Issue №3-20, 2021

Bifoveal Fusion Recovery by Liquid Crystal Glasses in Children

¹ Igor E. Aznauryan, ² Alexander A. Shpak, ¹ Victoriya O. Balasanyan, ³ Erik I. Aznauryan, ¹ Satenik G. Agagulyan

¹ Association of Pediatric Ophthalmology Clinics “Yasniy Vzor”, Moscow
² The S. Fyodorov Eye Microsurgery Federal State Institution, Moscow
³ Swiss Federal Institute of Technology, Zurich, Switzerland

ABSTRACT

INTRODUCTION. Rehabilitation of visual functions in childhood is an urgent problem for pediatric ophthalmology. Researchers are constantlylooking for new rehabilitation measures for diseases such as myopia and retinopathy of prematurity. But timely and effectiveimplementation of rehabilitation measures to restore binocular functions in case of strabismus is not least important.

AIM. This study aims to analyze bifoveal fusion recovery using method of LCD glasses with alternating occlusion of visual fields andcompare its efficacy with orthoptic treatment using synoptophore.

MATERIAL AND METHODS. Ninety-nine patients with prior esotropia, post-operative absence of bifoveal fusion and residual angle ofdeviation <10° were treated. All patients were hyperopic, the spherical refraction was not more than 4.75 diopters, the cylindricalrefraction not more than 1.5 diopters. At the same time, presence of mild amblyopia was allowed. Patients with vertical strabismusand cyclotropia identified during synoptophore examination and cyclotropy examination using Maddox rods, as well as patients withconcomitant ophthalmic pathology were excluded. All patients underwent a standard ophthalmological examination, as well as determinationof binocular vision by a 4-point test, a study on a synoptophore with the determination of the objective and subjectiveangles of strabismus. The main group included 46 patients who underwent treatment by alternating occlusion of visual fields with LCD glasses continuously for 4 hours/day, the control group included 53 patients who underwent synoptophore treatment for 12 months (3-4 courses). The observation period was 12 months.

RESULTS. Bifoveal fusion and binocular vision were significantly more often recovered by LCD glasses treatment as compared to thesinoptophore treatment. Stable bifoveal fusion was formed in 32 (69.5%) and 11 (21%) children, unstable in nine (19.6%) and two (4%); treatment was ineffective in five (10.9%) and 40 (75%) patients, respectively. Binocular vision was obtained in 18 (39.1%) and 11 (21%) patients, and taking into account the subsequent diploptic treatment in cases with unstable bifoveal fusion in 12 more patients (66.7%) in the main group.

CONCLUSION. Alternating occlusion of visual fields with LCD glasses is a more effective mean of bifoveal fusion and binocular visionrecovery than orthoptic treatment with a synoptophore in patients after successful strabismus surgery.

KEYWORDS: strabismus, sensory fusion, recovery, LCD glasses, synoptophore, strabismus rehabilitation, diploptic, binocular vision

Acknowledgments: The study had no sponsorship

Conflict of interest:: The authors declare no apparent or potential conflicts of interest related to the publication of this article

For citation: Aznauryan I.E., Shpak A.A., Balasanyan V.O., Aznauryan E.I., Agagulyan S.G. Bifoveal Fusion Recovery by Liquid Crystal Glasses in Children. Bulletin of Rehabilitation Medicine. 2021; 20 (3): 118-124. https://doi.org/10.38025/2078-1962-2021-20-3-118-124

For correspondence: Satenik G. Agagulyan, e-mail: agagulyan@prozrenie.ru

References:

1. Ivanova G.E., Mel’nikova E.V., Shmonin A.A., Verbickaya E.V., Aronov D.M., Belkin A.A., Belyaev A.F., Bodrova R.A., Bubnova M.G., Bujlova T.V., Mal’ceva M.N., Mishina I.E., Nesterin K.V., Nikiforov V.V., Prokopenko S.V., Sarana A. M.O., Stahovskaya L.V., Suvorov A.YU., Hasanova D.R., Cykunov M.B., Shamalov N.A., YAshkov A.V. Primenenie mezhdunarodnoj klassifikacii funkcionirovaniya v processe medicinskoj reabilitacii [Application of the international classification of functioning in the process of medical rehabilitation]. Bulletin of Rehabilitation Medicine. 2018; 1(89): 2-9 (In Russ.).
2. Tihonova T.G. Refleksoterapiya v pediatricheskoj praktike [Reflex therapy in pediatric practice]. Bulletin of Rehabilitation Medicine. 2014; 4(62): 86-91 (In Russ.).
3. Malayan E.A. O vozmozhnosti optimizacii vosstanovitel’nogo lecheniya miopii u detej s ispol’zovaniem faktorov fizicheskogo vozdejstviya [About possibility to optimization rehabilitation of myopia among children with physical factors]. Bulletin of Rehabilitation Medicine. 2017; 6(82): 86-88 (In Russ.).
4. Han M.A., Ivanov A.V., Rassulova M.A., Prikuls V.F., Mikitchenko N.A. Aktual’nye voprosy primeneniya magnitoterapii v pediatrii [Current issues of magnetotherapy in pediatrics]. Bulletin of Rehabilitation Medicine. 2015; 6(70): 42-47 (In Russ.).
5. Nefed’eva D.L., Bodrova R.A. Opredelenie reabilitacionnogo potenciala u nedonoshennyh detej na osnove mezhdunarodnoj klassifikacii funk-cionirovaniya, ogranichenij zhiznedeyatel’nosti i zdorov’ya (MKF) [Evaluation of rehabilitation potential of premature children on the basis of international classification of functioning, disability and health]. Bulletin of Rehabilitation Medicine. 2015; 6(70): 2-9 (In Russ.).
6. Kashchenko T.P. Binokulyarnaya zritel’naya sistema pri sodruzhestvennom kosoglazii. Dokt. Diss. [Binocular visual system with concomitant strabismus. Doct. Diss.] Moscow. 1978: 31 p. (In Russ.).
7. Hemptinne C., Aerts F., Pellissier T., Ramirez RuizC., Alves Cardoso V., Vanderveken C., Yuksel D.Motor skills in children with strabismus. Journal ofAAPOS. 2020; 24(2): 76.e1-76.e6. https://doi.org/10.1016/j.jaapos.2020.01.005
8. Birch, E. E. Stereopsis in infants and its developmental relation to visual acuity. Oxford University Press. London. 1993.
9. Huberman A.D. Mechanisms of eye-specific visual circuit development. Current Opinion in Neurobiology. 2007; (17): 73-80. https://doi.org/10.1016/j.conb.2007.01.005
10. Tychsen L. Can ophthalmologists repair the brain in infantile esotropia? Early surgery, stereopsis, monofixation syndrome, and the legacy of Marshall Parks. Journal of AAPOS. 2005; 9(6): 510-521. https://doi.org/10.1016/j.jaapos.2005.06.007
11. Sharma Pr. The pursuit of stereopsis. Journal of AAPOS. 2018; 22(1): 2.e1-2.e5. https://doi.org/10.1016/j.jaapos.2017.10.009
12. Bagheri M., Farvardin M. The clinical effect of surgical timing in infantile exotropia. Journal of AAPOS. 2018; 22(3): 167-169.e1. https://doi.org/10.1016/j.jaapos.2017.12.004
13. Rychkova S.I., Likhvantseva V.G. Rezultaty ispolzovaniya alterniruyushchego predyavleniya stimulov v ortopticheskom lechenii u detej [The results of the use of alternating presentation of the stimuli in orthoptic treatment in children]. Oftalmohirurgiya. 2019; (2): 50-58 (In Russ.).
