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Purpose. To examine clinical examples of the visual organ condition in patients with visually intense work (VIW) after cataract phacoemulsification (CEP) from the standpoint of ophthalmo-ergonomic indicators and “quality of life” (QOL).Methods. Clinical examples are based on observation of CEP patients after standard bilateral CEP and implantation of an intraocular lens (IOL) with an extended focal depth (“RayOne EMV”, model RAO200E, “Rayner Intraocular Lenses Limited”, Worthing, UK). Three months after the surgery on the second eye, patients underwent a comprehensive examination of their vision based on standard clinical methods (visometry, keratorefractometry, etc.), assessment of functional (objective accommodation) and ophthalmo-ergonomic (“Eye meter”, “Visual search” tests) indicators, as well as a study of QOL (according to the “FEC-22” questionnaire). The article presents two clinical examples, each of which comparatively discusses the examination data of two VIW patients — air traffic controllers.Results. The first clinical example presents a significant (15.9 %) deterioration in visual performance (VP) according to the “Eye meter” test under conditions of a deficit (3 sec) of time for presenting the test task, which is associated with the patient’s anisometropia (0.2 relative units). The second example presents a decrease (20.8 %) in VP according to the “Visual search” test due to the patient’s impaired accommodative function of the eye (habitual excessive accommodative tension). In both cases, the identified dynamics are accompanied by a decrease in the QOL indicator (by 3.7–5.8 %, respectively) according to the “FEK-22” questionnaire, which is associated with the methodological features of the development of this questionnaire.Conclusion. Conducting an ophthalmo-ergonomic examination in cataract surgery reflects the “social model” of health, which considers limitations of life activity as a social problem and, therefore, the goal of treatment is the complete integration of the individual into society or, in other words, preserving the “professional” vision of the VIW patient and continuing (after surgery) everyday visual activity with the required indicators of visual performance. Ophthalmo-ergonomic indicators closely related to the patient’s QOL allow us to determine the “reference points” for conducting the necessary set of therapeutic and preventive measures to preserve the “professional” vision of the VIW patient.

Purpose: analysis of clinical cases illustrating the classification features of severe stages of proliferative diabetic retinopathy (PDR).Patient and methods. Three clinical cases of PDR are presented, in which ophthalmoscopic signs (according to the classification of the Early Treatment Diabetic Retinopathy Study, 1991) corresponded to severe PDR (high risk 1, high risk 2) and advanced PDR. The ophthalmological status was assessed using standard methods based on measuring the best corrected distance visual acuity, performing ultrasound (Opticon 2000, Italy), photographic recording of the condition of the fundus (Carl Zeiss Visucam 500, Germany) and optical coherence tomography of the macular region (on an RTVue-100 tomograph, OptoVue, USA).Results and conclusion. The presented clinical examples will provide the ophthalmologist with a more complete understanding of the clinical picture of pathological changes in the retina in diabetes mellitus, which will ultimately increase the level of diagnosis and tactics of surgical intervention both during the initial (preoperative) examination and after vitrectomy.

Purpose — to study the dynamics of accommodative asthenopia (AA) in patients with visually stressful labor (VLT) after laser keratomileusis in situ (LASIK) with different degrees of myopia. Patients and methods. There were 300 patients with VLT under supervision, divided into three groups of equal age and gender, corresponding to weak (up to 3.0 diopters, 100 patients, 200 eyes), medium (3.25–6.0 diopters, 100 patients, 200 eyes) and high (6.25–8.0 diopters, 100 patients, 200 eyes) degrees of myopia. All patients underwent objective accommodation using the Righton Speedy-I device (Japan) with further calculation of the coefficient of microfluctuations of the ciliary muscle of the eye (CMF). Diagnosis of the type of AA was carried out according to the following indicators: with CMF less than 53.0 rel. un. — asthenic form of accommodative asthenopia (AFAA); at CMF from 53.0 to 58.0 rel. un. — NORM; at CMF more than 58.0 rel. un. — habitual excess tension of accommodation (PINA). The survey was carried out before and three months after the operation. Statistical analysis of the results of the study was performed on the basis of the rate of occurrence (in % of the total number of eyes) of different dynamics (before-after surgery) AA (NORM-NORM; PINA-PINA; AFAA-AFAA; NORM-AFAA; NORM; PINA-AFAA; AFAA-NORM; AFAA-PINA). Results. The change in the form of AA varied from 2 % (APAA-PINA) to 18 % (PINANORM), averaged 15 % and was not statistically significant. The results obtained naturally reflect the state of AA as an adequate physiological response of the accommodative system of the eye to long-term, intense visual work with a fairly high level of responsibility for the result. Based on the above situation and the patient’s desire to maintain (in some cases even increase) the volume of daily visual load after the operation, it is unlikely to expect a significant improvement in the state of accommodation. Conclusion. LASIK with different degrees of myopia in patients with VLT has practically no effect on the dynamics of AA and requires a complex of therapeutic and restorative measures based on the development of methodological principles from the standpoint of a differentiated approach to the form of AA and the basic provisions of medical rehabilitaton.

