Purpose. To develop a new method of amblyopia treatment in children with unstable central and eccentric fixation by centralizing visual fixation and increasing retinal photosensitivity in the macular region using biofeedback. Material and methods. The study included 27 patients (27 eyes) with amblyopia of various origins, aged 5 to 17 (averagely 9.15 ± 3.19 years), who were able to perform training sessions on the MP-3 Nidek microperimeter (Japan). In addition to standard examination, all patients underwent binocular status assessment using a four-point test, macular electroretinography, microperimetry, optical coherence tomography (OCT). The treatment, carried out on the microperimeter using visual (flickering checkerboard pattern) and sound signal biofeedback, consisted of 10—15 sessions, 10—12 minutes each. All patients were examined before treatment cycle, immediately upon the end of the cycle, and also 1 and 3 months after it. Results. Preliminary results showed an increase in best corrected visual acuity (BCVA) from 0.41 ± 0.24 to 0.68 ± 0.27 (33.9 %), the photosensitivity of the retina in the fovea increased from 27.07 ± 3.90 to 29.8 ± 3.3 dB (10 %), fixation density in the central region from 59.80 ± 31.08 to 72.05 ± 34.5 %(20.4 %) with its amplitude decreased by more than two times. After treatment, unstable central fixation changed to stable central fixation in all cases. With eccentric fixation, the fixation point shifted closer to the central region, and fixation characteristics improved in 75 % of cases. The obtained results retained throughout the observation period which lasted up to 3 months. Conclusion. The proposed new treatment method of amblyopia with impaired fixation of various degrees proved to be effective and safe and can be recommended for use in pediatric patients.
Aim: To conduct a correlation analysis of the parameters of visual fixation, light sensitivity of the retina in the central region, and the thickness of the central region of the retina and choroid with the best corrected visual acuity (BCVA), refraction (SER), and axial length of the eye (AL) in nystagmus and amblyopia of various origins. Material and methods: The study included 45 patients aged 544 years (mean 11.26.14 years). All patients were divided into six groups depending on the type of amblyopia and associated conditions (with nystagmus). The retinal photosensitivity and fixation parameters were studied using an MP-3 Nidek microperimeter (Japan). Chorioretinal parameters were studied using an RS-3000 Advance 2 spectral optical coherence tomograph (Nidek, Japan). The axial length of the eye was measured using a Galilei G6 Scheimpflug analyzer. Correlation analysis was performed using the linear Pearson correlation coefficient (r). Results: In nystagmus, refractive and dysbinocular amblyopia, a strong direct correlation was found between the indicators of BCVA and the characteristics of fixation. In the groups associated with congenital myopia, relationships were found between BCVA, retinal thickness, and light sensitivity of the retina in the central region. There was no relationship between the subfoveal choroidal thickness and functional parameters of the eyes. Conclusions: In nystagmus and amblyopia associated with strabismus and hyperopic refraction, the primary amblyogenic factor is a decrease in the density and amplitude of fixation. In relative amblyopia due to congenital myopia, the decrease in visual acuity correlates with the photosensitivity of the retina and does not correlate with fixation parameters, which indicates the partially organic nature of relative amblyopia. No relationship was found between the choroidae thikness and the degree of amblyopia, which does not cofine its participation in the pathogenesis of the disease.
Child health is a global health priority. Anomalies of refraction, complicated by amblyopia and squint, occupy one of the leading places in the pathology of the visual system of children. According to data obtained from 26 regions of Russia, the leading place in the ocular morbidity of children and adolescents is occupied by ametropia and strabismus with amblyopia. They account for up to 90 % of all cases of visual impairment in childhood. The term amblyopia is understood to mean a decrease in the maximum corrected visual acuity that occurred at an early age, which is caused by disorders of the functions of the visual analyzer, without changes in the fundus and organic lesions of the visual pathways and centers. Despite the outstanding achievements of 21st century medicine, today the questions of the pathophysiological essence of this condition remain open, which is the subject of discussions among pediatric ophthalmologists around the world. In this regard, the literature review presents the results of domestic and foreign authors who studied the morphological (optical coherence tomography) and functional (electroretinography, microperimetry) features of the retina in dysbinocular and anisometropic amblyopia. Some authors have demonstrated the presence of differences in the thickness of the central region and the layer of nerve fibers in patients with amblyopia compared with paired and healthy eyes, their correlation with functional parameters, as well as changes in the thickness of the choroid and microvasculature of the retina. Recently, there have been works devoted to the study of the photosensitivity of the retina in patients with amblyopia and visual rehabilitation using this equipment. A number of authors have shown that with amblyopia, the retinal photosensitivity parameters in the central region are reduced, and there is a correlation between these changes and morphological changes in the posterior pole. The microperimeter also makes it possible to carry out visual rehabilitation, in particular in pediatric patients, and isolated results have been published on the use of this method in patients with amblyopia. The literature data are quite contradictory, and more research remains to be done to determine whether these changes in the retina are primary in relation to this disease, or whether they can be the result of retrograde changes that are obscured by defocusing of visual images from birth.
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