14. Grigoryan A.Yu., Avetisov E.S., Kashchenko T.P., Yachmeneva E.I. Primenenie zhidkokristallicheskih ochkov dlya issledovaniya i vosstanovleniya binoku-lyarnyh funkcij [The use of liquid crystal glasses for the study and restoration of binocular functions]. Vestnik oftal’mologii. 1999; 115(1): 27-28 (In Russ.).
15. Erbagci I., Okumus S., Oner V., Coskun E., Celik O., Oren B. Using liquid crystal glasses to treat ambyopia in children. Journal of AAPOS. 2015; 19(3): 257259. https://doi.org/10.1016/j.jaapos.2015.04.001
16. Spierer A., Raz J., Benezra O., Herzog R., Cohen E., Karshai I., Benezra D. Treating amblyopia with liquid crystal glasses: a pilot study. Investigative Ophthalmology and Visual Science. 2010; 51(7): 3395-3398. https://doi.org/10.1167/iovs.09-4568
17. Wang J., Neely D., Galli J., Schliesser J., Graves A., Damarjian T., Kovarik J., Bowsher J., Smith H., Donaldson D., Haider K., Roberts G., Sprunger D., Plager D. A pilot randomized clinical trial of intermittent occlusion therapy liquid crystal glasses versus traditional patching for treatment of moderate unilateral amblyopia. Journal of AAPOS. 2016; 20(4): 326-331. https://doi.org/10.1016/j.jaapos.2016.05.014
18. Aznauryan I.E., Shpak A.A., Balasanyan V.O., Agagulyan S.G. Novyj metod vosstanovleniya sensornoj fuzii putem poperemennogo razobshcheniya polej vzora (predvaritelnoe soobshchenie) [A new method for recovery of sensory fusion by an alternating occlusion of visual fields (a preliminary report)]. Rossijskaya detskaya oftalmologiya. 2018; (1): 20-24 (In Russ.).
19. Aznauryan I.E., Shpak A.A., Balasanyan V.O., Aznauryan E.I., Agagulyan S.G. Sravnenie effektivnosti vosstanovleniya sensornoj fuzii pri lechenii na sin-optofore i zhidkokristallicheskimi ochkami detej s operirovannym sodruzhestvennym kosoglaziem [Comparison of bifoveal fusion recovery efficiency using synoptophore and the liquid crystal glasses in children operated for esotropia]. Oftalmohirurgiya. 2020; (1): 57-61 (In Russ.).
20. Aznauryan I., Agagulyan S., Aznauryan E., Balasanyan V., Shpak A. New method of sensory fusion rehabilitation using intermittent occlusion with LCD glasses. Journal ofAAPOS. 2018; 22(4): e20. https://doi.org/10.1016/j.jaapos.2018.07.068
21. Rychkova S.I., Schuko A.G., Malyshev V.V. Binarimetriya i zhidkokristallicheskie ochki v posleoperacionnoj reabilitacii detej s sodruzhestvennym skhodyashchimsya kosoglaziem [Binarimetry and liquid crystal glasses in the postoperative rehabilitation of children with concomitant esotropia]. Oftalmohirurgiya. 2008; (3): 24-26 (In Russ.).
22. Rychkova S., Ninio J. Alternation frequency thresholds for stereopsis as a technique for exploring stereoscopic difficulties. i-Perception. 2011; (2): 50-68. https://doi.org/10.1068/i0398
23. Wang J.Y., Leske D.A., Hatt S.R., Holmes J.M. Diplopia after strabismus surgery for adults with nondiplopic childhood-onset strabismus. Journal ofAAPOS. 2019; 23(6): 313.e1-313.e5. https://doi.org/10.1016/j.jaapos.2019.07.005

©

Эта статья открытого доступа по лицензии CC BY 4.0. Издательство: ФГБУ «НМИЦ РК» Минздрава России.
This is an open article under the CC BY 4.0 license. Published by the National Medical Research Center for Rehabilitation and Balneology.