Purpose: to study the relationship of various forms of accommodative asthenopia (AA) with the characteristics of the professional activity of patients with visually stressful work (VSW) with the phenomena of computer visual syndrome (CVS).Methods. There were 150 patients with VSW — professional users of personal computers (mean age 28.8 ± 1.4 years) with myopic refraction (mean value of spherical equivalent 2.8 ± 1.1 diopters) under observation. The patients were divided into three groups: “normal” (50 patients); asthenic form of accommodative asthenopia (AFAA, pathology, 50 patients); habitual excessive tension of accommodation (HETA), pathology, 50 patients). All patients underwent a comprehensive ophthalmological examination for 13 parameters. As a basic diagnostic method, a specially developed questionnaire aimed at assessing professional activity was used. Statistical analysis of the results of the study was performed on the basis of an assessment of the average values of the correlation coefficients (ACC) between the patient’s responses (in points) and the studied indicators of the visual system.Results. High ACC were determined on issues characterizing the amount of daily visual load. However, no differences were found between APAA and HETA. The occurrence of AFAA is more often associated with the input of information, HETA — with reading. Evaluation of issues related to the regularity of the use of optical correction revealed differences in ACC (p < 0.05) between the “normal” group and the “pathology” groups, while in the “normal” group, optical correction was used in most cases “often” or “constantly”, in the “pathology” groups — “sometimes”.Conclusion. The results of the correlation assessment of the relationship between various types of AA in patients with VSW with the characteristics of professional activity and the parameters of the visual analyzer indicate the leading role of the duration and nature (input, reading of information) of daily work at a personal computer. One of the leading risk factors for the development of AA is inadequate optical correction. At the same time, there were no significant differences between AFAA and PINA. The most informative parameters of the accommodative system of the eye are the volume of absolute and relative accommodation (by the subjective method), as well as the coefficients of microfluctuations and stability of accommodogram (by the objective accommodation method).

Рurpose — to study the frequency of occurrence of various forms of accommodative asthenopia (AA) in patients with visually stressful work (VSW) with different degrees of myopia planning LASIK.Methods. As part of the preoperative examination, 300 patients with VSW were under observation. There were three groups of equal age and gender, corresponding to weak (up to 3.0 diopters, 100 patients), moderate (3.25–6.0 diopters, 100 patients ) and high (6.25–8.0 diopters, 100 patients) degrees of myopia. All patients underwent objective accommodation using the Righton Speedy-I device (Japan) with further calculation of the coefficient of microfluctuations of the ciliary muscle of the eye (KMF). Diagnosis of the type of AA was carried out according to the following indicators: with KMF less than 53.0 rel. un. — asthenic form of accommodative asthenopia (AFAA), pathology; at KMF from 53.0 to 58.0 rel. — norm; at KMF more than 58.0 rel.un. — Habitual Excessive Tension of Accommodation (HETA), pathology.Results. The incidence of AA (any form) was 51–57 % and weakly depended on the degree of myopia. A significant increase (compared with the literature data) in patients with AA according to the results of this work is due to the following factors: the examination of patients exclusively with VSW, who daily perform professional visual activity at the time of the examination, as well as a wide (24–34 years) the age range of the subjects. The probability of occurrence of HETA and AFAA is quite comparable and amounted to 29–36 % and 21–23 %, respectively. The obtained results are illustrated by typical accomodograms. Conclusion: the high incidence of both forms of AA actualizes further research aimed at assessing the dynamics of the state of the accommodative system of the eye after excimer laser surgery for myopia, as well as the development of a method for correcting AA, taking into account a personalized approach that allows performing the correct diagnosis of various forms of AA (HETA, AFAA), which, ultimately, will provide adequate treatment from the position of choosing both the actual method (physical factor) and the required optical, amplitude and time parameters of exposure.

