considering it a progression factor. As methods of myopia control, doctors utilize optical correction, device-assisted therapy and pharmacological treatment of accommodative disorders, while parents prefer methods that require minimum time expenditures.

Current Management of Amblyopia with New Technologies for Binocular Treatment

Amblyopia is the most common cause of monocular poor vision affecting up to 3.7% of the global population. Classically, the first step in treatment has been optical correction, followed by patching and/or pharmacological treatment. However, this is an evolving scenario, since researchers and clinicians are interested in new binocular treatments due to the increasing development of new technologies. In this article main, current binocular treatments as Dig Rush, falling blocks, I-BiT, Occlu-tab, Vivid Vision, and movies are reviewed for binocular amblyopia management.

Еffects of optical correction methods on accomodation in children with progressive myopia (literature review)

Accommodation disorders in young people are more common than diagnosed. This review is based on the data of domestic and foreign literature and studies the effect of contact lenses of various designs on accommodation. Particular attention has been given to bifocal soft contact lenses as one of the recognized interventions for treating juvenile progressive myopia and their ability to slow axial elongation. Key words: accommodation, myopia control, bifocal contact lenses, orthokeratology.

Comparison of contrast sensitivity in myopic patients using spectacle and contact lens correction

Aim: To compare the contrast sensitivity in different categories of myopia using two different optical correction spectacles and contact lens correction. Methods: This cross-sectional study in design was conducted from August 2018 to May 2019 at the Ophthalmology Department of Madinah Teaching Hospital Faisalabad.45 subjects corrected with spectacles lenses and contact lenses all had corrected visual acuity of 6/9 or better were studied.The extent of myopia determined the three groups. All individuals were subjected to spectacles and Contact lens correction using slitlamp for anterior eye examination and for the fundus examination. The assessment of visual acuity was carried out by the Snellen vision Chart at 6m distance and contrastssensitivity was tested by Pelli- Robson chart. Results: Results showed a significant relationship between contrast sensitivity and type of optical correction. There were significant results of the independent t-test for spectacle and contact lenses 0.00 (p<0.005). However, the mean contrast sensitivity was better for all the three groupswith contact lens correction as compared to spectacle lens correction.Contact lenses provide better contrast sensitivity than spectacle lenses. Conclusion: Comparison between contact lens and spectacle correction was done and better quality contact lenses reduce optical defocus and give better results of contrast sensitivity. Results also concluded that loss of contrast sensitivity will be interpreted as early loss of retinal functions in severe myopes. Keywords: Myopia, Contrast sensitivity, Spectacle lens, Contact lens

The Monocle

A monocle is a single lens contained within a decorated rim and held in place between the brow ridge and the cheekbone or suspended with one hand. They became very popular, starting in the eighteenth century as “quizzing glasses”. A monocle, being only a single lens, can at most correct the vision in one eye at a time. Yet virtually all monocle users require optical correction in both eyes. What good does it do to only correct one side and ignore the other? Wouldn’t this make one’s vision “unequal”? And why was this device so popular with the wealthy and powerful?