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Axial myopia is a risk factor for the development of many concomitant pathological conditions, including those likely to lead to an irreversible loss of visual functions. Until now, specialists disagree about the terminology and the approaches to classification of pathological myopia. We propose a critical analysis of the state-of-the-art research and use them to offer, the definitions of such conditions as “myopic macular degeneration (myopic maculopathy)”, “myopic choroidal neovascularization” and “myopic traction maculopathy” and recommend them for use in the healthcare system of the Russian Federation

High myopia is a common ametropia associated with a significant risk of multiple comorbidities. Decreased visual functions of myopic patients may be caused by non-specific diseases such as cataracts, glaucoma and rhegmatogenous retinal detachment, which are very likely in myopia. Yet especially important are the specific changes such as atrophic, traction and neovascular manifestations of pathological myopia, the totality of which is defined as myopic macular degeneration or myopic maculopathy. The review highlights current approaches to the diagnosis and treatment of various diseases associated with high myopia, including original schemes for managing patients with myopic choroidal neovascularization and myopic traction maculopathy, developed by experts from the Expert Council on Retinal and Optic Nerve Diseases of the Russian nationwide public body Association of ophthalmologists, and includes an information leaflet for patients.

Myopic refraction is the most common ocular pathology, currently affecting about 1.5 billion people worldwide. Recent decades have seen a trend towards a significant increase in myopia prevalence, which is likely to continue in the near future. Therefore, we observe some kind of an epidemic of myopia. The greatest concern is caused by cases of uncorrectable visual impairment associated with myopia, which make pathological (degenerative) myopia one of the leading causes of low vision and blindness in many countries. At the same time, there is still no uniform interpretation of such important concepts as “high myopia” and “pathological myopia”, which can negatively affect various aspects of clinical and scientific interaction among ophthalmologists. The article provides an overview of modern work on the above issues and proposes definitions of terms to be used in the healthcare system of the Russian Federation

Purpose: to assess the biophysical properties of the sclera by measuring its acoustic density in keratoconus, highly myopic, and healthy eyes. Material and methods. We examined 34 patients (67 eyes) aged 15–45 with keratoconus of various stages, 15 patients (30 eyes) aged 17–28 with high myopia and 15 people (30 eyes) aged 28–37 without ophthalmic pathology. The acoustic density of the sclera (ADS) was measured on the Voluson Е8 ultrasound device (GE Healthcare, USA) in the posterior eye pole (ADS-1) and in the equatorial area (ADS-2). The axial length (AL) of the eye, corneal thickness (CT), anterior chamber depth (ACD), and lens thickness (LT) were determined using Galilei G6 (Ziemer Group, Switzerland). The vitreal chamber depth (VCD) was calculated according to the formula: VCD = AL – СT – ACD – LT. Results. In keratoconus patients, the average ADS-1 value was 242.5 ± 7.4 conventional units (CU), ADS-2 averaged 234.1 ± 12.1 CU, AL was 24.6±1.1 mm long, and VCD was 17.1 ± 0.4 mm. In high myopia group, the average value proved to be significantly lower: ADS-1 was 210.3 ± 15.7 CU, ADS-2 — 201.2 ± 11,2 CU, while AL and VCD were higher: resp. 27.0 ± 0.7 mm and 19.2 ± 0.5 mm (p < 0,05). In the control group (healthy eyes), ADS-1 was 247.5 ± 2.8 and ADS-2 was 238.1 ± 0.6 CU, which practically showed no difference to the keratoconus group (p > 0.05). AL was 23.7 ± 0.6 mm, and VCD was 16.0 ± 0.6 mm. An insignificant tendency toward ADS drop in keratoconus eyes with AL over 25.0 mm was observed. Probably, we are dealing here with a combination of keratoconus with axial myopia. Conclusion. The acoustic density of the sclera of keratoconus patients approaches the respective parameter of healthy eyes and is significantly higher than that of highly myopic eyes. The analysis of acoustic density of the sclera and vitreal chamber depth may be considered as a method of additional differential diagnostics of keratoconus and congenital myopia with high corneal refraction and astigmatism.

Purpose: to evaluate near visual work performance of those wearing spectacles with Stellest™ lenses and the impact of their continuous wear on refraction changes, accommodation and binocular interaction after 6 months from the start of use. Material and methods. 35 children aged 8-13 with myopia of 3.15 ± 0.19 D were prescribed eyeglasses with Stellest™ lenses. 32 children with myopia of 2.68 ± 0.18 D who used monofocal glasses served as control. Visual performance, refraction, axial length (AL), accommodation and binocular interaction were assessed. Results. According to the Burdon test, the number of errors in counting letters in Stellest™ glasses was 4.5 ± 0.64, whilst in monofocal glasses it was- significantly less, 2.96 ± 0.42 (p < 0.05); the rate of test progress was the same in the two groups. After 6 months from the start of wearing Stellest™ glasses, the objective cycloplegic refraction increased by 0.11 ± 0.04 D, the average year progression rate (YPR) was 0.22 ± 0.08 D. In contrast, the children wearing monofocal glasses showed an average refraction increase of 0.35 ± 0.05 D, and the average YPR value of 0.7 ± 0.09 D. In the Stellest™group, YPG drop was observed in 87 % of cases and averaged 0.95 ± 0.11 D. In the control group, YPR was found to drop in 65 % of cases and averaged 0.49 ± 0.1 D. In the Stellest™ group, AL increased by 0.04 ± 0.02 mm; in the control group, the increase in AL was 2.8 times greater — by 0.11 ± 0.02 mm (p < 0.01). In the Stellest™ group, relative accommodation reserves (RAR) increased by 0.88 ± 0.14 D, which is significantly higher than in the group wearing monofocal glasses, where the increase was 0.39 ± 0.12 D (p < 0.01). No differences were revealed between the groups in objective indicators of accommodation and binocular interaction. Conclusion. Wearing spectacles with Stellest™ lenses for 6 months contributes to slowing down the progression of myopia in children. Over the observation period, the refraction increase in the main group was 3.2 times lower than in the control group, whilst AL growth was 2.8 times lower than that in the control group. The children using spectacles with Stellest™ lenses showed a higher increase in RAR as compared to children wearing monofocal spectacles. The accommodation tone and objective accommodation parameters were essentially the same in both groups. Wearing Stellest™ glasses had no pronounced effect on binocular interaction.

Purpose: to analyze the results of a survey aimed at assessing the patients’satisfaction with the results of excimer laser or orthokeratological correction of myopia. Materials and methods. 135 patients aged 35 to 50 took part in a satisfaction survey: 105 after excimer laser and 30 after orthokeratological correction of myopia. Excimer laser surgery was performed with planned binocular hypocorrection within -0.75 — 1.5 D depending on age. To participate in the survey, the patients signed a preliminary consent. The questionnaire asked for age, gender, occupation, self-assessment of visual functions under a variety of conditions (vision at dusk, at close distance, at far distance, while driving a vehicle, etc.), self-assessment of satisfaction with the result. The questionnaire required to answer 15 questions on a multiplechoice basis. Results. Over 50 % of the patients have no difficulty working at close distance, at far distance, or when driving a vehicle, and do not restrict themselves in professional or everyday activities. More than 90 % of the patients would recommend excimer laser correction in binocular format with a planned hypo effect or orthokeratological correction to others. 125 out of 135 patients gave the maximum satisfaction score points. Conclusion: excimer laser correction of myopia with a planned hypoeffect in binocular format and orthokeratological correction can be recommended for patients over 35.

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.

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.

Purpose: a comparative study of corneal and total wavefront aberration changes after traditional PRK and FemtoLASIK.Material and methods. Corneal and total wavefront aberrations were studied on OPD-Scan III aberrometer (Nidek) in 63 patients (126 eyes) with moderate and high myopia before and after FemtoLASIK (Ziemer + Nidek-Quest, Japan) (44 patients, 88 eyes) and PRK (Nidek-Quest, Japan) (19 patients, 38 eyes). Spherical aberration (SA) was considered as the sum Z4 + Z8 + Z12.Results. The corneal asphericity coefficient Q changed to positive values after both types of intervention. Corneal RMS HOA increased in both Femto and PRK groups. Corneal Tilt 1 increased after FemtoLASIK and moved to negative values after PRK, corneal tilt 2 moved to negative values after Femto and to positive values after PRK. The vertical trefoil showed no significant change in the Femto group and dropped in the PRK group. The vertical and horizontal coma (coma 7, coma 8) changed synchronously. Corneal SA increased after Femtolasic, and became negative after PRK. The total aberrations showed a lesser change and the changes were not synchronized with the corneal ones: in particular, the RMS HOA fell from 0.28 ± 0.05 to 0.19 ± 0.05 in the Femto group, while the corneal RMS increased significantly. In the PRK group, the corneal RMS HOA showed some increase, but it was much less than corneal RMS: from 0.25 ± 0.07 to 0.62 ± 0.02 μm. The total SA increased from 0.11±0.03 to 0.27±0.02 in the Femto group and showed an insignificant drop from 0.09±0.03 to 0.03 ± 0.01, while remaining positive in the PRK group.Conclusions. The changes of the wavefront after FemtoLASIK and PRK are both significant and different. The revealed differences in the changes of corneal aberrations correspond to different profiles of the anterior surface of the cornea formed after FemtoLASIC and PRK. The internal optics of the eye partially compensates the corneal aberrations induced by excimer laser surgery.