Purpose. Comparative assessment of the dynamics of visual performance (VP) of a patient with visually intense work with binocular cataract after various technologies of cataract phacoemulsification (PEC).Methods. There were 300 patients with binocular cataract under our observation. Patients were divided into three equals in number (n = 100), age (from 38 to 66 years, mean age 55.8 ± 1.3 years), gender (78 % — men; 22 % — women), refractive values of the group who underwent PEС using the following technologies: delayed sequential bilateral cataract surgery (DSBCS), immediate sequential bilateral cataract surgery according to the traditional (trISBCS) and developed algorithms (maISBCS). Examination of the state of vision of patients in all groups was performed before and 3 months after surgery according to clinical (BCVA in terms of the difference between the first and second eye) and the following ophthalmo-ergonomic indicators, which were assessed using special computer programs: “Visual productivity”, “Glazomer”, “Visual search”.Results. Differences between the clinical outcomes of the first and second eyes with maISBCS and DSBCS are practically insignificant (UDVA within 0.02 rel. units), after trISBCS they are statistically significant (by 0.08–0.09 rel. units, p < 0.05). After the operation, a pronounced (p < 0.001) increase in VP was noted in all groups. At the same time, there were differences between the groups of patients who underwent maISBCS and trISBCS, manifested by a decrease in VP in the trISBCS group according to the “Visual Search” and “Eye Meter” tests, by 16.1–22.1 % (p < 0.05).Conclusion. The postoperative level of VR achieved during maISBCS and and DSBCS is almost identical. It has been determined that with an increase in the level of complexity of the ophthalmo-ergonomic tests presented (“signal-response”; “selection of a signal from several — response”; “selection of a signal in conditions of time pressure”), there is a corresponding increase in the difference in the level of SR between groups of patients who were maISBCS and trISBCS, were performed (by 1.5 %, p > 0.05; 16.1 %, p < 0.05; and 22.1 %, p < 0.05, respectively), which may be associated with the occurrence of postoperative anisometropia.

Purpose. Development of the final version of the “quality of life” (QoL) questionnaire for a patient after cataract phacoemulsification (PEC) based on an expert assessment by ophthalmologists.Methods. According to the results of the previously completed stage of work, 35 possible complaints of the patient were identified. The study was performed with the participation of 47 expert ophthalmologists with professional experience from 7 to 35 years (average 19.2 ± 1.4 years), including experience in performing PE from 1 to 24 years (average 11.9 ± 1. 7 years). Each of the experts performed three main tasks: analysis of the primary version of the questionnaire for adding and (or) correcting questions; assessment of the relevance of each of the questions from the standpoint of the degree of influence on the patient’s QoL (0 points — the question is not relevant; 10 points — the question is very relevant); assessment of the “severity” of the complaint in terms of the frequency of occurrence (in the range from 10 points — the occurrence of a symptom does not determine the severity of the disease, to 0 points — the occurrence of a symptom determines the highest severity of the disease). At the same time, the following scaling procedure was used: “Practically no problems” (occur during 0–4 % of the patient’s total active time), “Mild problems” (5–24 %), “Moderate problems” (25–49 %), “Severe problems” (50–95 %), “Absolute problems” (96–100 %). “Virtually no problems” was indicated as 10 points.Results. As part of the solution of the first task, the number of questions was increased from 35 to 52. Mathematical analysis of the results of the second task was carried out on the basis of calculating the basic parameters of descriptive statistics for all 52 questions — the arithmetic mean (as a “weight” coefficient of the question) and standard deviation (as indicator of consistency of the position of the respondents). Subsequently, the “ejection” of insignificant questions was performed (according to the Pareto method with 80 % of the “pool” of questions with the maximum contribution to relevance), as well as the clinical association of similar questions and the assessment of statistical validation (feasibility) of such an association.Conclusion. An expert assessment of ophthalmologists confirmed the validity of using the “social model” of health based on the development of “domains” of the international classification of functioning when developing the QoL questionnaire after FEC. The final version of the «FEC-22» questionnaire fully complies with the content validity requirements.

