Low vision seriously affects life, work and study. Low vision in children not only has a huge impact on their future lives, but can also be a heavy burden on families and society. Low vision can cause autism and has a huge negative impact on a child’s personality building. The best time to treat weakness is before the age of 6, and it is difficult to cure after the age of 12. So severe amblyopia must be treated early by seizing the golden time for treatment.
I. Definition:
Severe amblyopia refers to amblyopia caused by high refractive error, monocular strabismus, nystagmus, post-cataract surgery, etc. It is called severe amblyopia. 0.2 or below low vision, which can seriously affect normal life, learning and work, but most of them can improve their vision through amblyopia training and greatly improve their life and learning ability, this paper refers to children with vision 0.2 or below, which can be improved through vision enhancement training, as children with low vision This paper refers to children with vision 0.2 or below, which can be improved by vision enhancement training, as children with low vision.
II. Principles of vision enhancement training for children with low vision
(a) The nature of low vision.
It is certain congenital causes (such as congenital cataract, strabismus, nystagmus or high myopia and high hyperopia, high binocular refractive error, etc.) resulting in visual cells in a state of inhibitory sleep or dysplastic atrophy (i.e., sleep, atrophy state).
(b) The basic principle of treating low vision: remove the cause, wake up the sleeping cells with special color light, and forge the atrophied vision with threshold icons.
(iii) The principle of vision enhancement of various therapeutic instruments to improve low ability.
1, the threshold icon vision enhancement function: is the most effective direct vision enhancement function, “threshold” is the threshold, that is, the child can just see clearly but there is a certain difficulty of the threshold, cross this hurdle, vision will improve.
(1) Threshold “E” or “C” icon: suitable for children over 3.5 years old (see Dr. Eye 3-5 generation amblyopia instrument for details)
(2) Threshold grating (visual physiology) icon: suitable for children under 2.5 years old and uncooperative (see Dr. Eye’s eye-mask type low vision amblyopia device for details)
(3) Threshold image icon: suitable for children aged 2.5 to 3.5 years old who can recognize images (see Dr. Eye’s eye-mask type low vision amblyopia device for details)
2.RGB color light vision enhancement function: It is the most effective function to wake up the visual cells and indirectly increase vision. It can wake up the three types of RGB visual cells (sensitivity) in the retina of the fundus and increase vision indirectly (such as the RGB color light enhancement in Dr. Eye amblyopia device);
3, RGB eye sensitivity vision enhancement: use RGB color light to wake up the sleeping visual cells and use color light position change to train focusing sensitivity.
III. Difficulties, methods and possibilities of vision enhancement training for children with low vision
(A) Difficulties of vision enhancement training for children with low vision.
The effect of vision enhancement training for children with low vision depends on three aspects: the thoroughness of removing the etiology, the age at the time of treatment and the vision enhancement training apparatus. However, it is very difficult to train low vision children in the highly sensitive period due to the lack of cooperation at a young age, incomplete removal of the cause, and inability to use efficient instruments.
Difficulty 1: The younger the age at which the vision enhancement training begins, the better the vision enhancement training effect. However, the younger the child, the less cooperative he or she is, and the more difficult it is to improve the visual enhancement effect. This contradiction must be resolved in order to achieve good results.
Difficulty 2: The higher the generation of vision enhancement training devices, the more functions, the higher the fineness, the better the effect, but the more difficult it is for children to cooperate. This contradiction must be resolved in order to achieve good results.
Difficulty 3: the cause is difficult to remove completely: such as strabismus correction is not in place or recurrence, cataract post-operative post-obstruction, high myopia, farsightedness, such as optometry, wearing glasses do not cooperate, etc. can significantly reduce the effectiveness of treatment.
(ii) Treatment plan for severe amblyopia.
1.Early: that is, start treatment as early as possible: amblyopia is stunted vision, just like a twisted sapling, the sooner it is corrected, the easier it is to recover.
2, mirror: that is, reasonable to wear glasses: required to wear all day (sometimes wear, sometimes not wear will reduce the effectiveness of treatment, or even ineffective). Note: farsightedness or astigmatism at the beginning of wearing glasses vision is mostly worse than not wearing glasses, can feel underground unevenness, dizziness or shaking, is normal, adhere to wear 3 to 7 days after adaptation, vision will rise. And myopia at the beginning of wearing a mirror vision is good, but with the development of myopia, vision will get worse.