Purpose. To study the parameters of visual fixation, photosensitivity of the retina in the macular region, thickness of the central region of the retina and the choroid and their relationship with the best corrected visual acuity (BCVA) and refraction in nystagmus and various types of amblyopia.Material and methods. 65 patients aged 5 to 44 (mean age 12.61 ± 7.12 years) were divided into 6 groups depending on the type of amblyopia and associated conditions. The control group was composed of subjects of the same age range without eye pathologies. The retinal photosensitivity and fixation parameters were studied using an MP-3 Nidek microperimeter (Japan). Chorioretinal parameters were evaluated using an RS-3000 Advance 2 spectral optical coherence tomograph (Nidek, Japan).Results. Retinal photosensitivity was lower in the groups with nystagmus and relative amblyopia in congenital myopia compared with the control group. The indices of density and stability of fixation were the lowest in nystagmus and dysbinocular amblyopia. In all groups with nystagmus, a smoother profile of the foveal region was revealed as compared to the control group. The grossest violations of the differentiation of the central fossa were found in nystagmus in combination with congenital myopia. In nystagmus, refractive and dysbinocular amblyopia, a significant correlation was found between the indicators of BCVA and the density of fixation. In the groups associated with congenital myopia, a relationship was found between BCVA, refraction, and foveal photosensitivity.Conclusion. With nystagmus, violations of both fixation and photosensitivity are revealed. With relative amblyopia due to congenital myopia, the fixation is normal while photosensitivity is impaired. With dysbinocular and refractive amblyopia, the photosensitivity of the retina remains within the normal range, and the fixation parameters are slightly reduced.

Purpose: to evaluate the wave-front and accommodation changes in various stages of keratoconus corrected by scleral contact lenses.Material and methods. 20 patients (39 eyes) aged 18–37 with keratoconus of various stages (8 eyes with stage I, 3 eyes with stage II, 12 eyes stage II/III and 16 eyes with stage III wore OneFit or OneFitMed scleral lenses, made of hard gas-permeable material Contamac (Great Britain) with Dk 100 and mean thickness of 200–220 μm. All patients were examined using refractometry before and after cycloplegia, tested for uncorrected and best corrected visual acuity, relative accommodation reserve (RAR), binocular and monocular accommodation response (with Grand Seiko Binocular Open Field Autorefkeratometer WR-5100K, Japan) for full spectacle correction and scleral contact lens correction. 17 patients (34 eyes) were tested for corneal aberrations with OPD Scan III aberrometer (Nidek) without correction and with scleral contact lenses.Results. Patients with keratoconus demonstrated a manifest form of refraction -5.26 ± 0.45 D (by sphere equivalent) and a cycloplegic refraction of -4.75 ± 0.33 D. Uncorrected visual acuity averaged 0.26 ± 0.05, increasing with full spectacled correction to 0.54 ± 0.07 and with scleral contact lenses correction to 0.95 ± 0.08. Keratoconus patients demonstrated binocular accommodative response (BAR) of +4.5 to -6.12 D averaging -1.43 ± 0.34 D with full spectacled correction diopters and of -0.5 to -8.13 D averaging - 2.83 ± 0.23 D with scleral contact lenses, р ≤ 0.01. We could not measure the BAR in 3 patients with keratoconus stage III. Monocular accommodative response (MAR)with a full correction with glasses averaged -0.98 ± 0.33 D (from + 6.0 to -5.0 D) with full spectacled correction and -2.41 ± 0.27 D (from +1.25 to -5.5 D) with scleral contact lenses, р ≤ 0.02. At the same time monocular accommodative response of 4 patients with keratoconus of the third stage of disease was not available to assess. So, accommodative response significant increased with scleral contact lenses. Positive relative accommodation with a full correction with glasses averaged 1.50 ± 0.35 D, with scleral contact lenses – 2.25 ± 0.29 D, р ≤ 0.01. The level of all aberrations, from lower to higher orders was significantly increased. With scleral contact lenses that correct the shape of the anterior surface of the cornea, the level of all corneal aberrations dropped to nearly normal values, while the coefficient of asphericity dropped below normal values, and the point spread function parameter (PSF) increased by fifteen times (to reach 0.06).Conclusions. Patients with keratoconus demonstrated a generally lower objective accommodative response as compared to normal values, but with the scleral lenses it increases to the normal level. Scleral contact lenses normalize corneal aberrations and increase the quality of vision. All of the above justifies the recommendation to use scleral contact lenses for optical correction of keratoconus to increase the vision, the accommodation response and visual comfort, including that of near-visual work.

Purpose: to evaluate visual functions, accommodation, and local tolerance in children instilled with Phenylephrine hydrochloride 2.5 % and sodium hyaluronate solution (Stelphrin Supra). Material and methods. 30 children (60 eyes) aged 8 to 12 (ave. 10.04 ± 0.24) with low (28 eyes) and moderate (32 eyes) myopia (ave. -2.96 ± 0.17 D) were tested. Refractometry, subjective and objective accommodation, optical biometry, anterior corneal surface examination, Norn test, and polling were performed prior to one-time instillation, 30 minutes after it, and after 1 month of daily bedtime instillations of Stelphrin Supra. Results. We noted a significant decrease in the tone of accommodation in the open field by 90 % from the initial value, an approximation of the nearest point of clear vision by 27 %, an increase in the volume of absolute accommodation by 57 % and the objective amplitude of accommodation by 20 %, which indicates an increase in the accommodation ability. The pupil width increased 30 minutes after a single instillation of Stelphrin Supra, which coincided with an increase in the relative accommodation reserve by 25 % from the initial one. After a month, the pupil width significantly decreased, and the positive relative accommodation reserve decreased to a level only 12 % higher than the original one. Tear film break time significantly increased by 0.89 sec, singular spot stainings disappeared in 2 out of 6 patients, lacrimation — in 6 out of 10, pain — in 1 out of 2, blurring in 4 out of 6, feeling of “sand” — in 7 out of 9 patients who had these symptoms before instillations. Conclusion. Regular instillations of Stelphrin Supra reduce the habitual tone of accommodation, increase the accommodation ability, and improve the condition of the eye surface.

The article presents expert study results about myopia control. The study was conducted by Russian eye care practitioners in 2019.Purpose. to summarize the views of eye care practitioners on the problem of myopia control in Russia.Methods. The study was conducted by mailing (sending) questionnaires to practitioners. The questionnaire contained 9 questions. Base questionnaire was developed by British Contact Lens Association (BCLA) for global study, translated into Russian and updated with items of interest to Russian practitioners.Results. 356 questionnaires were received and processed. Concern increasing frequency of pediatric myopia was highest (9.0 ± 0.08 on a 10 point scale). Orthokeratology was perceived to be the most effective method of myopia control, followed by myopia control soft contact lenses and increased time outdoors. Perceived effectiveness rated as percentage was 50.7 ± 1.6 %, 44.9 ± 1.8 % и 42.9 ± 1.7 % respectively. Perifocal spectacles correction was perceived to be the most effective method in the Southern area of Russia (56.8 ± 11.1 %), atropine — in the Northwestern Federal District (39.5 ± 7.1 %), scleroplasty — in the Far East (55.1 ± 7.6 %). Under-correction was perceived to be the least effective method in all areas (11.6 ± 1.0 %). Increased time outdoors was a priority for most practitioners (on average 94.0 ± 7.8 prescriptions per month by one practitioner). Practitioners prescribed single vision spectacles as the primary mode of correction for myopic patients (47.2 ± 3.6 prescriptions per month by one practitioner). Phenylephrine instillation was used often (49.4 ± 3.6 prescriptions per month by one practitioner). This trend was in most areas. Vision therapy was used most frequent in Siberia and the Urals and in the Far East (70.4 ± 11.5 и 20.0 ± 5.2 prescriptions per month by one practitioner respectively). The most common reasons practitioners gave for not adopting myopia control strategies were: they were felt to be uneconomical (42.1 %); they considered there to be inadequate information about the modalities (22.2 %). 45 % practitioners from the Far East called the last reason the main one. 42.9 % practitioners from Northwestern Federal District did not believe that these are any more effective methods then single vision correction.Conclusion. The active promotion and introduction into everyday clinical practice of myopia control methods that have proven to be highly effective could help reduce the frequency of progressive and degenerative myopia

AIM: The study aims to compare the results of objective parameters such as autorefractometers of the open field Grand Seiko and closed field TONOREF III. and the subjective parameters such as the positive of relative accommodation (PRA) and the amplitude of accommodation (AA). MATERIAL AND METHODS: 30 children (60 eyes) with low and moderate myopia (on average -2.96 0.17 D) aged from 8 to 12 years (on average 10.04 0.24 years) were examined. Subjective (PRA, AA) and objective parameters of binocular adaptation (BAO) and monocular adaptation (MAO) response on the Grand Seiko Binocular Open Field Autorefkeratometer WR - 5500K (Japan) and the AA on the automatic refractokeratotonometer pakhimetre TONOREF III (Nidek, Japan) were determined. RESULTS: The average of BAO and MAO at 33 cm was -1.93 0.04 D and 1.86 0.05 D, respectively. The average PRA was 1.5 0.16 D. The objectively measured average AA was 5.25 0.4 D. The average minimum AA value was -2.86 0.16 D, and the average maximum value was 8.11 0.46 D. The subjective AA on the Iksar device was on average 4.17 0.43 D; Amin, on average -3.77 0.26 D; Amax, on average was -7.94 0.59 D. CONCLUSION: The objective and subjective measurements of AA produced comparable results. BAO and MAO reflected other characteristics of accommodation, different from its amplitude, and characterized the adequacy of the accommodation response to a specific accommodation task. The advantage of objective accommodation is that it is independent of the patients responses and intellectual level.