Purpose. Scientific substantiation of methodological approaches to the development of a “quality of life” (QoL) questionnaire after cataract phacoemulsification (PEC) in patients with visually stressful work (VLT), based on a “medico-social” health model.Methods. The study was carried out on the basis of methodological standards for the development of new tools for assessing symptoms in clinical medicine developed by specialists from the International Center for the Study of Quality of Life (St. Petersburg). This article presents the first stage of development aimed at the formation of a preliminary version of the questionnaire. The initial volume of questions (complaints) of the patient was carried out in the following areas: individual interviews (according to the standard developed methodology) with 50 patients with ZNT; analysis of proven methods for studying QOL in cataracts (“NEI-VFQ”, “Cataract Symptom Scale”, “Catquest-9SF”, etc.); analysis of proven methods for studying QoL in keratorefractive surgery and asthenopic conditions in patients with RNT; analysis of the classification structure of the International Classification of Functioning (ICF) from the standpoint of the development of characteristic “domains”.Results. The data obtained indicate that a total of 35 patient complaints were identified (7 — “visual”; 6 — “professional”; 16 — “functional”; 4 — “household”; 4 — “medical and psychological”). The fundamental difference between the development of the methodology for assessing the patient’s QoL after performing PE is the use of a “social model” of health, which confirms the leading (46 % of all complaints) place for “functional” manifestations of the patient’s subjective status, based on specific “domains” of the ICF. Along with this, the practical application of the basic provisions of the ICF involves scaling the severity of the patient’s complaints in the context of the ratio of the duration of the complaint to the total active time of the patient with a gradation: “Mild problems” (5–24 %); “Moderate problems” (25–49 %); “Severe problems” (50–95 %); “Absolute problems” (96–100 %).Conclusion. The results of the first stage of the development of the patient’s QoL questionnaire after the FEC testify to the compliance with clinical standards in terms of content validity, since the questions, scales and general content reflect the significance for the patient and important parameters from a clinical and functional point of view. A distinctive feature and scientific novelty of the questionnaire is the use of a “social model” of health based on the development of “domains” of the international classification of functioning, as well as optimization of the procedure for scaling patient responses.

The review presents an analysis of traditional and promising approaches to assessing the quality of life (QoL) in cataract surgery. Literature data indicate statistically significant correlations between QoL and objective indicators of the visual system both during the initial examination of the patient and, more importantly, in the course of therapy. Traditional approaches to the study of QoL in cataract surgery reveal a trend towards the development of targeted questionnaires featuring optimized psychometric testing of questions and the procedure for scaling answers. New QoL questionnaires are developed in order to improve the collection and evaluation of information by taking into account the quantitative assessment of patient complaints made by an expert ophthalmologist, who can reliably evaluate their impact on QoL. It also seems appropriate to use the "International Classification of Functioning, Disabilities and Health", develop more targeted questionnaires aimed at assessing modern aspects of cataract surgery, and optimize the study itself.

Purpose: a comparative assessment of the quality of life (QOL) of patients with symptoms of computer vision syndrome (CVS), depending on the type of accommodative asthenopia: habitual excessive accommodation stress (HEAS) and the asthenic form of accommodative asthenopia (AFAA). Material and methods. 60 patients aged 22–34 engaged in visually extensive work who had typical asthenopic complaints were examined. The main criterion for diagnosing the type of asthenopia was the coefficient of ciliary muscle microfluctuation, measured by objective accommodation on a Righton Speedy-I device (Japan). The patients were divided into two groups of 30 people each with similar age and sex distribution, corresponding to the two forms of asthenopia studied. The main method of QOL examination was the study of an innovative CVS-22 questionnaire filled in by the testees. Results. The comparative assessment of the overall test indicator revealed no significant differences between the examined groups of patients with HEAS (QOL = 40.2 ± 1.2 pts) and AFAA (QOL = 42.2 ± 1.0 pts), p > 0.05. For some of the complaints, certain differences were found, partly associated with the pathogenesis of HEAS and AFAA, however, they do not fully reflect the “specificity” of the main types of accommodative asthenopia. Conclusion. The results obtained indicate the absence of reliable subjective diagnostic criteria of CVS. The fact may be associated with a wide range of risk factors for the development of functional disorders of the body in general and the visual system in particular when the patients is engaged in activities requiring the use of electronic systems in information management.

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.