3, instrument: that is, the choice of amblyopia instrument treatment with the condition: from the pathogenesis, amblyopia is manifested as vision “atrophy” and optic cell “sleep”, you can use the amblyopia instrument in the “icon” The amblyopia can be cured by using the “icons” in the amblyopia device to exercise the “atrophied” vision or using the “color light” to wake up the “sleeping” optic cells. Amblyopia apparatus can be divided into 6 generations according to the fineness of the visual marker, with or without strengthening function and myopia prevention and memory enhancement function. The 3rd generation or above is a compound amblyopia device that has both strengthening vision enhancement, myopia prevention and memory enhancement functions, which is suitable for refractory amblyopia and difficult to heal amblyopia.
4, cover: that is, cover the healthy eye (i.e., the eye with normal vision): when the difference in vision between the two eyes is more than 2 rows, cover the healthy eye with vision of 0.9 or more, which can lift the inhibition of the healthy eye on the poor eye, so that the poor eye can get more exercise and improve vision. When the vision of both eyes does not grow for a long time, you can cover both eyes alternately, changing “two-eye view” to “one-eye view” to increase the intensity of gaze and promote the growth of visual acuity.
The duration of eye coverage should be strictly controlled, either too long or too short is not conducive to improving visual acuity, and should be determined according to the child’s condition and level of binocular vision, the presence of strabismus and eye tremor, etc. (It is best to consult an experienced amblyopia treatment specialist).
(C) The most effective vision enhancement methods for children with low vision at low ages
1, non-cooperative children preferred eye-mask type amblyopia device (such as Dr. Eye eye-mask type low vision amblyopia device), can recognize the visual acuity table after the choice of 4-5 generations of embracing amblyopia device, in addition to having a variety of vision enhancement features, can prevent children’s non-cooperation, eye tremor, etc. resulting in training failure.
Having the above-mentioned RGB color light, threshold icon and visual focus sensitivity functions, etc..
2.Threshold icon function training: image type threshold icon for uncooperative people, “E” and C icons for cooperative people.
3, sensitivity color-coded visual augmentation training.
4, RGB visual physiological icon stimulation.
5.Removal of etiology.
(1) strabismus, first cure the healthy eye or postoperative treatment, or alternate cover eye
(2) Cataract: remove the posterior cataract (can IOL surgery to remove the anterior segment vitreous and posterior capsule membrane. Keep the pupil area more than 2mm transparent.
(3) Ocular tremor: take integrated tremor reduction measures to reduce tremor (see Prof. Liu Dongguang’s website for details)
(4) Fill-in treatment module for uncooperative children
1.Hooded amblyopia apparatus: it can cause absolute dark surroundings to reduce eye tremor, not affected by children turning their heads or eyes, so that children who open their eyes see the most effective vision-enhancing icons or color light and get the most effective vision-enhancing stimuli.
2, using low vision threshold icon vision table to check visual acuity, non-cooperative people take 0.03 a 0.05 as the basis for the production of threshold training icons.
3, RGB sensitivity moving color scale stimulation training.
4, the provision of four pulse light sources to awaken the visual cells.
5. single threshold image icon stimulation training.
6. multi-graphic threshold raster icons to stimulate training.
7.Children’s songs or music to increase brain excitability.
(v) The possibility of vision enhancement in children with low vision.
About 80% or more of children with low vision can improve their visual acuity by more than 3 rows through effective vision enhancement training, because
1, most of the causes of low vision can be prevented and treated: for example, strabismus, congenital cataract, can be surgically prevented and treated; high myopia, high hyperopia, high refractive aberration, can be corrected with glasses; nystagmus can be alleviated by using a comprehensive defibrillation method.
2, preschool children’s vision is in the developmental stage, low vision is like a sapling after effective training (using special color light to wake up the visual cells, using special patterns to exercise the atrophied vision), it is likely to redevelop, so parents should have confidence and actively cooperate with the doctor’s treatment.