Purpose: to study the effect of bifocal soft contact lens (BSCL) with an ADD of 4 diopters on peripheral refraction (PR), optical and ergonomic eye parameters in children with myopia.Patients and methods. 26 patients (52 eyes) with myopia –3.09 ± 1.13 diopters at the age of 10.04 ± 1.5 years without correction and with correction by BSCL Prima BIO Bi-focal ( Okay Vision Retail, Russia). All patients underwent a horizontal and vertical PR study on an open field autorefractometer Grand Seiko WAM-5500 (Japan), wavefront aberrations were studied on OPD-Scan III aberrometer (Nidek, Japan), contrast sensitivity under mesopic conditions were studied on a Mesotest 2 instrument (Oculus, Germany) and visual productivity was studied using test tables.Results. The visual acuity of the distance with a BSCL correction of 0.98 ± 0.04 did not differ (p = 0.26) from the maximum visual acuity corrected by spherocylindrical glasses of 0.99 ± 0.04. BSCL induces myopic defocus in all peripheral zones, with a maximum value of 15° and a sharp decrease of 30°. Peripheral myopic defocus induced by the lens at a horizontal and vertical angle of 15 degrees did not depend on the initial degree of myopia. BSCL increases the total RMS from 0.07 ± 0.02 μm to 0.19 ± 0.07 μm in the 3 mm zone (p < 0.01) and from 0.27 ± 0.09 μm to 1.18 ± 0, 23 μm in the 6 mm zone (p < 0.01), mainly due to an increase in spherical aberration from –0.0005 ± 0.006 μm to 0.06 ± 0.01 μm (p < 0.01) and from 0.01 ± 0.09 μm to 0.58 ± 0.14 μm (p < 0.01) in the 3 mm and 6 mm zones, respectively. An increase in the overall RMS in BSCL reduces the quality of eye optics and contrast sensitivity under mesopic conditions, but does not impair visual productivity.Conclusion. BSCLs with a high ADD of 4 diopters are capable of inducing significant myopic peripheral defocus due to the induction of spherical aberration, while maintaining high visual acuity and not changing ophthalmic ergonomics, which makes them a pathogenetically substantiated method for correcting myopia and preventing its progression in children and adolescents.

Purpose: to assess the thickness of the central region of the retina and choroid, the layer of nerve fibers in the macular and peripapillary regions, the density of the superficial and deep plexus of the retina and the choroid in congenital and acquired myopia and see how they are related with the refraction and axial length of the eye.Material and methods. 33 patients aged 6 to 16 (averagely, 12.07 ± 3.09 years) were divided into 3 groups: 1) with congenital myopia (23 eyes), 2) with acquired myopia (9 eyes), and 3) the control group with emmetropia (20 eyes). Chorioretinal and hemodynamic parameters were determined using an RS-3000 Advance 2 spectral optical coherence tomograph (Nidek, Japan). Correlation analysis was performed using Pearson’s linear correlation coefficient (r).Results. Structural changes in the sensory and vascular membranes of the eye were revealed in both myopic groups as compared to the control group. Of the two clinical groups, more severe structural disorders were found in congenital myopia. Hemodynamic parameters revealed abnormalities in the deep retinal layers, as well as in the choriocapillary layer. The comparative analysis showed that morphological changes in the posterior pole have a stronger correlation with anatomical parameters as compared to optical ones.Conclusion. Optical coherence tomography is an informative method of differential diagnosis, monitoring, and prognostication of changes in the posterior pole in myopia.

Purpose: to evaluate dynamics of subjective and objective accommodation in children wearing bifocal soft contact lenses (BSCLs) for myopia control with +4.00 D addition power. M e t h o d s: the study involved 22 patients (44 eyes).Mean age amounted to 10.1 ± 1.46 years and mean myopic refraction amounted to –3.21 ± 1.23 D. Patients were fitted Prima BIO Bi-focal BSCLs (OKVision Retail, Russia). All patients underwent cycloplegic refraction assessed with Auto Ref/Keratometer ARK 530A (Nidek, Japan), had axial length measured with IOL Master 500 optical biometry device (Carl Zeiss, Germany), had positive relative accommodation (PRA) assessed with and without lenses and had binocular (BAR) and monocular (MAR) accommodative response assessed at a distance of 33 cm with WAM-5500 Binocular Accommodation Auto Ref/Keratometer (Grand Seiko, Japan) prior to wearing BSCLs as well as 3, 6 and 12 months after wearing BSCLs.Results: neither MAR nor BAR measured without lenses changed after 3, 6 and 12 months of wearing BSCLs (p >0,05). A change in PRA evaluated without lenses was noted after 12 months (p < 0,05). PRA evaluated with lenses after 3, 6 and 12 months differed from baseline significantly (p < 0,001). Over 12 months of wearing BSCLs, changes in AL (0.09 ± 0.17 mm) and cycloplegic refraction (0.3 ±0.43 D) correlated with baseline BAR and MAR loosely. C o n c l u s i o n: objective accommodation (MAR and BAR) did not change in the course of wearing BSCLs with +4.00 D addition power. Increase in PRA evaluated without BSCLs may be associated with improvement of accommodation due to a full correction in the optic zone. The gradual increase in PRA evaluated with BSCLs probably indicates an adaptation of patients to addition zone in near vision conditions.

The purpose of the review is to analyze the data of recent studies (performed in the last two decades) of the efficacy and safety of sclera reinforcement surgeries for progressive myopia in children and adults. Short-term and long-term observation results are presented, indicating the impact of the initial degree of myopia, the patient's age, surgical technique and the choice of plastic material on the outcome of the intervention and the further course of the myopic process. The advantages of a biologically active synthetic graft are described, which makes it possible to deposit drugs that stimulate scleral crosslinking and have a biomechanical, trophic and hemodynamic effect. Crosslinking of scleral collagen is a promising approach to the treatment of myopia.

Purpose. Comparative analysis of the wavefront aberrations and ophthalmoergonomic parameters after excimer laser and orthokeratological correction of myopia in patients aged over 35 years.Patients and methods. The study included 21 patients: 12 (24 eyes) after excimer laser correction of myopia (group 1) and 9 (18 eyes) after orthokeratology (group 2). The average age of patients after excimer laser surgery was 38.5 years, after orthokeratological correction 46.1 years. Special studies included ophthalmoergonomical tests: far and near distance visual acuity, capacity of the visual analyzer, visual productivity, reading velocity, mesopic vision, relative accommodation reserves, objective accommodative response, pseudo-accommodation volume. Wavefront aberrations were conducted on the OPD-scan 3.Results. The spherical equivalent of residual refraction was –0.625 ± 0.08D in the excimer group, and –1.58 ± 0.24D in orthokeratological group. Despite the difference in refraction, values of distance binocular and monocular visual acuity were the same in both groups: in group 1 monocular visual acuity was 0.74 ± 0.03, binocular 0.85 ± 0.03; in group 2 — 0.71 ± 0.06 and 0.89 ± 0.05 respectively. The parameters of both monocular and binocular accommodative response measured on Grand Seiko were 50 % higher in the excimer group compared to those in the orthokeratological group. Relative accommodation reserves appeared to be two times more in the excimer group. The volume of pseudo-accommodation was 2.375 ± 0.12D in group 1, which appeared to be 20 % more than in the group 2 (p = 0.0414). The level of wavefront aberrations was significantly higher in orthokeratological group with the exception of vertical aberrations and, especially horizontal coma, which were significantly higher after excimer laser surgery. Generally, the dynamics of aberrations in both groups correlates with changes of the corneal topography.Conclusion. Excimer laser surgery with hypocorrection is more recommended for patients aged 35–40, and orthokeratological correction for patients over 45 years old.

Purpose. To study the state of refraction, accommodation, and blood flow in eye vessels of children with habitually excessive accommodation stress (HEAS) and pseudomyopia practicing badminton.Material and methods. The study involved 11 patients (20 eyes) aged 7 to 11 years (average M±SD: 9.24 ± 1.06 years) with pseudomyopia and HEAS: 4 patients with myopia (7 eyes), 3 children with hyperopia (6 eyes), 4 children with emmetropia (7 eyes) before they started practicing badminton and after playing it for a certain time. All patients were tested for visual acuity, subjective and objective accommodation, optical biometry, aberrometry, velocity of blood flow in eye vessels, and choroidal thickness.Results. After 1 year of regular badminton workout, the subjects revealed a 0.92 ± 0.82 D weakening of manifest refraction, a decrease in accommodation tone by 0.85 ± 0.77 D, an increase in blood flow rate in ophthalmic artery and the central retinal artery, an increase in positive spherical aberration, a decrease in aberrations associated with mismatch and irregularity ofoptical system elements (tilt, trefoil, coma), which indirectly indicates a strengthening of the ligamentous apparatus of the lens.Conclusion. Practicing sports (badminton) contributes to the elimination of pseudomyopia, improvement of uncorrected visual acuity, accommodative ability, and ophthalmic hemodynamics indicators.

The paper isaimedat comparing the level of aberrations, structure of the wavefront, and its response to cycloplegia in children with different refractions before they started practicing badminton regularly and after a year’s duration of this practice.Material and methods.40 children (80 eyes) with refractive errors from +6.63 to -6.75 D (average -1.28 ± 2.28 D) aged 7 to 11 years (average 9.24 ± 1.06 years) were examined before the practice, 6 months after practice start (38 children, 72 eyes) and after 1 year of badminton playing (27 children, 54 eyes). All patients underwent wavefront aberrometry before and after cycloplegia on an OPD-Scan III (Nidek) aberrometer. We analyzed Zernike coefficients up to the 12th order inclusive: vertical and horizontal slope (tilt 1, tilt 2), vertical and horizontal trefoil (trefoil 6, trefoil 9), vertical and horizontal coma (coma 7, coma 8), spherical aberration (SA), mean square deviation from the ideal wavefront (RMS).Results.SA in myopia was found to be negative, in hyperopia positive; tilt 1, tilt 2, trefoil 9, coma 7 in myopia were significantly higher, and coma 8 significantly lower than in hyperopia. The slope of the wavefront (tilt 1, tilt 2) in cycloplegia falls significantly in hyperopic eyes and does not change in myopic ones. The latter fact points to insufficient tension of Zinn ligaments in the myopic eye. Regular badminton practice results in significant changes in wavefront aberrations, indicating a strengthening of the ligaments of the lens and the normalization of the ciliary muscle tone.Conclusions.The structure of the wavefront in children with different refractions shows significant differences. Badminton helps strengthen the ligaments of the lens.

