Method for predicting unfavorable course of habitually excessive accommodation tension in school-age children

Abstract

FIELD: pediatric ophthalmology.SUBSTANCE: child undergoes an ophthalmological examination and additionally determines the amplitude of accommodation, the reserve of relative accommodation and the flexibility of the accommodative response. At the next stage, the heart rate variability indicators are recorded with the calculation of the standard deviation of successive cardiointervals SDNN, the root mean square deviation of successive cardiointerval differences RMSSD, and the LF / HF power ratio. Pupillometry is performed in four functional modes to determine the amplitude of accommodative miosis; a survey is conducted using the COMPASS-31 scale to calculate the total score; then psychofunctional testing is performed using the Luscher eight-color test to determine the vegetative coefficient. Next, an assessment is made of the quantitative values of the studied indicators, and if there are deviations from the threshold values of the studied indicators, an unfavorable course of habitually excessive accommodation tension (HEAT) and a high risk of its transition to myopia are predicted. In particular cases, pupillometry is performed at rest with accommodation, under the influence of a directed light stimulus, under an accommodative load, and under conditions of pharmacological cycloplegia. In a particular case, the threshold values of the indicators are: accommodation amplitude less than 8.6 diopters, relative accommodation reserve less than 1.5 diopters, decreased flexibility of the accommodative response relative to the age norm. In a particular case, the threshold values of the indicators are: SDNN < 30 ms, RMSSD < 25 ms, LF / HF > 2.0, accommodative miosis amplitude < 0.5 mm, total score on the COMPASS-31 scale > 30 units, autonomic coefficient according to the Luscher test > 1.8.EFFECT: method allows to increase the accuracy and informativeness of predicting the unfavorable course of HEAT and the risk of its transition to myopia.4 cl, 2 ex, 1 tbl

Description

[0001] The invention relates to the field of pediatric ophthalmology and is intended to predict the unfavorable course of habitually excessive accommodation tension in school-age children, taking into account the state of the autonomic nervous system and psychofunctional characteristics.

[0002] Technique level.

[0003] Habitually excessive accommodation tension (HAET) in school-age children is one of the most common forms of accommodation disorders. Modern research on accommodative disorders in children points to the significance of HAET as a leading risk factor for the development and progression of myopia. Diagnosis of this condition is traditionally based on ophthalmological parameters: the difference between manifest and cycloplegic refraction, accommodation amplitude, relative accommodation reserve, and accommodation flexibility. These methods can detect decreased accommodative function, but they primarily reflect the function of the ciliary muscle and do not take into account the influence of the autonomic nervous system or the child's psychofunctional state.

[0004] Meanwhile, it is known that ocular accommodation is regulated by the interaction of the sympathetic and parasympathetic divisions of the autonomic nervous system. Heart rate variability, pupillometric data, and cutaneous dermatographism may reflect the specifics of this regulation, but in ophthalmological practice, they are rarely used and are used in isolation. Subjective signs of autonomic dysfunction and emotional stress are determined using tests and questionnaires, but their results are usually not compared with ophthalmological data.

[0005] Therefore, there is no unified approach to comprehensively assessing the impact of autonomic regulation on the course of PINA in children. Existing methods do not allow us to determine the risk of an unfavorable course and the progression of PINA to myopia.

[0006] Thus, the urgent task is to develop a method that combines ophthalmological, autonomic and psychofunctional indicators into a single quantitative assessment system, ensuring increased prognostic accuracy and clinical information content when examining children with PINA.

[0007] A known method for predicting myopia progression in children includes a study of the accommodative function using computer accommodationography with the calculation of the accommodative response coefficients and microfluctuations, as well as the determination of corneal-compensated intraocular pressure taking into account the viscoelastic properties of the cornea. With a combination of habitually excessive accommodation tension (HECT) and weak accommodation, characterized by values ​​of the accommodative response coefficient less than 0.4 and the microfluctuation coefficient greater than 65, as well as with intraocular pressure of 18 mmHg and above, ophthalmic hypertension syndrome of accommodation overstrain is diagnosed and myopia progression is predicted (patent RU 2688710 C1, published 05 / 22 / 2019).

[0008] The disadvantages of this method are that it is aimed at predicting the progression of myopia and does not include an assessment of the autonomic nervous system and psychofunctional factors influencing accommodation regulation. It lacks an analysis of the interaction between ophthalmological and autonomic parameters, which precludes assessing the child's overall functional state and identifying the risk of an unfavorable course of PINA as a precursor. Furthermore, the method does not provide a comprehensive prediction of the progression of PINA to myopia, as it examines accommodative parameters in isolation, without considering systemic regulatory mechanisms.