The purpose is to conduct an expert (medical) assessment of the main complaints of patients with symptoms of computer visual syndrome (CVS).Methods: as part of the preliminary stage of work, an individual interview was performed (according to the standard developed methodology) with 100 patients aged 24–36 years, whose professional daily activity (at least 2 years) was characterized as visually-intense work associated with electronic systems displaying information (at least 4 hours a day) and with a fairly high level of responsibility for the final result. During the main stage of the study, a special questionnaire was developed, in which the identified complaints were transformed into questions. The task of the expert — ophthalmologist was to assess the relevance of each of the questions in terms of the severity of the impact on the “quality of life” of the patient. In this case, the assessment was carried out on a 10-point scale, where 0 points — the question is not relevant; 10 points — the question is very relevant. The study involved 96 ophthalmologists aged 41.3 ± 1.6 years (age range from 32 to 62 years) with an average of 17.3 ± 1.4 years of professional experience (range from 6 to 37 years).Results: more pronounced “ocular” manifestations of the CVS were established (mean score — 8.0 ± 0.2, range from 5.0 to 9.4 points, the highest scores for 8 complaints from 8.6 to 9.4 points) compared with “visual” (average score — 6.5 ± 0.2, range from 4.1 to 8.8 points, the highest scores for 5 complaints from 7.8 to 8.8 points). A sufficiently high level of practical significance of “professional” subjective manifestations of the CVS has been established.Conclusion. The obtained data can be basic in the framework of the prospective development of a questionnaire for assessing the “quality of life” of patients with CVS symptoms, since the use of an expert (medical) assessment of identified complaints from the position of the severity of a change in subjective status significantly increases the level of reliability, reliability, as well as meaningful and constructive validity methods of assessing the “quality of life”.

Purpose: to analyze the main subjective manifestations of computer vision syndrome (CVS).Materials and methods. We examined 100 patients aged 24–36, whose daily professional activity (at least for 2 years) involved visual-intensive work associated with electronic display systems (at least 4 hours a day) and requiring a sufficiently high responsibility level. All patients had complaints characteristic of asthenopia in CVS, indicating the stages of subcompensation or decompensation (in accordance with the recommendations of the Expert Council for Accommodation and Refraction of All-Russian Public Organization “Association of Ophthalmologists”). Each patient underwent an individual interview which was conducted according to the standard technique in order to identify the range of complaints that arise from long-term work with a computer.Results. The most common ocular (visual) subjective manifestations included the foreign body sensation, “sand” and itching in the eye; dry eyes; tiredness of vision; redness of the eyeballs; tension of eye muscles; “cramps”, burning in the eye — (which was mentioned by 100% of the testees). Other manifestations were somatic (headache — 89%; pain in the neck and the back — 79%), professional (patients wishing to interrupt work or take a break — 83%; periodic loss of visual concentration — 77%) and medico-psychological (the fear of vision deterioration — 65%).Conclusion. The established subjective manifestations improve the prospects of CVS diagnostics and can serve as basis for assessing the quality of life of patients engaged in vision intensive work.

Purpose: to study the clinical and functional state of the visual analyzer of patients after surgery for the epiretinal membrane (ERM) from the standpoint of the relevance of postoperative rehabilitation.Patients and methods. There were 158 patients under observation (158 eyes, main group, MG), among whom 66 % were men, 34 % were women aged 45–74 years (the average age of patients was 62.4 ± 1.5 years) with a diagnosis of ERM. At the same time, the leading form of ERM was idiopathic (122 patients, 77.2 %). As a control group (CG), were examined 32 patients of equal age and gender, who did not have visual organ pathology. In order to remove ERM, all patients underwent subtotal posterior vitrectomy with intraoperative administration of antioxidants, in particular glutathione contained in a balanced salt solution “BSS-PLUS” (Bausch + Lomb, USA). A comprehensive examination of the clinical and functional state of the visual analyzer was performed one month after surgery.Results. The data obtained indicate that almost all the studied parameters revealed a significant deterioration in the MG compared to the CG with a fairly good anatomical effect (the thickness of the central retinal zone after the operation was 287.1 ± 11.6 μm). In particular, a decrease in the subjective indicator “Quality of life” (by 53.1 %), as well as a deterioration in the objective indicators of the critical frequency of flicker fusion, the magnitude of the electrical lability of the retina and the threshold of electrical sensitivity of the retina (by 36.2; 38.2 and 45, 5 % respectively).Conclusions. A fairly good anatomical effect of vitreoretinal surgical intervention for ERM is accompanied (one month after the operation) by a significant decrease in the functional state of the visual analyzer. In order to restore vision more quickly, it seems advisable to conduct early postoperative rehabilitation (based on the complex use of physiotherapeutic effects and combined drug therapy) aimed at correcting functional disorders of the retina, which will lead to a decrease in the severity of characteristic complaints and an increase in the “Quality of life” of the patient.