Purpose: to evaluate subfoveal choroidal thickness (SFCT) and other anatomical parameters of the eye in the early stages after orthokeratological correction of myopia. Material and Methods. The study was conducted on 20 myopic Caucasian patients (40 eyes) with moderate myopia. The main group consisted of 10 children with myopia -4.5 ± 1.03 D aged 11 ± 2.26 years, who were examined before the correction with orthokeratological lenses (OK-lenses) ESA-DL (Dr Lens Tehno, Russia) and 3 weeks after it. The control group comprised 10 patients (20 eyes) with myopia -3.84 ± 1.12 D aged 11.6 ± 1.17 years, who wore monofocal glasses as a correction. SFCT was measured with RS-3000 Advance optical coherent tomograph (OCT) (Nidek, Japan), while axial length (AL), peripheral eye length (PEL), and anterior chamber depth (ACD) was measured with IOL Master 500 optical biometer (Carl Zeiss, Germany), and central cornea thickness (CCT), epithelial thickness (ET) and corneal stroma (ST) thickness, with OCT Avanti Rtvue XR (Optovue, USA). All patients were tested before and 3 weeks after the start of wearing lenses or glasses. Results. SFCF increased by 24.25 ± 19 μm as compared with changes in the control group (p < 0.001) after 3 weeks of wearing OK-lenses. A notable negative correlation of changes in AL and SFCT was revealed in the main group (r = -0.48). CCT decreased by 14.6 ± 2.54 μm in the group wearing OKlenses. The main OK-lens contribution to the statistically significant change in the CCT concerned the epithelium, whose thickness showed a 12.7 ± 1.58 μm (22.6 %) change as compared with the initial data (p < 0.001) and with the change in the control group (p < 0.001). The decrease in AL showed an insignificant correlation with the decrease in the CCT: r = 0.16. ACD, PEL and ST did not change significantly (p > 0.05). Conclusion. SFCT shows an increase in the early stages after OK correction. When controlling the growth of the eye in patients with OK lenses, we need to take into account the impact of the choroid on the results of AL measurement.

There is detailed review of multi-factoral mechanisms of spectacles with peripheral defocus influence in children with progressive myopia in this article. At present local retinal mechanisms of neuro-regulatory control of eye growth are most effective in prevention of myopia development and progression. Optical correction of relative peripheral hyperopia with following peripheral myopic defocus affects the biochemical cascade from retina to choroid and sclera, which constrains an eye growth. Optical methods of myopia control, including spectacles, widely used in native and foreign ophthalmology practice. Since 2011, in Russia Perifocal-M spectacles are using, said spectacles provides bigger functionality of influence on myopic eye comparing to foreign analogues. Construction features of said spectacle lens have a complex influence on different optic-physiological eye structures and each of said structures affects refractogenesis. Perifocal spectacles takes into account specific for myopic eye features of central and peripheral refraction along horizontal and vertical meridians. They have stronger refraction in horizontal, which allows to eliminate specific optical disbalance in myopic eye and to create optical balance in the eye. Perifocal-M lens construction with asymmetric horizontal progression allows to correct relative peripheral hyperopia, to create myopic defocus in horizontal and to affect relations between refraction of nasal and temporal halves of retina. The latter is due to the fact that optical influence starts earlier and has bigger effect on nasal half of retina relative to temporal. Perifocal spectacles are inducing positive spherical aberrations in the eye, increasing accommodation functions, supporting high binocular visual acuity, improving binocular interaction during near work, fighting against heteroforias. Thus, optical features of Perifocal-M spectacles for the first time creates conditions for versatile functional influence on main myopogenic factors simultaneously, it effectively stops myopia progression.

Purpose:to evaluate, using transpalpebral rheoophthalmography (TP ROG), the effectiveness of sclera-strengthening and trophic treatment of progressive myopia with a new biologically active chitosan-containing transplant.Patients and methods. 40 children and adolescents with moderate or high progressive myopia, averagely aged 12.6 ± 0.38 years, were examined after receiving low invasive sclera-strengthening surgery on one eye with a biologically active chitosan-containing transplant. The initial refraction of the operated eye was — 6.25 ± 0.23 D, while that of the fellow eye was — 5.85 ± 0.28 D. The yearly gradient of myopia progression averaged 1.10 ± 0.04 D. Hemodynamic parameters were measured using TP ROG) prior to intervention, then 1, 6 and 12 months after intervention. At the same time points, scleral acoustic density (SAD) was determined by analyzing tissue histograms obtained with a multipurpose ultrasound device, VOLUSON 730 Pro «GE».Results. One year after sclera-strengthening treatment, a 4.4-fold reduction of myopia progression rate on the operated eye was noted, supplemented by a 2.2-fold reduction of same on the fellow eye. Stabilization of refraction was accompanied by an increase of SAD: 6 months after the surgery, SAD was averagely 19.7 conventional units higher than the original figure in the posterior pole of the operated eye, and 16.2 conventional units higher in the equatorial area. One year after the surgery, the figures were, respectively, 15.9 (p < 0.05) and 14.0 conventional units (p < 0.01). The rheographic index of TP ROG increased with regard to the initial value by 139 % after one month, by 69.8 % after 6 months, and by 34.6 % after 1 year. On fellow eyes, the index also tended to increase: by 123.3 % after 1 month, by 65.2 after 6 months, and by the end of the follow-up period it exceeded the original value by 28.7 %, which is an evidence of a pronounced trophic effect of sclera-strengthening myopia treatment with chitosan not only on the operated eye but also (to a lesser extent) on the fellow eye.Conclusion. TP ROG is an effective evaluation method of sclera-strengthening treatment of progressive myopia. This method can also be used to study eye hemodynamics in a variety of ophthalmic pathologies, including those managed in pediatric clinical practice.

The purpose of the work was to study peripheral refraction in myopic patients without correction, in soft contact lenses (SCL), in monofocal glasses, and in Perifocal-M glasses.Material and methods. A total of 97 patients (184 eyes) aged 9–18 years with various degrees of myopia were examined. The peripheral refraction was measured using a Grand Seiko WR-5100K binocular open-field autorefractometer without correction, in glasses, and in the SCL. For the eviation of gaze, a nozzle was designed, which was attached to the device stand at a distance of 50 cm from the patient's eyes. On the nozzle, there were 4 marks for fixing the gaze in the position of 15° and 30° to the nose (N) and to the temple (T) from the central position.Results. In patients with myopia of various degrees without correction and with correction by monofocal glasses, hyperopic defocus formed in all zones on average. In eyes that were corrected with SCL and were mildly myopic in all zones, hyperopic defocus was detected. In moderate myopia, myopic defocus was detected in the zones T30° and N30°. With a high degree of myopia, myopic defocus was detected on the periphery in all zones except T15°, reaching -2.23 ± 1.35 D in the T30° zone and -1.56 ± 0.82 D in the N30° zone. In Perifocal-M glasses, myopic defocus formed in mildly myopic eyes: in the T15° zone its value was -0.95 ± 0.12 D, -0.24 ± 0.05 D in the N15° zone, and -1.14 ± 0.13 D in the T30° zone. Hyperopic defocus was observed only in the zone at N30°, and its value was minimal compared to other types of correction which was 0.13 ± 0.05 D. In moderate myopia, myopic defocus was observed only in the zone N15° at -0.28 ± 0.04 D. In all other zones, hyperopic defocus remained, but its magnitude was minimal compared to monofocal glasses: 0.6 ± 0.1 D at T30°, 0.05 ± 0.04 D at T15°, and 0.74 ± 0.11 D at N30°. Conclusion. In relation to peripheral defocus, perifocal glasses have an advantage in correcting myopia of a low and, in part, moderate degree.

Purpose: to evaluate the results of symmetric binocular hypocorrection of myopia with FemtoLasik surgery in patients with presbyopia of various age groups.Material and methods. 33 patients (66 eyes) with myopic refraction, aged 36 to 50, were operated by FemtoLasik. The intended Femto Flap thickness was 100 μm. The patients were divided into three groups depending on age; group 1 included 16 patients (32 eyes) aged 39–44, group 2 had 12 patients (24 eyes) aged 45–50, and group 3 (controls) was composed of 5 patients (10 eyes) of pre-presbyopic age (36–38 years).Results. The symmetric binocular hypocorrection proved efficient in 35 % of cases in the group 1 and 50 % of cases in group 2. In the control group the intended and obtained values coincided in all 100 % of cases.Conclusion. A possible cause of the discrepancy between the intended and the obtained hypocorrection effect may be a reduced corneal hydration of patients older than 39 years.

Purpose. This paper presents the results of objective accommodation measurements taken from patients with concomitant strabismus. Materials and methods. The experiment was performed on 32 patients (64 eyes) ranging from 5-26 years of age (in average 13.5 ± 1.43 years old): 26 patients with esotropia (52 eyes), 2 patients with exotropia (4 eyes), and 4 patients with secondary strabismus (8 eyes). 8 of the patients (10 eyes) identified amblyopia of various degrees. 51 of the eyes exhibited hyperopia from 0.5 to 9.5 D according to spherical equivalent refraction, and 16 eyes exhibited myopia from 0.25 to 10 D. The control group consisted of 30 children with hyperopia (16 eyes), emmetropia (10 eyes), and myopia of various degrees (34 eyes) without strabismus. To determine specific indicators of objective accommodation - Binocular (BAR) and Monocular Accommodative Response (MAR), the options of consensual accommodation, as well as the resting state of accommodation (RSA) in concomitant strabismus - the open field autorefkeratometer Grand Seiko WR - 5100K was used. The degree of deviation was determined using the Hirschberg test and a handheld ophthalmoscope. Results. The MAR ranged between normal and drastically lower values averaging at -1.85 ± 0.1 D. The BAR averaged at 2.23 ± 0.1 D and was greater than the MAR in half of the measured cases (61.3 %). The interocular difference in the BAR reached 2.95 D, averaging at 0.87±0.14 D. The interocular difference in MAR reached 0.85 D, averaging at 0.34 ± 0.07 D. In the control group, BAR values were lower than MAR; the interocular differences consisted of 0.13 ± 0.01 and 0.08 ± 0.01 D, respectively. Highly amblyopic eyes had equal and drastically decreased BAR and MAR (average of -0.16 ± 0.07 D); in the fellow eyes, BAR and MAR were higher -1.08 ± 0.14 and -1.0 ± 0.14 D, respectively. In esotropic eyes, RSA was higher in the misaligned eye, and in exotropic eyes, RSA was lower in the misaligned eye. The straight and concomitant responses were decreased: until -1.43 ± 0.1 and -1.32 ± 0.15 D respectively. In the control group, the straight and concomitant accommodative response was similar (average of -1.77 ± 0.17 D in both cases). Conclusion. The results showed the characteristic changes in accommodative parameters as a result of heterotropia, not typical for orthotropic patients with various types of refraction // Russian Ophthalmological Journal, 2017; 1: 49-54. doi: 10.21516/2072-0076-2017-10-1-49-54.

