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The review presents recent research works on new technologies of scleral collagen crosslinking, a promising approach to sclerastrengthening treatment of progressive myopia. We assess the advantages and limitations of a number of experimental techniques of photochemical and medicinal crosslinking of the sclera, as well as donor tissue crosslinking aimed at optimizing the plastic material for sclera-strengthening surgery. Successful experiments and effective first clinical implementation results of the approach can be viewed as the basis for its further improvement and wider introduction of the technology into ophthalmological practice.

Purpose: to evaluate the effect of wearing glasses with Stellest® lenses on the spherical equivalent of refraction (SER) dynamics, the yearly progression gradient (YPG) and the axial length (AL) of the eye in children with progressive myopia 12, 18 and 24 months after the start of use. Material and methods. The main and the control groups of the study included children aged 8 to 13 years with low to moderate myopia at the beginning of observation. Stellest® glasses (the main group) were prescribed to 35 children with myopia 3.15 ± 0.19 D, while single vision (SV) glasses (the control group) were prescribed to 32 children with myopia 2.68 ± 0.18 D. The dynamics of the SER, YPG, and AL of the eye were assessed. Results. In the main (Stellest®) group, after 24 months of observation, SER increased by ave. 0.20 ± 0.06 D. YPG was shown to decrease in 93.5 % of cases by ave. 0.81 ± 0.05 D. The AL increased by an average of 0.15 ± 0.03 mm. In the control group, after 24 months of observation, the SER averaged 0.95 ± 0.08 D. YPG showed a decrease of ave. 0.38 ± 0.05 D in 61.1 % of cases. The AL of the eye increased by an average of 0.48 ± 0.04 mm. Conclusion. Stellest® glasses, if worn constantly, effectively slow myopia progression and axial elongation as compared with SV glasses. By the end of the follow-up period, in the Stelest® group, SER showed an increase by 79 % less than in the control group of SV glasses, and the AL showed increase in the length of the eye which was 69 % less than in the control group. Over the 24 months’ wearing of Stellest® glasses, YPG turned out to be 4.8 times lower than in the control group.

Purpose: to develop a technique for an objective multifactorial assessment of accommodation parameters, including accommodation stability and microfluctuations (MF), and an assessment of the diagnostic value of the technique. Material and methods. The dynamic monocular accommodative response (MAR) was measured using a WAM-5500 device (Grand Seiko, Japan) over a period of 10 to 60 seconds with a recording frequency of at least 6 Hz. The approximating cubic spline was calculated, and the temporal change of signal trend was assessed. The developed technique was used to evaluate the dynamics of MAR for 46 eyes of 23 patients aged 8–12 years with acquired myopia from -0.87 to -5.75 D (ave. -2.96 D). Results. In the examined eyes, the MF frequency varied from 0.4 Hz to 2.3 Hz (ave. 1.4 Hz), and the maximum amplitude ranged from 0.4 D to 2.47 D (ave. 1.2 D). Over the research period, the MAR trend remained constant in 10 eyes, increased from 0.17 to 0.47 (ave. 0.29 D) in 8, and decreased from 0.1 to 1.53 D (ave. 0.35 D) in 28 eyes. MAR varied from 0.79 to 2.63 (ave. 1.8 D). A correlation was found between the minimum MAR and the signal range with the trend level (r= 0.29 and r=0.4, respectively) and a weak correlation was revealed between the MF frequency and the signal range (r=0.2). A set of criteria for accommodation instability was identified: a decreasing trend of more than 0.35 D, a MF frequency of more than 1.4 per second and/or a maximum signal span of more than 1.2 D. Conclusion. The developed technique or objective multifactorial assessment of accommodation parameters, including stability and MF, in real time and space proves to be useful for the diagnosing of accommodation disorders.

Purpose: to study the relationship between the parameters of reflex and tonic accommodation measured using various objective methods.Material and methods. A comprehensive parallel study of objective accommodation parameters of 57 children (114 eyes) with low and moderate myopia (average -2.6 ± 1.4 D) aged from 8 to 12 years (average 9.9 ± 1.6 years) was carried out on three devices: Grand Seiko WAM-5500K, Acomoref 2 K-model Righton; TONOREF III, Nidek.Results. Both coincidences and differences of the indicators obtained by different methods as well as their correlations were revealed: positive - between the values of AR in the open field and in the virtual space (r = 0.23, r = 0.2); between the virtual responses to Righton K-2 and Nidek (r = 0.38); direct correlations of the accommodation response with accommodation tones. A correlation of average strength (r = 0.44) was found between the HAT on the Grand Seiko WR-5100K and the CMF on the Righton K2, which allows us to consider them as synonymous indicators. A negative relationship of CMF with PRA and SE refraction was found. A positive correlation of CMF with the rate of progression of myopia and a negative one with PRA suggests that a high CMF is a bad prognostic sign. However, CMF positively correlates with the magnitude of the accommodative response on all three devices. In this case, it turns out that an increase in CMF accompanies an increase in the amplitude of accommodation and, therefore, is not always a troublesome factor. Perhaps we are dealing with the limits of the norm for this indicator, which still need to be studied.Conclusion. With the help of objective methods of studying qualitatively different characteristics of one process, it is possible to investigate the actual and prognostic parameters of accommodation, which will allow us to offer an individualized approach to the treatment of patients with myopia using optical and drug instruments.