Rehabilitation treatment of a patient with symptoms of computer visual syndrome and concomitant asthenic form of accommodative asthenopia in an asthenic-neurotic state of psychosomatic genesis is discussed. The treatment was based on an integrated approach that takes into account diagnostic criteria (the volume of absolute accommodation, indicators of objective accommodation, the severity of asthenopia, the state of psychological adaptation) and the basic principles of medical and rehabilitation measures, including, along with traditional methods of correcting asthenic-neurotic states, sequential and staged physiotherapeutic and optical-reflex effects on the accommodative system of the eye.

Optical-reflex treatment of patients with myopia and computer visual syndrome with a concomitant asthenic form of accommodation asthenopia seems relevant and not fully developed. The basic provisions that determine the tactics of treatment are monocular exposure in order to increase the absolute accommodation rate and staging (outpatient room, home conditions) of training. Measures aimed at improving the effectiveness of optical reflex treatment at home include the development of alternative instrumentation with reasonable (in accordance with the clinical and physiological characteristics of the functioning of the ciliary muscle of the eye) optical, amplitude and temporal parameters of the training process.

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.

Рurpose. Evaluation of the clinical efficacy of the original procedure for fixing the posterior chamber intraocular lens (IOL) after phacoemulsification of cataracts (FEC), complicated by the violation of capsular lens support.Patients and Methods. 194 patients were examined after FEC, complicated by a capsular lenticular impairment. They were divided into 3 groups. In the main group (OG, 64 eyes) the IOL was sutured with an original technique, fundamentally different method, there nodes formed at the ends of the filaments were fixed in the layers of the cornea. In 2 controls groups, there the traditional IOL under the scleral flap (K1, 68 eyes) was performed and the IOL was attached to the iris (K2, 62 eyes). A comprehensive examination of the patients’ vision state included an evaluation of clinical, functional and subjective indicators.Results. The lowest total probability of postoperative complications development was noted in OG (6.4%) compared to K2 and K1 (16.0–17.7%). The overall probability of changing the positions of the IOL in the exhaust gas is 6.4%, which is significantly lower than in the K2 (9.6%) and K1 (14.6%) groups. The developed method in comparison with the traditional methods of fixation provides a higher level of patient’s quality of life (by 10.2–11.7%, p < 0.05) and functional indicators associated with the brightness and contrast sensitivity of the eye.The conclusion. The developed technique provides, in comparison with the traditional, a higher level of safety and functionality of IOL fixation.

Effectiveness of the patients with the vitreoretinal pathology with different quality of life (QL) comparative evaluation methods. Methods. 129 patients (before and after standard vitrectomy) with the 3 types of the vitreretinal pathology were examined (38 — with intraocular hemorrhage, 43 — proliferative diabetic retinopathy (PDR), 48 — retinal detachment). Complex examination (36 clinical, haemodynamic and electrophysiological indications) were performed before and 1 month after surgery. QL research was based on the QL-25 (Russian type of the VFQ-25), QL-9 (Russian type of VF-14) and authorial QL-20 questionnaire. Results. QL increasing was detected after the surgery (15.8–20.9%) in all cases of the vitreoretinal pathology type. Correlation analysis of the different QL hasshown obvious QL-20 advantages, comparing to QL-9 and mostly QL-25, that was indicated by the statistically significant difference of the middle (all 36 indicators) KK (0,44±0,02; 0,35±0,02; 0,15±0,03) and higher KK relating to prognostic informative vision indicators (0,75–0,84; 0,69–0,74; 0,21–0,70). Conclusion. Results indicate actuality of the QL-20 method adaption in dispensary observation of the patients with different types of vitreoretinal pathology.