Eye wavefront aberrations have a strong impact on the formation of an image on the retina and vision quality. A relationship has also been found between the aberrations and accommodation, which plays a significant role in visual performance and refraction change. It is hypothesized that not only the correction of lower-order aberrations but also that of higher-order ones can affect the quality of the image. Recently, many research papers have reported on wavefront correction by soft contact lenses in a variety of configurations. Contact lenses are available that may induce or, conversely, neutralize the aberrations. The question of how these lenses interact with the eye’s own aberrations, remains unresolved: it is not clear yet if the lenses compensate the aberrations or add up to them // Russian Ophthalmological Journal, 2016; 2: 102-107. doi: 10.21516/2072-0076-2016-9-2-102-107.

Purpose: to evaluate the thickness of corneal epithelium after orthokeratological (OK) correction with the help of SDOCT. Material and methods: 18 patients (36 eyes) averagely aged 12.11 ± 1.68 with myopia of -3.21 ± 0.94 D and axial length of 24.47 ± 0.7 mm were examined. All patients were checked for corneal epithelial thickness (ET) with the help of SD-OCT Avanti RTVueXR (Optovue Inc., Fremont, CA, USA), which created maps of 6 mm in diameter before OK correction with lenses ESA-DL (Dr. Lens Technology, Russia) and 36.44 ± 5.81 days after it. A corneal ET map was divided into 17 sectors with average values indicated, and 3 zones (the central zone of 2 mm, the paracentral zone from 2 to 5 mm, and the mid-peripheral zone from 5 to 6 mm). We calculated the maximum (Max) and the minimum (Min) values of ET, the difference between them (Max Min) in the 5 mm zone, and standard deviation of values in the 5 mm zone (Std Dev). Results. The corneal ET showed no difference among the sectors of the 6-mm map (p > 0.05) before OK lenses were worn. The ET in the central zone was 53.1 ± 1.68 μm. The ET in the central zone decreased by 16.6 % from the initial value after 36.44 ± 5.81 days of OK correction, with a single sector (S) showing a statistically significant difference in the paracentral zone. In the mid-peripheral zone, the ET increased by 14.1 % from the reference. Max and Min ET, and Max-Min Std Dev in the 5-mm zone differed significantly after OK correction (p < 0.05). Conclusion. After OK correction, the ET significantly decreases in the central zone and increases in the mid-peripheral zone. These changes account for the flattening of the anterior corneal surface and contribute to the refractive effect of OK lenses. For citations: Milash S.V., Tarutta E.P. Changes of corneal epithelial thickness before and after OK-correction according to SD-OCT. Russian ophthalmological journal. 2017; 10 (3): 49-54. doi: 10.21516/2072-0076-2017-10-3-49-54 (in Russian).

The change of peripheral refraction and the shape of 52 myopic eyes of 26 patients aged 8 to 16 (averagely, 10.4 ± 0,9 years) resulting from overnight wearing of orthokeratology lenses was followed up for 3.2 ± 0.9 years on average. The use of Ortho-k lenses was found to form relative peripheral myopia, whose value correlated with the initial degree of myopia and was averagely equal to -1.4 ± 0.13 D, -1.9 ± 0.17 D and -4.4 ± 0.13 D, respectively for low, moderate and high myopia. The ratio coefficient APA/HD between the length of the anterioposterior axis (APA) and the horizontal diameter (HD) of the eye changed from the initial value, which was averagely equal to 1.01 ± 0.06 (1.00 ± 0.002 for low myopia, 1.01 ± 0.008 for moderate myopia, and 1.02 ± 0.003 for high myopia), to -0.98 ± 0.006 (-0.94 ± 0.001 for low myopia, 0.98 ± 0.007 for moderate myopia, and - 1.00 ± 0.006 for high myopia) by the end of lens wearing term. This dynamics of APA/HD variation is an evidence of eyeball shape change as a result of prolonged use of ortho-k lenses toward the shape of a oblate ellipsoid. This is accompanied by the formation of a peripheral myopic defocus // Russian Ophthalmological Journal, 2016; 1: 62-6.

Today, a variety of medications are used in ophthalmology practice to o produce cycloplegia and mydriasis. Purpose: to compare the extent of cycloplegia by residual accommodation response after instillations of various medications. Materials and methods. 54 patients, aged 8 to 23, with varied degrees of myopia were instilled twice, with an interval of 10 minutes, with one of the following medications: Cyclopentolate 1 %, Tropicamide 1 %, Midrimax, and Phenylephrine 2.5 %. The patients were examined before the first instillation and 40 minutes after it using autorefractometry and measurement of objective monocular accommodation response (MAO) with a Grand Seiko Binocular Open Field Autorefkeratometer WR-5100K. The value of MOA, i.e. residual accommodation, was used to assess the completeness of cycloplegia. Results. The difference between manifest and cycloplegic refraction was -0.13 D after Cyclopentolate, -0.2 D after Tropicamide, -0.11 D after Midrimax, and -0.02 D after Phenylephrine. No intergroup differences in this parameter were noted (р > 0.05). MAO fell after Tropicamide and Midrimax but remained sufficiently high: -0.83 D and -0.71 D, respectively. Phenylephrine had no paralyzing action on the ciliary muscle; it even strengthened slightly (by 0.12 D) the objective accommodation response. The only medication to provide true cycloplegia was Cyclopentolate 1%: upon presentation of an accommodation task of 3.0 D, МАО was found to be only -0.1 D. The difference in MAO after Cyclopentolate 1% and all other medications is statistically significant, р < 0.05. Conclusion. For a dynamic observation of patients with no suspicion of elevated tone of the ciliary muscle, Cyclopentolate, Tropicamide and Midrimax are equally effective. In cases of primary examination or if a habitually excessive accommodation strain or accommodation spasm is observed, Cyclopentolate or Atropine must be used. Phenylephrine 2.5 % is a curative medication which normalizes the tone of the ciliary muscle and heightens the accommodation response. It is not advisable to use it for diagnostic purposes as mydriasis is weak and cyloplegia is absent. For citation: Tarasova N.A., Tarutta E.P., Markosian G.A., Maksimova M.V. Objective accommodation response value (completeness of cycloplegia) after diagnostic instillations of diverse medications. Russian ophthalmological journal. 2018; 11 (2): 22-6. doi: 10.21516/2072-0076-2018-11-2-22-26 (In Russian).

Purpose: comparison of some ophthalmobiometric parameters in natural and cycloplegic conditions in myopia and hypermetropia.Material and methods: eyes biometric parameters were examined (the depth of the anterior chamber, the lens thickness and AL)before and after cycloplegia (1% Cyclopentolate hydrochloride — 2 times) in 244 eyes with myopic and hyperopic refraction in 122patients aged 5–32 years. Biometric parameters were examined on the Galilei G6 optical system analyzer (Ziemer Ophthalmic SystemsAG 6.0.6). The thickness of the choroid was measured with a spectral optical coherent tomograph (SD-OCT wavelength 800 nm) of Nidek RS-3000 Retina Scan Advance in 20 eyes of 10 patients aged 11 ± 1.3 years from the examined group before and 40 minutes after double injection of 1% Cyclopentolate hydrochloride. Results: the depth of anterior chamber and the axial, both in the narrow pupil and under the cycloplegia, are significantly higher in the myopic eyes than in the hyperopic eyes (p < 0.05 for ACD and p < 0.01 for AL), and the lens thickness is practically does not differ. In absolute terms, the position of irido-lens diaphragm, i.e. distance from the posterior surface of the cornea to the center of the lens in myopia group was significantly higher than with hyperopia respectively, of 5.62 ± 0.02 mm of 5.29 ± 0.01 mm (p < 0.01). However, the coefficient Lowе ((ACD + 1/2LT)/AL) in myopia was significantly lower (of 0.219 ± 0.001 and 0,238 ± 0,001, respectively) is due to the greater of the AL. After cycloplegia, in both myopic and hyperopic eyes, DAC increases: in myopia, on average, 0.12 mm, with hyperopia — by 0.14 mm, and accordingly the thickness of the lens decreases. The coefficient Lowe in both cases is increased by 0,04 mm. Interesting changes were observed in the length of AL: under conditions of cycloplegia, it decreased by 0.03 mm (30 microns) in eyes with myopia (p > 0.05) and by 40 microns (0.04 mm) with hyperopia (p < 0.01). Conclusion: In cyclopegic condidions, as compared to the existing accommodation, increasing the depth of the anterior chamber decreased the thickness of the lens center of the lens somewhat extended posteriorly and decreases the axial length. The revealed changes in the AL can be associated with a change in the position of the pigment epithelium layer due to changes in the thickness of the choroid under different accommodation conditions. The significant changes in the thickness of the choroid the influence of cycloplegia was not proved in this study.

