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An overview of the historical stages of “restorative ophthalmology” is presented, taking into account the main directions of the concept of “Wellness of Healthy Eyes” in order to prevent and correct asthenopia in patients with visually strenuous work, based on a three-level system of prevention and correction of functional visual disorders. The first level is aimed at increasing the patient’s awareness of issues of vision protection and hygiene. The second level is aimed at reducing the adverse effects of environmental factors on the state of vision. The third level is realized in the form of methods of specific and nonspecific stimulation of the organ of vision. The urgency of considering a new scientific problem in ophthalmology related to the development of the concept of diagnostics and assessment of the therapeutic measures effectiveness from the standpoint of modern requirements for medical rehabilitation has been substantiated. It is proposed that a practical solution to this problem should be carried out through the development of qualificatory signs of the international classification of functioning, adequate questionnaires for assessing the “quality of life” in actual eye pathology (asthenopia,cataract), as well as an assessment of traditional (conservative, surgical) treatment from the standpoint of modern basic characteristics of medical rehabilitation (rehabilitation goal, rehabilitation diagnosis, rehabilitation prognosis, etc.). Conclusion. The most important task of medical focus is to preserve the functional state of the human operator’s visual analyzer at a level that allows performing professional activities with the required reliability and quality indicators.

Purpose: scientific substantiation and development of methodological principles of the “quality of life” (QOL) assessment questionnaire in patients with symptoms of computer visual syndrome (CVS).Material and мethods. As part of the first stage of the study, an individual interview was carried out (according to the standard developed methodology) with 100 patients with visually strenuous labor, according to the results of which the entire spectrum of complaints arising during prolonged work with a computer was determined (44 complaints in total). As part of the second stage, a special questionnaire was developed, in which the identified complaints were transformed into questions. The study involved 96 ophthalmologists aged 32 to 62 years with an average of 17.3 ± 1.4 years. The task of an expert ophthalmologist was to assess the relevance each of the questions in terms of the influence degree on the patient’s QOL, as well as the “severity” of the complaint in terms the of occurrence frequency.Results. The development of the questionnaire was based on the sequential implementation of five stages (development of a conceptual framework; development of a preliminary version and confirmation of validity content; additional modification; scaling procedure development; psychometric properties determination). The results obtained made it possible to form the questionnaire (22 questions) the final version, which (according to the analysis) meets the requirements of meaningful and constructive validity (specificity, reflection of questions and scales of significance for the patient, the results of an expert assessment by ophthalmologists of the psychometric response scale) with the weight coefficients development, the required values correlation coefficients (according to Pearson) between the relevance assessment of the question from the points according to the symptom severity, as well as the high level of consistency according to the “Cronbach-α” indicator.Conclusion. The main direction of the assessment QOL improving of a patient with GLC is active participation in the ophthalmologist’s questionnaire development. Our results determine that the expert assessment provides a mathematically confirmed choice of the most significant (in terms on QoL impact) subjective manifestations, which (in conjunction with the development of each patient’s possible responses expert assessments, in points) provides the required level of the questionnaire meaningful and constructive validity. The developed questionnaire can be recommended for further clinical testing.

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

The authors consider presented in the literature tested new approaches to diagnosis, prevention and correction of symptoms of asthenopia in persons visually-intense work related to theoretical aspects of asthenopia in fact, the selection of spectacle correction and application of a multidisciplinary approach. Determines the pattern of allocation in the traditional classification of asthenopia (accommodative, muscular, sensory) classification criterion is the presence or absence of phenomena of psychological maladjustment. Along with this, it is established that the astigmatic component correction of complex myopic astigmatism, it is advisable to perform in the range of 60–75 % of the required (according to cycloplegics examination of refraction). At the same time, the level of visual performance (in the most difficult conditions of presentation of test information of the type “choice of signal from several — evaluation of the signal — response ratio”) with incomplete (60–75 %) correction by 12.7–20.4 % (p < 0.05) is higher than with partial (75–85 %) and complete, taking into account minor differences in the achieved visual acuity (0.04–0.08, p > 0.05). In addition, the practical expediency of applying a multidisciplinary approach to the correction of asthenopia, based on the complex effects of specific and non-specific methods of stimulation of vision. It was found that the combined use of multidirectional technologies of physical impact (low-energy laser radiation, cranial osteopathic effects and special training of the cervical-thoracic spine) provides effective correction of accommodation disorders, which is confirmed by a pronounced, statistically significant positive dynamics of clinical and functional, ophthalmic-ergonomic and subjective indicators of the visual system after a course of therapeutic and restorative measures.