The aim of the study was to develop a methodology for assessing the quality of life in patients with different types of vitreoretinal pathology. The first stage is detection of target group, collection data of diseases, choosing the key features and principles of valuation developed questionnaire. The detailed list of questions, determination the type of questionnaire, method of data collection, as well as developing (if necessary) scaling system (indexation) of answers is made on the second stage. The preliminary version of questionnaire on the base on 2 first stage. At the final stage of development assess the reliability, validity and sensitivity of the method of construction with the possibility of some modification of both the questionnaire and psychometric evaluation of the parameters of the test should be accessed. We conducted a broad survey of 28 experts-ophthalmologists (mean age 42.4 years), with extensive experience as a general clinical practice (average work experience is 20.4 years), and immediate surgical operation in the field of medical and surgical treatment of patients with various types of vitreoretinal pathology. The list of suggested questions for patients (total 37 questions), and the time of occurrence of the symptom criteria for psychometric scale responses was presented to the every expert. The choice of psychometric rating scale is (along with the definition of specific issues) the basic methodological position of developing the questionnaire. The most appropriate time scaling with the month period. Therefore the answers were presented in the the form of «permanent», «once a day», «every week», «every month», «absent». From a practical point of view it is extremely important to the The consideration of a quantitative estimation of the responses is extremely important from the practical point of view.

Increased load on the visual analyzer of an operator, increase in everyday visual performance, universal introduction of information displaying on cathode-ray tubes result in temporary and stable visual disturbances. Accommodative refractive apparatus of an eye is one of the key points of application of visually intensive labor. Work associated with permanent eyestrain overloads oculomotor and accommodative apparatus thus provoking myopic shift, increase in dynamic refraction, exophoric or esophoric shift of initial visual equilibrium. Accommodation disorders are accompanied by changes in ciliary muscle blood supply, abnormalities of vegetative segment regulation, parasympathetic brain vascular dystonia due to the decreased tonus of sympathetic nervous system. Evaluation of certain kind of activity in terms of ergonomics includes examination of visual status and visual working capacity, development of visual professiograms and vision standards for certain professions, justification of methods and tools of visual work optimization. Visual disturbances in operators developing in the course of visually intensive occupational work should be considered from the viewpoint of traditional accommodation and refraction disorders as well as functional manifestations of general fatigue or thoracic cervical spine dysfunction. Symptoms of accommodative asthenopia can be regarded as a functional manifestation of general fatigue syndrome or functional neurosis. Development of multidisciplinary approach to the correction of accommodation refraction disorders in visually intensive labor persons is of scientific urgency and practical reasonability. There is a long-felt need in additional attraction of different specialists who use in their work physical factors for accommodative asthenopia correction. Development of multidisciplinary approach to accommodation refraction disorder correction in visually intensive labor persons is based on syndromic pathogenic treatment approach. Specific visual stimulation as well as tonic and psychorelaxation methods which provide correction of psychoemotional state and thoracic cervical spine dysfunction are the most actual tools. Cranial osteopathic therapy which uses specialized systems based on biological feedback principle are of special importance. These methods provide cervical muscle training and audio-visual stimulation as well.

Aim: To study the efficacy of functional (physiotherapeutic) stimulation of an eye in visually intensive work patients with the initial symptoms of presbyopia.Methods: 104 visually intensive work patients before and after complex physiotherapy (low-energy laser radiation, magnitotherapy, stimulation of accommodation) were examined.Results: Physiotherapy improved near vision (by 0.16 RU on average) and subjective psychophysiological status (by 11.8 %) and reduced eye strain (by 2.1 times). Additionally, objective accommodography indices improved, brightness sensitivity thresholds decreased by 16.5 %, and psychological status improved by 18.2 %. These positive effects of physiotherapeutic stimulation enabled to delay eyeglasses prescription for 6 months in 76 % of patients and for 9 months in 42 % of patients.Conclusion: Functional (physiotherapeutic) stimulation provides effective correction of initial presbyopia in visually intensive work persons.

Purpose: to study the dynamics of the volume was an accommodation during the day.Methods: We investigated the amount of accommodation in 36 patients (men aged 25-30 years) without pathology of the vision five times during the day.Results: the highest rates were observed in the amount of accommodation from 12 to 16 hours, the maximum oscillation is 1.34 D or 24.3%.Conclusion: the analysis of the accommodative function of the various problems of ophthalmology and alternative specialties (neurology, rehabilitation medicine, etc.) must be compared the identified changes in the state of the accommodative apparatus of an eye to possible biological rhythms during the day.