The review gives a detailed account of research data on myopia predictors. The most reliable predictors include cycloplegic sphere equivalent of axial refraction less than +0.75 D in children under 6 years, the axial length of more than 23.5 mm with the refractive error ≤ +1.0 D, myopic parents, axial length / corneal radius ratio (AL/CR) of less than 3, AC/A ratio over 4 Δ/D, pseudomyopia, heterophoria of more than 4 Δ, peripheral refraction of the nasal half of the eye at 20-30° higher than the temporal refraction in both eyes more than 0.5 D, reduced outdoor activity and high visual activity. Measures of prevention of myopia development are presented: adhering to the regiment of visual activity load, ergonomic stereotypes of near visual work, creation of binocular central and peripheral myopic defocus - positive spectacles or spectacles with Perifocal-P lenses with a central refraction of +0.25 D for permanent wear, home accommodative training exercises, physical exercises and sports, outdoor activity at least 90 minutes a day during daylight hours. For citation: Tarutta E.P., Proskurina O.V., Tarasova N.A., Ibatulin R.A., Kovychev A.S. Myopia predictors as a starting point for active prevention of myopia development. Russian ophthalmological journal. 2018; 11 (3): 107-12 (In Russian). doi: 10.21516/2072-0076-2018-11-3-107-112

A variety of factors that change the topography of the cornea may also induce changes in peripheral refraction. Purpose. The paper is aimed at assessing the peripheral refraction and retinal contour of myopic eyes after FS-LASIK and orthokeratological (Ortho-k) correction. Materials and methods. We examined a total of 30 patients (60 eyes) aging from 28.86 ±2.83 years which included 12 patients (24 eyes) with myopia of -5.11 ± 0.5 D and with an axial length (AL) of 25.04 ±0.33 mm before and 1 month after FS-LASIK surgery, and also included 18 patients (36 eyes) with myopia of -5.4 ± 0.24 D and AL of 25.78 ± 0.2 mm who wore ESA-DL Ortho-k lenses. The peripheral refraction of all the patients was measured using the Grand Seiko Open-field binocular autoref/keratometer and the peripheral eye length was measured using the IOL Master 500 (Carl Zeiss) at 15° and 30º nasally (N) and temporally (T), respectively, from the center of fovea. Results. The peripheral eye length measured before and after FS-LASIK as well as after Ortho-k correction was less in all peripheral zones than in the center, which corresponds to characteristics observed in hyperopic peripheral defocus. Refraction measured after FS-LASIK showed the formation of myopic defocus with a maximum at 30° from the following results: -2.49 D at T15°, -2.5 D at N15°, -6.73 D at T30°, and -7.8 D at N30°. The maximal myopic defocus after Ortho-k correction was detected in the middle periphery from these following results: -4.89 D at T15°, -5.51 D at N15°, -2.92 D at T30° and -2.4 D at N30°. Conclusions. Both procedures induced a significant peripheral myopic defocus. In the first case, the maximum values of defocus were detected in the peripheral zone (30° from the center of the fovea); in the second case, the maximal effect on the middle periphery was identified 15° from the center. Such patterns of peripheral refraction fully coincided with the specific changes in corneal topography after the two procedures. The retinal contour within 30° from the center retained the relative hyperopic defocus characteristic of intact myopic eyes // Russian Ophthalmological Journal, 2017; 1: 31-5. doi: 10.21516/2072-0076-2017-10-1-31-35.

This article presents the review of the literature focusing on the current state-of-the-art in genetic, clinical, functional, and biomechanical aspects of pathogenesis, diagnostics, and treatment of congenital myopia. The involvement of hereditary factors in etiology of myopia has been repeatedly confirmed in numerous publications. Suffice it to mention that at least 23 MYP loci localized in 15 different chromosomes are associated with the development of myopia and determine the quantitative characteristics of this pathology. Nevertheless, the specific genes and alleles responsible for the predisposition to myopia belong, with a high degree of probability, to different polygenic systems and are therefore extremely difficult to identify. The results of investigations into congenital myopia give evidence that it must be a special clinical form of myopia characterized by certain peculiar patterns of the retinal relief in the foveal area, specific biophysical properties of the fibrous capsule of the eye, and a particular, both ophthalmologically and morphometrically, shape of the optic nerve. A substantial variation in the optic disc size and excavation patterns associated with congenital myopia as well as the relationship between these two parameters should be taken into consideration when examining the adult highly myopic patients for the early differential diagnostics of glaucoma. The biomechanical properties of the corneoscleral capsule affect the morphometric parameters of the optic disc in congenital and acquired myopia in the children which should be taken into account when choosing the type of the surgical treatment in the event of myopia progression and controlling its advancement. The available results of investigations confirm that contact correction in combination with additional spectacle correction is the most efficient method for the treatment of the patients presenting with congenital myopia. The data obtained show that the reconstructive treatment of the sclera including buckling of the posterior pole provides a very promising approach to the prevention of progression of myopic macular dystrophy and addressing a variety of forms and stages of myopic staphylomas.

Background: Quantitative assessment of hemodynamic parameters is an important element of ophthalmic diagnostics especially in early detection of myopia, glaucoma, diabetic retinopathy. The assessment of hemodynamic changes is essential in evaluating of the efficiency of treatment. Objective : Our aim was to determine the adequate of eye hemodynamics assessment using reoophtalmography in patients with various clinical refractions. Methods: A controlled study was carried out. All tests were performed using transpalpebral tetrapolar method. Signal registration lasted for 20 seconds in the supine position, and then the diagnostic parameters were calculated. Results: We present the results of examination of 76 patients aged 5 to 22 years (average age 13.0 ± 1.1). 32 patients had low myopia (62 reoophtalmography records), 23 patients had moderate myopia (42 records) and 5 patients had high myopia (12 records). The control group was composed of 16 patients. The main differences were found in the rheographic index, which is equal to 58.1 ± 4.1 mOhm in the control group. It is significantly reducing with refraction increase, from 47.8 ± 3.2 mOhm in low myopia to 34.0 ± 2.5 mOhm in high myopia (p =0.050). This is an evidence of blood supply deficiency in the myopic eyes. Conclusion : Rheographic index was shown to differ in different breathing phases, which agrees with the known physiological regularities. The proposed method is highly informative and sufficiently accurate what allows assessing the eye blood supply state objectively. It is easy to apply and requires no contact with the eye surface, which is especially important in pediatric practice.

To compare the wavefront and accommodation parameters without correction and in soft contact lenses (SCL) in natural and cycloplegic conditions in eyes with myopia and hyperopia.A total of 142 myopic (mean -5.6±1.4 D) and 48 hyperopic (mean +3.5±1.1 D) eyes were examined in 95 patients aged 5-32 years (mean age 16.9±0.9 years) to compare the wavefront aberrations without correction and with different SCL before and after cycloplegia (two drops of cyclopentolate hydrochloride 1%). The device was set up for 4 mm zone for both narrow and wide pupils. To compare the accommodation parameters under different correction conditions, 85 patients aged 8-23 years (mean age 14.9±0.6 years) with average myopia of (-)5.27±1.4D (123 eyes) and average hyperopia of +3.53±1.2 D (46 eyes) were chosen from the study group. Among the measured parameters are objective accommodative response (OAR), relative accommodation reserves (RAR), pseudoaccumulation amplitude (PA), higher-order aberrations: RMSHOAs, 6-9 Trefoil, 7-8 Coma, spherical aberration (SA).In myopic eyes with SCL Coma 7 decreases, Coma 8 increases with transition to positive values, and Trefoil 9 increases. In hyperopic eyes, trefoil 6 decreases, Coma 7-8 go negative. In myopic or hyperopic eyes with SCL, SA goes from positive to negative. In both myopia and hyperopia, accommodation and PA rates are higher in SCL than in glasses.SCL change certain wavefront parameters for myopia and hyperopia in different ways. The accommodation parameters in SCL are elevated in both myopia and hyperopia. The negative spherical aberration induced by contact lenses improves the accommodative response. The revealed features should be considered in the development of correction methods that target refractogenesis.Цель - cравнение параметров волнового фронта и аккомодации без коррекции и в мягких контактных линзах (МКЛ) в естественных и циклоплегических условиях в глазах с миопией и гиперметропией. Материал и методы. Обследовано 142 миопических (в среднем (–)5,6±1,4 дптр) и 48 гиперметропических (в среднем (+)3,5±1,1 дптр) глаз у 95 пациентов в возрасте 5-32 лет (в среднем 16,9±0,9 года) для сравнения аберраций волнового фронта без коррекции и в КЛ разного дизайна до и после циклоплегии (1% Cyclopentolate hydrochloride - 2 раза). Учитывая наличие у прибора опции с выбором зоны зрачка, была выбрана 4-миллиметровая зона как для узкого, так и для широкого зрачка. Для сравнения параметров аккомодации в разных условиях коррекции из всей группы было обследовано 85 пациентов в возрасте 8-23 лет (в среднем 14,9±0,6 года) с миопией в среднем (–)5,27±1,4 дптр (123 глаза) и гиперметропией в среднем (+)3,53±1,2 дптр (46 глаз). Измеряли объективный аккомодационный ответ, запасы относительной аккомодации, объем псевдоаккомодации (ПА), аберрации высшего порядка: RMSHOAs, trefoil 6 и 9, Coma 7 и 8, сферическую аберрацию (SA). Результаты. В миопических глазах в МКЛ уменьшается Coma 7, увеличивается с переходом в положительные значения Coma 8 и увеличивается trefoil 9. В гиперметропических глазах уменьшается trefoil 6, переходит в отрицательные значения Coma 7 и 8. SA в МКЛ как при миопии, так и гиперметропии переходит из положительной в отрицательную. И при миопии, и при гиперметропии показатели аккомодации и ПА в МКЛ выше, чем в очках. Заключение. МКЛ по-разному изменяют некоторые параметры волнового фронта при миопии и гиперметропии. Параметры аккомодации в МКЛ повышаются как при миопии, так и гиперметропии. Индуцированная КЛ отрицательная сферическая аберрация способствует повышению аккомодационного ответа. Выявленные особенности следует учитывать при разработке методов коррекции, целенаправленно влияющих на рефрактогенез.

To determine the posterior pole contour of the eye based on the relative peripheral refractive error and relative eye length.A parallel study was performed, which enrolled 38 children (76 eyes) with myopia from -1.25 to -10.82 diopters. The patients underwent peripheral refraction assessment with WR-5100K Binocular Auto Refractometer ("Grand Seiko", Japan) and partial coherence tomography with IOLMaster ("Carl Zeiss", Germany) for the relative eye length in areas located 15 and 30 degrees nasal and temporal from the central fovea along the horizontal meridian.In general, refractometry and interferometry showed high coincidence of defocus signs and values for the areas located 15 and 30 degrees nasal as well as 15 degrees temporal from the fovea. However, in 41% of patients defocus signs determined by the two methods mismatched in one or more areas. Most of the mismatch cases were mild myopia.We suppose that such a mismatch is caused by optical peculiarities of the anterior eye segment that have an impact on refractometry results.