Laser technologies of corneal surgery perfection was one of the important events in ophthalmology in the past decades. Despite to the significant success in refractive surgery and the achieved high result in visual acuity, the ideal healing of the cornea, the absence of dry eye syndrome, some patients in the postoperative period present asthenopic complaints. Patients may notice a decrease in visual acuity when working near, difficulty in refocusing from far to near distance, fuzzy, blurred images, red eyes, tearing, periodic or permanent diplopia at different distances in the postoperative period. Adaptation to emmetropic refraction in these patients can cause discomfort, headache and visual fatigue even with insignificant visual loads, which leads to the development of asthenopia and worsening of their subjective status. Corneal refractive surgery leads to changes in the anatomical and optic parameters of the eye, which contributes to the formation of new accommodation-convergence interactions. If the accommodative and binocular functions were disrupted preoperatively, there is a risk of decompensation and development of postoperative asthenopic syndrome (AS). Refractive surgery, saving patients from glasses and contact lenses, can not completely eliminate their existing imbalances between accommodation and convergence. This can be explained with the fact that the existence of a formed pathological system does not cease with the elimination of the etiologic factor. In order to correct the disturbed parameters, additional research methods and effective methods of functional treatment of patients in the postoperative period were suggested. However, most of them are aimed at pathogenetic effects on accommodative muscles, often without taking into account disturbances in the oculomotor apparatus and binocular function. Thus, existing algorithms for investigating and managing patients with refractive disorders do not allow us to identify predictors for the development of asthenopia before refractive surgery, there is no set of preventive restoration measures aimed at restoring accommodative capacity and binocular interaction in the preoperative period to increase satisfaction with the results of surgery in patients at risk of postoperative AS.

Purpose. A comparative analysis of the results of two-stage optico-functional rehabilitation of patients with a high risk of postoperative asthenopic syndrome (AS).Materials and methods. 36 patients (72 eyes) who had no binocular vision at a distance of 5 m and had a symmetrical position of the eyes, or a position close to symmetry, were randomly divided into 2 equal groups of comparison. Patients in both groups underwent functional treatment followed by the correction of refractive errors with FemtoLASIK technology. To eliminate accommodation dysfunctions, a medical device OXYS was used. Diploptic treatment was carried out using a Speckle-M laser apparatus and Bagolini raster glasses. To expand fusional reserves, a prism compensator (OKP-20, Russia) and a Speckle-M laser apparatus were used. The patients of the first group underwent a fast course of medical and functional rehabilitation for 5 working days (2 times a day with a break of 2–3 hours). As an additional pharmacological support, daily instillations of phenylephrine hydrochloride 2.5 % without preservatives were prescribed. The other group received the same functional treatment for 10 working days.Results. After the fast and the standard rehabilitation courses, the patients revealed an increase in absolute accommodation and a decrease in the coefficient of micro fluctuations, an expansion of fusional reserves, an increase in stereovision acuity, and an increased number of cases of binocular vision. No statistically significant difference of clinical and functional parameters obtained as a result of the fast and the standard rehabilitation courses was revealed.Conclusions. Functional and medicament treatment of patients with refractive disorders and the absence of binocular vision prior to FemtoLASIK is shown to be effective. This treatment reduces the risk of postoperative AS and increases the patient’s satisfaction with the results of the surgery.

According to the definition of the Expert council on accommodation and refraction, asthenopia is a functional disorder of vision with typical symptoms manifested in the fact that visual work becomes difficult or impossible. The paper suggests a classification of asthenopias which generalizes literary data and takes account of the authors’ own research results. The classification distinguishes among four forms of asthenopia, depending on the causes inducing the condition: accommodative (or refractive-accommodative), muscular (motoric), sensory (neuroreceptive) and psycho-emotional asthenopia. We also propose to distinguish three stages of asthenopia with regard to the severity of the symptoms: compensation, subcompensation, and decompensation stages // Russian Ophthalmological Journal, 2016; 4: 69-73. doi: 10.21516/2072-0076-2016-9-4-69-73 .