The article discusses the main etiological factors in the development of binocular diplopia and differential diagnostic signs of diplopia induced by late acquired comitant and incomitant strabismus.Purpose: to identify the most common causes of binocular diplopia in adults, and to assess typical features of various etiologies of binocular diplopia.Material and methods. 168 patients with binocular diplopia aged 6.5 to 85 years received a complete ophthalmological examination, which included a qualitative evaluation and characterization of the nature of diplopia, and determination of eye mobility in eight directions of gaze which indicated the affected muscle. A numerical assessment of diplopia was done using a prismatic compensator.Results. In 66.7% of cases, diplopia was induced by comitant strabismus, predominantly (96.4%) the converging one. A comitant strabismus with a small angle was observed more frequently than one with a larger angle: 5° or less, in 50% of cases, and 10° or less in 25% of cases. In 64.3% of cases, the deviation angle did not conform with the value of the compensating prism, which turned out to be twice as high as the “calculated values”. In 79.5% of cases, diplopia induced by comitant strabismus developed before the age of 45. In 33.3% of cases, diplopia was induced by incomitant strabismus, with the deviation angle varying from 0 to 35°, different directions of eye deviation, and limitation of mobility. In 44.6% of cases, mobility restrictions could not be visually detected. The deflection angle conformed to the strength of the compensating prism. In 58.9% of cases, diplopia induced by incomitant strabismus developed at the age of 45 years and older.Conclusion. Diplopia frequently develops in young and middle-aged people. The most common cause of the development of diplopia is a late acquired comitant converging strabismus with a small angle (5° or less), which develops in parallel with myopia. A correct identification of strabismus nature (comitant vs. incomitant), which induces diplopia, contributes to optimally choosing a further tactics for diplopia elimination.

Purpose: to compare anatomical and optical parameters and aberrations of both eyes in patients with acquired and congenital anisometropic myopia.Material and methods. 22 patients (44 eyes) aged 18–35 (averagely, 25.2) with acquired and congenital anisometropic myopia were examined using the Galilei G6 optical eye system analyzer (Ziemer, Switzerland). The analysis of total, corneal and internal aberrations of the eye was carried out on an OPD-Scan III (Nidek) aberrometer.Results. In both groups with acquired and congenital anisometropic myopia, the axial length of the higher myopic eye was greater than that of the fellow eye. A greater asphericity and higher astigmatism of the cornea were revealed in higher myopic eyes of patients with congenital myopia as compared to acquired myopia. The total RMS HOA in congenital myopia was significantly greater in the higher myopic eye compared to the fellow eye (1.07 D and 0.68 D, respectively) and greater than in cases of acquired myopia. All HOA were greater in higher myopic eyes as compared to the fellow ones in cases of congenital myopia. In case of acquired myopia only the total coma appeared to be greater in the higher myopic eye. Corneal aberrations in acquired anisometropic myopia did not differ in the paired eyes. In case of congenital myopia, the total tilt was significantly greater in the higher myopic eye, and total coma and spherical aberration have lower values, even with a transition to negative ones (p < 0.05).Conclusion. The revealed differences of the wavefront of the eyes with anisometropic congenital and acquired myopia are rather a consequence of anatomical and optical differences (the axial length of the eyes and the topography of the cornea), than the cause of anisometropia.

Purpose: evaluation of the remote functional and refractive results of mixed astigmatism correction in preschool children with “plus” cylinders in the framework of a long-time longitudinal study.Material and methods. 38 children (75 eyes) aged 1.5–7 years (averagely 4.2 years) with mixed astigmatism of 0.75 to 4.25 D (averagely 1.85 D) were followed up for 6-15 (averagely 7.3) years. At the first examination, all children were prescribed to permanently wear (+) cylinders of 0.5 D to 3.5 D. Over the follow-up period, (+) Cyl could be weakened in 24 eyes (32 %) due to a decrease in astigmatism, while (-) Sph had to be added in 24 eyes (32 %). due to an increased refraction. In cases when the full correction using a “plus” cylinder left an excessively large myopic defocus, the power of the “plus” cylinder was reduced so as not to add a “minus” sphere, and a second pair of glasses was prescribed for near vision, which offered a full correction of astigmatism with the “plus” cylinder.Results. After 6–15 years, astigmatism changed in 85 % of the examined eyes: it increased in 7 eyes (averagely, by 0.3 D) and decreased in 53 (averagely, by 0.9 D, p < 0.05; with the maximum reduction of 2.75 D). The spheric-equivalent refraction changed in 51 % of eyes, with an average increase of 0.53 D. The maximum increase of refraction was 2.8 D, while the maximum drop was 1.4 D. Visual acuity of the children who wore the prescribed eyeglasses permanently, showed after two years an increase, average achieving the level of 0.84, which by the end of the follow-up period achieved 0.99.Conclusion. The proposed plan of mixed astigmatism correction, which preserves residual weak myopic defocus, fully ensured both tactical and strategic effects: prevention and elimination of amblyopia, and containment of refraction myopization.

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.