The growing prevalence of progressive myopia and its disabling consequences explains the elaboration of reliable diagnostic markers and new treatment strategies based on the research results of molecular mechanisms underlying the development of the condition. The paper reviews recent basic pathogenetic research studies which have greatly broadened the awareness of the deep causes of progressive myopia associated with the activity of certain growth factors, local and systemic protein metabolism, and regulation of hormonal and neural processes. Practical clinical guidelines for new criteria of diagnosis and control of myopia are published as they could be useful while selecting individual treatment plans including indications to sclera-strengthening therapy and its evaluation. The results may be promising in the elaboration of systemic and local medications for the prevention of myopia progression, which should address the regulation of connective tissue disorders, hormonal shifts, and imbalanced autonomic nervous system.

A total of 150 patients (300 eyes) aged from 6 to 23 with myopia of different degrees were assessed to define differential diagnostic criteria of accommodative disorders such as accommodative insufficiency, habitual excess, and spasm. The patients were divided into 4 groups. Group 1 included 88 patients (175 eyes) with myopia from -0.75 to -8.5 diopters (general group), group 2-23 patients (46 eyes) with accommodative insufficiency, group 3-20 patients (39 eyes) with habitual accommodative excess, and group 4-20 patients (40 eyes) with accommodative spasm. In all cases subjective and objective parameters of accommodation were fully assessed and differential diagnostic criteria identified.

A device called dynamic plug in two varieties (a perforated plate and a flattened spiral spring) exploiting the shape memory effect and a method for its application in the treatment of high myopia are proposed. The application of this device allows low-traumatic correction of the shape of the posterior eye pole and strengthening of the sclera. The shape memory effect of the device permits to submit it to significant pseudoplastic deformation. In the process of implantation, the device remains in the non-functioning condition during the time needed for its placement on the eyeball posterior pole surface. Heated up to 42 °C by an external source of heat, the device restores its initial shape and creates pressure on the pathologically deformed eye surface. Experiments on laboratory animals show promising results, although further studies are required.

The correlation between biomechanical properties of the corneoscleral tunic and stereometric parameters of the optic nerve head in children and adolescents with congenital and acquired myopia has been studied comparatively. The results showed that in children with high myopia, congenital or acquired, the corneoscleral parameters (scleral echodensity at the equator and the posterior pole, corneoscleral hysteresis, cornea resistance factor, and ocular rigidity coefficient) are lower than those in emmetropes. Moreover, the corneoscleral biomechanical characteristics affect the optic nerve head parameters. This fact has to be taken into account when examining adults with high myopia for the purpose of early diagnostics of glaucoma.

Reports have been made that corneal aberrations of all orders, including astigmatism, often significantly increase with the use of night orthokeratology lenses. In this study the dynamic changes of total and corneal astigmatism in myopes using orthokeratology lenses was evaluated by different methods. The study enrolled 38 patients (76 eyes) with low and medium myopia (28 and 48 eyes correspondingly) and initial astigmatism less than 2 diopters. The assessment was made before and in different terms after the patient started to wear orthokeratology lenses. Induced astigmatism (or =1 diopter) was found in more than 50% of cases. The degree of astigmatism gradually increased from the centre to the periphery within the papillary zone. The maximum values were found within a 4-mm zone ("uptake zone") and minimal - within a 8-mm zone ("equalization zone"). In all patients, despite the presence of induced astigmatism and residual myopia (0.83+/-0.09 diopters in average), distance visual acuity was high enough without an additional correction (0.82+/-0.05 in average). Apparently, in these patients the aberrations (astigmatism in particular) exceed the focal depth.

Prognostic value of acoustic density of sclera (ADS) is studied in development of peripheral vitreochorioretinal degenerations (PVCRD) in myopia. Children aged 8-10 years old with noncomplicated high and moderate myopia were divided into two groups after ADS measurement: 1 with ADSor = 39dB - unfavorable prognosis, 2 with ADS39dB - favorable prognosis. Follow-up during 10 years with examinations twice a year confirmed prognosis accuracy: in the 1st group PVCRD developed 2.5 times as often as in the 2nd group (64.6 and 25.6% respectively).

to perform a comparative study of peripheral refraction and retinal contour in patients with congenital versus acquired high myopia.A total of 30 patients (60 eyes) with high myopia aged 8 to 18 years (11.2±0.32 years on average) were examined. The patients were divided into 2 groups. Group 1 consisted of 21 patients (42 eyes) with acquired myopia of -6.0 to -10.25 diopters (-7.55±0.17 diopters on average), group 2 - of 9 patients (18 eyes) with congenital myopia of -8.75 to -28.75 diopters (-16.39±1.24 diopters on average). Using the Grand Seiko WR-5100K binocular open-field autoref/keratometer (Japan), relative peripheral refraction was assessed with account to relative peripheral eye length measured by the IOL Master partial coherent interferometer ('Carl Zeiss', Germany) at 15° and 30° nasally and temporally from the foveal center along the horizontal meridian.In acquired myopia, relative peripheral refraction and relative peripheral eye length readings evidenced the formation of peripheral hyperopic defocus in all examined zones. Congenital high myopia cases were notable for myopic defocus at 15° of the nasal retina (N15 zone): -0.67±0.33 diopters against the eye length change of -0.33±0.13 mm.The research helped identify retinal contour changes characteristic of congenital myopia and indicative of posterior pole irregularity.Цель - изучить особенности периферической рефракции и контура сетчатки в сравнительном аспекте при врожденной и приобретенной миопии высокой степени. Материал и методы. Обследованы 30 пациентов (60 глаз) с миопией высокой степени в возрасте 8-18 лет (в среднем 11,2±0,39 года). Пациенты были разделены на 2 группы. В 1-ю группу вошел 21 пациент (42 глаза) с приобретенной миопией от (–)6,0 до (–)10,25 (в среднем (–)7,55±0,17) дптр, во 2-ю - 9 пациентов (18 глаз) с врожденной миопией от (–)8,75 до (–)28,75 (в среднем (–)16,39±1,24) дптр. Всем пациентам проводили параллельное исследование относительной периферической рефракции (ОПР) с помощью бинокулярного авторефкератометра открытого поля Grand Seiko WR-5100K (Япония) и относительной периферической длины глаза (ОПД) с помощью частично когерентной интерферометрии с использованием аппарата IOL Master ('Carl Zeiss', Германия) в идентичных зонах 15 и 30° к носу и к виску от центра фовеа в горизонтальном меридиане. Результаты. При приобретенной миопии и ОПР и ОПД свидетельствовали о формировании во всех исследуемых зонах периферического гиперметропического дефокуса. При врожденной миопии высокой степени в 15° носовой периферии сетчатки выявлялся миопический дефокус: (–)0,67±0,33 дптр по ОПР и (–)0,33±0,13 мм по ОПД. Заключение. Проведенное исследование выявило характерные для врожденной миопии изменения контура сетчатки, свидетельствующие об иррегулярной форме заднего полюса глаза.

The rational for the study was the high prevalence of myopia in the world. According to the World Health Organization (WHO), myopia is one of the five leading causes of blindness and low vision. Of recent reports on conservative measures for the stabilization of myopia, two areas of investigation deserve attention: methods of optical correction that affect peripheral refraction, orthokeratology lenses (OKL) in particular, and pharmacotherapy. The aim of the study was to evaluate the effectiveness and safety of myopia control in pediatric patients by combining two methods - OKL wearing and instillation of extra low doses of atropine (0.01%).Within a prospective cohort study, 31 patients (62 eyes) aged 8 to 14 years with acquired myopia of low 14 (28), medium 11 (22), or high 6 (12) degree, were examined before and 6 months after adding 0.01% atropine instillations to OKL wearing. Refraction (Huvitz MRK 3100P), axial eye length (IOL-Master, 'CarlZeiss', Germany), absolute accommodation (Grand Seiko WRK-5100K), accommodative reserves, and pseudoaccommodation were assessed.The most significant effect on reducing the rate of disease progression was observed in patients with low and moderate myopia (1.5 and 1.7 times, correspondingly, p0.05). In high myopia no reliable changes were noticed. Obviously, the inhibitory effect of OKL, which is conditioned by optical factors (peripheral myopic defocus in particular), even in combination with atropine, is not able to stop the progression of high myopia, which is based on structural and biomechanical changes of the sclera.Judging from these preliminary results, one should not claim 100% effectiveness of prolonged minute-concentration atropine use, however, the positive effect exists and the study continues.Обоснование исследования - распространенность миопии в мире. По данным ВОЗ, миопия - одна из пяти ведущих причин слепоты и слабовидения. Среди имеющихся сообщений об использовании консервативных методов лечения для стабилизации миопии в последние годы заслуживают внимание два направления: это применение оптических методов коррекции (в частности, ортокератологической коррекции) с воздействием на периферическую рефракцию и фармакологических средств. Цель исследования - оценка эффективности и безопасности контроля миопии у пациентов детского возраста при использовании сочетания двух методов - ортокератологической коррекции и инстилляций сверхмалых доз атропина (0,01%). Материал и методы. В проспективное когортное исследование включен 31 пациент (62 глаза) в возрасте от 8 до 14 лет с приобретенной миопией слабой 14 (28), средней 11 (22) и высокой 6 (12) степени. Пациентов обследовали до и через 6 мес после присоединения 0,01% раствора атропина к ношению ортокератологических линз (ОКЛ) при продолжающемся процессе прогрессирования миопии. Измеряли рефракцию (Huvitz MRK 3100P), переднезаднюю ось (IOL-Master, 'CarlZeiss', Германия), объективный аккомодационный ответ (Grand Seiko WRK-5100K), запасы относительной аккомодации, псевдоаккомодацию. Результаты. Наиболее заметная эффективность снижения темпов прогрессирования наблюдалась при миопии слабой (в 1,5 раза, р0,05) и средней (в 1,7 раза, р0,05) степени, при высокой миопии достоверных изменений не отмечено. Очевидно, тормозящий эффект ОКЛ, обусловленный оптическими факторами (а именно - периферическим миопическим дефокусом), даже в сочетании с атропином не может остановить прогрессирование высокой миопии, в основе которого лежит нарушение структурных и биомеханических свойств склеральной капсулы. Заключение. На сегодняшний день предварительные результаты не позволяют говорить о 100% эффективности длительной атропинизации сверхмалыми концентрациями, тем не менее положительный результат наблюдался, исследование продолжается.