A frequent reason for visiting an ophthalmologist for patients of working age is computer vision syndrome (CVS): statistics show that up to 90% of users of personal electronic computers (PCs) suffer from this disease. Therefore, the actual task of modern rehabilitation medicine and ophthalmology is the search for an effective and safe way to prevent and treat the CVS among employees of enterprises., The Purpose of This Study: Was a scientific justification, an assessment of the effectiveness and safety of the use of electroneurostimulation (ENS) of the cervical sympathetic ganglia in patients with CVS., Material and Methods: 120 patients with the syndrome observed on an outpatient basis were examined. Patients were divided into 3 groups using simple randomization method. The 1st group (the main group - MG) included 39 patients who, against the background of gymnastics of the oculomotor muscles and muscles of the shoulder girdle, used ENS on the area of the sympathetic ganglia; in the 2nd group (group of comparison - GoC) included 41 patients who strictly performed the same muscle gymnastics (after every 2 hours of work with the PC); Group 3 (control group - CG) consisted of 40 patients who took an ENS course of exposure in placebo mode. In the dynamics, the stock of relative accommodation, near heterophory, tear production, threshold electrical sensitivity of the retina, electrolability of the optic nerve, contrast sensitivity, reading speed, print speed and accuracy and the level of subjective asthenopia were evaluated., Results: Initially, groups of patients with CVS did not differ among themselves in any of the investigated parameters. After a course of procedures in the MG, in contrast to the other two (GoC and CG), statistically significant positive shifts were revealed in relation to the selected endpoints, reflecting the severity of asthenopia, sensorineural, accommodative and oculomotor functions of the visual analyzer, as well as ophthalmoergonomics. Of the side effects of the procedures were recorded: moderate drowsiness (in 4 patients), a feeling of heaviness of the head (in 1 patient) and an increase in blood pressure (BP) by more than 15% of the initial (in 1 patient). They disappeared on their own and did not require withdrawal of treatment. A patient who noted a single increase in blood pressure subsequently received therapy every other day. Redness of the skin of the neck in the area of application of the electrodes was found with the same frequency in MG and CG., Conclusion: The inclusion of ENS in the rehabilitation treatment of workers professionally using a personal computer significantly increases the effectiveness of therapeutic measures, which proves the appropriateness of applying the proposed technology in CVS. The therapeutic action of complex therapy is realized through the effect of the ENS on an important reflexogenic zone - the cervical sympathetic ganglia, the activation of which ensures the normalization of the central, peripheral and autonomic functioning of the visual analyzer. Analysis of the frequency of registration of side effects in patients of the three groups allows us to conclude that the technique is safe.

Purpose: To develop a rehabilitation system for people with functional vision disorders., Material and Methods: The study included 56 schoolchildren with functional visual impairments aged 8-17 years, among which 7 had spasm of accommodation, and 49 - paralysis or paresis of accommodation. The examination included visometry, refractometry, ophthalmometry, measurement of the axial eye length, absolute and relative accommodation parameters, fusional reserves, as well as character of binocular vision and asthenopic complaints., Results: The patients with spasms, pareses and paralyses of accommodation were revealed to have decreased visual acuity, absence or sharp decrease in absolute and relative accommodation, fusional reserves, and simultaneous vision. A method for treating such patients has been developed, which aims for improvement of the blood supply to the ciliary muscle, accommodation reflex, visual acuity and differential sensitivity of the retina, vergence and version accommodation tonicity, convergence and fusion ability. The treatment led to normalization of absolute and relative accommodation, and increase of fusional reserves. The character of vision became binocular, asthenopic complaints stopped. The 'anlauf' glasses allow long-term preservation of the effect of received treatment, as well as prevention of visual disturbances in eye-straining work., Conclusion: The complex approach to the treatment of patients with spasms, pareses and paralyses of accommodation leads to restoration of the functions of visual analyzer in fairly short time (15-20 sessions).

The authors present results of specified hygienically justified timing regulations for setting the variants of work and rest modes within electric welders shift, who work in various postures with variable visual strain while welding in heating microclimate.

Peculiarities of drivers' work require visual strain. The studies prove considerable changes in accommodation (value of absolute and resources of relative accommodation), muscular balance, visual performance in correction test, that prove visual fatigue of automobile drivers, especially aged 20 to 30.