J.ophthalmol.(Ukraine).2019;3:57-58.

 

Received: 28 January 2019; Published: 27 June 2019

http://doi.org/10.31288/oftalmolzh201935758


Refractive correction with spectacles and ametropia

L.A. Brutskaya, Cand Sc (Med)

Filatov Institute of Eye Diseases and Tissue Therapy, NAMS of Ukraine; Odessa (Ukraine)

E-mail: bruskayal@gmail.com

Keywords: refractive correction with spectacles, ametropia


Refractive errors are the leading cause of visual impairment in children, and the proportion of the cases of visual impairment and blindness due to these errors is as high as 22.4% to 98.4% [1, 2]. 

Visual functions develop in parallel with the maturation of the mechanisms that control accommodation, binocular vision and ocular motility [3-7]. Since central vision is influenced also by refractive errors [8-9], the latter should be corrected rationally and at the right time [10-12].

Maintaining high visual acuity in the amblyopic eye and ensuring the development of binocular vision is a challenge for the ophthalmologist [13-15].

The purpose of this report is to identify the role of refractive correction with spectacles in the treatment of refractive errors.

Asthenopia and refractive amblyopia are the most important signs of visual system deconditioning. Refractive amblyopia is most commonly seen in eyes with hypermetropic refraction [16, 17].

In spite of advances of contact lens and surgical correction of refractive errors, the use of these modalities in children is limited, and treating these errors with spectacles remains the most popular method of correction. As multiple factors should be considered in selection of optimal correction for a particular child with ametropia, it is a difficult task for the doctor. Foreign ophthalmologists prefer correcting even slightest non-zero refractive errors [17].

Astigmatism of at least 1D affects visual comfort. Spectacle prescription for an amblyopic child should be determined only based on the objective measurement of the refractive error under cycloplegia, with the latter required for improvement in the excessive ciliary muscle tone. In children presenting for refractive errors, it is reasonable to administer atropine twice daily for three days from the day of presentation. A hypermetropic child aged two to four should be prescribed spectacles for constant wear with age norms for visual acuity taken into account. Prescribe a spherical lens power that is 1 D less than the amount of hypermetropia determined by cycloplegic objective measurement.

Cyclomed 1% is a popular cycloplegic option and can be used in children with refractive errors both at presentation and follow-up.  It is well tolerated by children and adolescents and exerts no allergic or toxic effects on the cardiovascular system. 

Traditionally, the main criteria for selecting the refractive correction with spectacles have been the amount of ametropia, ocular function (i.e., visual acuity, position of the eyes, type of binocular vision, and the effect of correction on these characteristics), patient’s age, presence or absence of asthenopia, correction tolerance, etc. [18-21]. As refraction changes with child’s age and with axial growth, the approach to this selection should be individualized [1, 22-23].

In conclusion, it should be noted that adequate correction for ametropia is required for effective rehabilitation measures and prevention of disabilities in children with amblyopia.

 

References

1.Alifanova TA. [Blind and visually impaired children of school age in the Ukrainian SSR: the ways for advancing their rehabilitation]. [Abstract of Cand Sc (Med) Thesis]. Odessa: Filatov Institute of Eye Disease and Tissue Therapy; 1991. 16 p. Russian.

2.Libman ES, Shakhova EV. [Blindness and disability due to pathology of the organ of vision in Russia]. Vestn Oftalmol. 2006 Jan-Feb;122(1):35-7. Russian.

3.Bobrova NF, Vit VV. [Atlas of congenital and inherited diseases of the eye]. Odessa: Palmira; 2006:68-9. Russian.

4.Boichuk IM, Mukhina AIu. [Stereovision in children with congenital myopia and those with myopic amblyopia]. In: [Proceedings of the Filatov Memorial Lectures 2017, Ophthalmology Conference with International Speakers].  2017 May 25-26; Odessa, Ukraine. p. 207. Russian.

5.Boichuk IM, Bushuieva NN, Soloviova KN. [Outcomes of treating children with disbinocular amblyopia with a set of stereograms]. Oftalmol Zh. 2003;(5): 44-6. Russian.

6.Vit VV. [The structure of the human visual system]. Odessa: Astroprint; 2003. Russian.

7.Taylor D, Hoyt C. [Practical Pediatric Ophthalmology]. Moscow: BINOM; 2007. Russian.

8.Rozenblium IuZ. [Optometry]. St Petersburg: Gippokrat; 1996. Russian.

9.Batuiev AS, editor. [Physiology of sensor systems]. Leningrad: Meditsina; 1976. Russian.

10.Brutskaia LA. [On refractive correction with spectacles for accommodative concomitant esotropia]. Oftalmol Zh. 2013;(1): 94-6. Russian.

11.Brutskaia LA. [Hypermetropic astigmatism and strabismus]. Oftalmol Zh. 2017;(2): 74. Russian.

12.Proskurina OV. [Use of various cycloplegics in refraction study]. Sovermennaia optometriia. 2001;3(2):32. Russian.

13.Venger LV. [Methods of treatment for amblyopia and their efficacy]. Oftalmol Zh. 2000;(4): 74-9. Russian.

14.Kolomiiets VA, Brutskaia LA. [Treatment of amblyopia with polychromatic polystructural symbols]. Oftalmol Zh. 2001;(2): 15-9. Russian.

15.Kolomiiets VA. [Diagnosis and correction of impaired binocular function in ametropia, anisometropia and concomitant strabismus]. [Dissertation of Dr Sc (Med)]. Odessa: Filatov Institute of Eye Disease and Tissue Therapy; 1999. 270 p. Russian.

16.Serdiuchenko VI, Kliuka IV, Boĭchuk IM, Balezina TV. [Major characteristics of the accommodative-convergence system in preschool children with hypermetropia without strabismus and with accommodative concomitant strabismus]. Oftalmol Zh. 1993;(5-6): 285-9. Russian.

17.Kanski JJ. [Clinical ophthalmology: A systematic approach]. Moscow: Logosfera; 2006. Russian.

18.Avetisov SE. [Current approaches to correcting refractive disorders]. Vestn Oftalmol. 2006. Vestn Oftalmol. 2006 Jan-Feb;122(1):3-8. Russian.

19.Avetisov ES, Kovalevskiĭ EI, Khvatova AV. [Manual of pediatric ophthalmology]. Moscow: Meditsina; 1987. Russian.

20.Brutskaia LA. [On prescription of refractive correction with spectacles for hypermetropic astigmatism]. Oftalmol Zh. 2009;(3): 92-3. Russian.

21.Kovalevskiĭ EI. [Prevention of visual impairment and blindness in childhood]. Moscow: Meditsina; 1991. Russian.

22.Avetisov SE, Rybakova EG. [Methods for correcting astigmatism]. Oftalmol Zh. 1996;(2): 68-72. Russian.

23.Avetisov ES. [Concomitant strabismus]. Moscow: Meditsina; 1977. Russian.