The global prevalence of myopia in adults varies between 20-50% in Europe and the US and 60-90% in Asian countries. According to WHO, myopia is one of the five leading causes of blindness and low vision in the world. Prevention or deceleration of myopia progression is an important public health problem. In recent years, orthokeratology (ortho-k) contact lenses worn at night have been found effective in slowing down the progression of myopia, however, the follow-up period in related studies is no longer than five years.to investigate the effects of long-term (10 years) overnight wear of ortho-k lenses on the dynamics of axial eye growth in children and adolescents.This is a prospective cohort study of the effects of ortho-k lenses on the dynamics of anterior-posterior elongation of the eyeball in 84 patients (168 eyes) aged 7 to 16 years and diagnosed with progressive myopia of 1.0 to 7.0 diopters. Patients were examined every three months, including the slit lamp examination to detect possible side effects of lens wear.The study proves the decelerating effect of the method on disease progression: the average 10-year increase in the axial eye length was 0.7±0.02 mm that corresponds to myopia progression of 2.4 diopters. A comparative analysis of the annual axial eye growth depending on patient age and the degree of myopia at baseline was performed. The increase was found to be generally greater in young children with higher initial myopia.Long-term wear of orthokeratology lenses is able to slow down the axial eye growth, i.e. the progression of myopia.Обоснование исследования — распространенность миопии в мире варьирует в пределах 20—50% среди взрослого населения стран Европы и США, тогда как в странах Азии эти показатели достигают 60—90%. По данным ВОЗ, миопия — одна из 5 ведущих причин слепоты и слабовидения в мире. Предотвращение или замедление прогрессирования миопии — важная задача здравоохранения. В последние годы появилась возможность замедления прогрессирования миопии при ночном использовании ортокератологических контактных линз (ОКЛ), но срок наблюдений в этих работах не превышает 5 лет. Цель исследования — проследить долгосрочный (10 лет) эффект ношения ОКЛ в ночном режиме на динамику переднезадней оси (ПЗО) у детей и подростков. Материал и методы. Проведено проспективное когортное исследование влияния ОКЛ на динамику длины переднезадней оси глаза у 84 пациентов (168 глаз) в возрасте от 7 до 16 лет с прогрессирующей миопией от 1,0 до 7,0 дптр. Пациенты проходили обследование каждые 3 мес; в те же сроки пациентов осматривали с помощью щелевой лампы для выявления возможных побочных эффектов ношения линз. Результаты. Показано тормозящее влияние метода: увеличение длины ПЗО за 10 лет составило в среднем 0,7±0,02 мм, что соответствует прогрессированию миопии на 2,4 дптр. Проведен сравнительный анализ ежегодного удлинения ПЗО в зависимости от возраста пациента и исходной степени миопии. Выявлено большее увеличение ПЗО у детей младшего возраста и с исходно более высокой мопией. Заключение. Длительное ношение ОКЛ может замедлить рост переднезадней оси глаза, т.е. прогрессирование миопии.

to comparatively investigate accommodation, pseudoaccommodation, and higher-order aberrations in children and young adults with myopia and hyperopia.A total of 39 myopic (the mean error of (-)5.2±1.5 diopters) and 53 hyperopic (the mean error of (+)3.1±1.15 diopters) eyes of 46 patients aged 5-20 years (11.6±0.6 years on average) were enrolled. Examination included evaluation of the objective accommodative response, relative accommodation reserves, pseudoaccommodation volume (calculated as the difference between the (+)3.0-diopter lens that is necessary for cycloplegic reading at a 33-cm distance and the weakest possible plus lens that enables reading), and higher-order aberrations (HOA), particularly the root mean square (RMS) value, vertical and horizontal trefoil, vertical and horizontal coma (coma7, coma8), and spherical aberration (SA).Both objective and subjective parameters of accommodation were reliably lower in myopia as compared to hyperopia, while wavefront aberrations (RMS HOA, vertical trefoil, coma7) and pseudoaccommodation - reliably greater. SA was found to be reliably more pronounced in those myopes, who demonstrated larger volume of pseudoaccommodation. At the same time, there was a mismatch in wavefront parameters of myopes and hyperopes at different levels of accommodation and pseudoaccommodation. In myopic eyes, vertical trefoil decreased down to negative values as the accommodative response improved. In contrast to that, in hyperopic eyes with large volume of pseudoaccommodation, SA decreased below zero.Myopia has been shown to be associated with reduced accommodation parameters as well as stronger HOA and pseudoaccommodation. Wavefront and accommodation parameters interrelations differ in myopic and hyperopic eyes. The nuances revealed should be taken into account when developing correction methods that purposefully influence refractogenesis.Цель - сравнительное изучение аккомодации, псевдоаккомодации и аберраций высшего порядка у детей и молодых лиц с миопией и гиперметропией. Материал и методы. Обследованы 39 миопических (в среднем (–)5,2±1,5 дптр) и 53 гиперметропических (в среднем (+)3,1±1,15 дптр) глаза у 46 пациентов 5-20 лет (средний возраст 11,6±0,6 года). Измеряли объективный аккомодационный ответ, запасы относительной аккомодации, объем псевдоаккомодации (как разницу между необходимым для чтения в условиях циклоплегии на расстоянии 33 см расчетным добавочным стеклом (+)3,0 дптр и силой минимального плюсового стекла, с которым в действительности было возможно чтение), аберрации высшего порядка: среднее квадратичное отклонение суммарных аберраций (RMS), вертикальный и горизонтальный трефойл (trefoil), вертикальную и горизонтальную кому (coma7, coma8), сферическую аберрацию (SA). Результаты. Объективные и субъективные параметры аккомодации были достоверно ниже при миопии, чем при гиперметропии, а аберрации волнового фронта (RMS HOA, вертикальный trefoil, coma7) и псевдоаккомодация - достоверно выше. Обнаружено достоверно более высокое значение SA при миопии в глазах с большим объемом псевдоаккомодации. В то же время выявлено несовпадение параметров волнового фронта при разном уровне аккомодации и псевдоаккомодации в глазах с миопией и гиперметропией: только в миопических глазах величина вертикального трефойла снижалась до отрицательных значений при повышении аккомодационного ответа; в гиперметропических глазах, в противоположность миопическим, при высоком объеме псевдоаккомодации SA достоверно снижалась, переходя в отрицательные значения. Заключение. При миопии выявлены снижение показателей аккомодации, повышение уровня аберраций высшего порядка и псевдоаккомодации. Параметры аккомодации и волнового фронта обнаруживают разную связь между собой в глазах с миопией и гиперметропией. Выявленные особенности следует учитывать при разработке методов коррекции, целенаправленно влияющих на рефрактогенез.

To study the magnitude of objective accommodative response (OAR) with account to the method of image defocusing. The latter can be realized by bringing the object nearer to the eye or by adding a minus lens in front of the viewer.We examined 63 patients (126 eyes) with different refraction aged from 7 to 31 years. All patients underwent a series of OAR measurements on WR-5100K Grand Seiko Binocular Open-Field Autorefkeratometer under different conditions, including negative spherical lenses of -3.0 D and -5.0 D, test optotypes corresponding to visual acuity of 0.2 and 0.7 and presented at a distance of 5 m, and a set of variably sized optotypes presented at a distance of 33 cm and 20 cm.A disparity was found between the magnitude of accommodative responses evoked through different means: placing a negative lens in front of the viewer while he/she looks into the distance or bringing the object closer to the eye. In almost all cases lens-induced responses were less pronounced than distance-induced. In all myopic children, accommodative lag was longer at near than at distance. Generally, in all groups, OAR to distant objects as well as responses to a 3.0 D accommodative task at near did not depend on the size of the object. There was an insignificant and statistically unreliable difference for objects placed 20 cm away (5.0 D accommodative task): OAR to a smaller font was stronger than that to a larger one.In children and adults with emmetropia, hyperopic children, and myopic adults, longer accommodative lags were characteristic of lens-induced responses. In children with myopia, longer lags were observed at near. Moreover, at near, OAR to a smaller font was stronger than that to a larger one.Цель - изучить величину объективного аккомодационного ответа (ОАО) в зависимости от способа расфокусировки изображения: приближением объекта или добавлением 'минусовых' линз при взгляде на удаленный объект. Материал и методы. Обследовано 63 пациента (126 глаз) с различной рефракцией в возрасте от 7 лет до 31 года (в среднем 21,2±0,3 года). Всем пациентам проведена серия измерений величины ОАО с помощью аппарата Grand Seiko Binocular Open Field Autorefkeratometer WR-5100K в разных условиях: с добавлением отрицательных сферических линз силой (–)3,0 и (–)5,0 дптр при фиксации оптотипов, соответствующих остроте зрения 0,2 и 0,7, на расстоянии 5 м и оптотипов разной величины на расстоянии 33 и 20 см. Результаты. Выявлено несоответствие величин аккомодационного ответа, вызванного разными способами: приставлением рассеивающих линз при взгляде вдаль и приближением объекта фиксации. Практически во всех случаях ленсиндуцированный ответ был ниже дистанционного. У детей с миопией отставание ОАО вблизи было выше, чем в зоне дальнего видения. В целом во всех рефракционных группах величина ОАО в зоне дальнего видения и при решении аккомодационной задачи в 3,0 дптр вблизи не зависела от размеров объекта фиксации. Незначительное, статистически недостоверное, различие выявлено для объектов на расстоянии 20 см (аккомодационная задача в 5,0 дптр): ОАО на мелкий шрифт был несколько выше, чем на крупный. Заключение. У детей и взрослых с эмметропией, детей с гиперметропией и взрослых с миопией отставание ленсиндуцированного ОАО превышает отставание дистантного ОАО. У детей с миопией большее отставание ОАО отмечено вблизи. ОАО на мелкий шрифт вблизи несколько выше, чем на крупный.