[0009] The closest approach to the claimed prototype method is a differential diagnosis method for PINA, which consists of the following: Anamnesis is collected, autorefractometry, and computer accommodation are performed. If a history reveals a progressive decline in distance visual acuity, decreased vision with previously selected glasses or contact lenses, an increase in myopic refraction, as determined by autorefractometry with a small pupil and under cycloplegia compared to previous examinations, and an accommodative microfluctuation coefficient (AMF) greater than 62, as determined by computer accommodation, this condition is classified as PINA combined with progressive myopia.If a history of inadequate use of optical correction devices, as determined by autorefractometry, the presence of hyperopic refraction and astigmatism, and a CMF greater than 62 as determined by computer accommodation, is detected, this condition is classified as PINA associated with uncorrected hyperopic refraction and astigmatism. If a history of inadequate use of optical correction devices, as determined by autorefractometry, a refractive error difference between the right and left eyes of 1.0 D or more, and a CMF greater than 62 as determined by computer accommodation, is detected, this condition is classified as PINA associated with anisometropia. If a history of age over 35 years, any type of refractive error, according to autorefractometry data, the presence of a CMF above 62, according to computer accommodation data, is detected, this condition is classified as PINA in pre-presbyopic age.If a history of psychotropic medication use, any type of refractive error based on autorefractometry, or a CMF greater than 62 based on computer accommodation are detected in the patient's medical history, this condition is classified as acute ciliary stress syndrome (ACS) in patients taking psychotropic medications. If a history of refractive laser surgery within the last two weeks, myopic refraction based on autorefractometry, or a CMF greater than 62 based on computer accommodation are detected in the patient's medical history, this condition is classified as ACS as a consequence of acute ciliary stress following keratorefractive surgery.If a history of progressive vision loss, decreased vision with previously selected glasses or contact correction, difficulties in selecting optical vision correction means, progressive growth of myopic refraction and astigmatism, according to autorefractometry data during dynamic examinations, the presence of a CMF above 62, according to computer accommodation data, is detected, this condition is classified as PINA in patients with keratoconus (patent RU 2838551 C1, published 04 / 21 / 2025).

[0010] The disadvantages of this known method include its reliance primarily on ophthalmological parameters and reflecting only the state of the eye's accommodative apparatus. It does not take into account the influence of the autonomic nervous system and psychofunctional factors that can determine the nature and course of PINA. It does not assess objective indicators of autonomic regulation, nor subjective signs of emotional stress, which makes it impossible to identify autonomic dysfunctions or predict the risk of an unfavorable course of PINA and its progression to myopia.

[0011] The objective of the invention is to increase the prognostic accuracy and clinical information content when examining children with PINA.

[0012] The technical result consists in increasing the accuracy and information content of predicting the unfavorable course of PINA and the risk of its transition to myopia.

[0013] The proposed method is as follows.

[0014] A sequential, step-by-step assessment of the child's accommodative function and autonomic and psychofunctional regulation is performed. The first stage involves an ophthalmological examination, including determination of uncorrected and best-corrected visual acuity, manifest and cycloplegic refraction, and cycloplegia achieved using the standard 1% tropicamide instillation protocol. A quantitative assessment of accommodative function is also performed, including determination of the accommodation amplitude, relative accommodation reserve, and accommodation flexibility.

[0015] The next stage assesses the state of autonomic regulation. This includes recording heart rate variability, pupillometry in four functional modes (at rest with accommodation, under the influence of a directed light stimulus, under accommodative load, and under conditions of pharmacological cycloplegia), and a questionnaire using the COMPASS-31 scale with calculation of the total score. Heart rate variability is assessed using cardiointervalography in a sitting position after a 10-minute rest. The study includes an analysis of temporal and spectral parameters: the standard deviation of consecutive RR intervals (SDNN), the root mean square deviation of consecutive RR interval differences (RMSSD), the power of the low-frequency (LF) and high-frequency (HF) ranges, and their ratio (LF / HF).In pupillometry, the primary indicator is the amplitude of accommodative miosis, which reflects the degree of parasympathetic activation during accommodative loading and characterizes the functional state of autonomic regulation. The COMPASS-31 scale assesses six domains—orthostatic, vascular, secretory, digestive, genitourinary, and cardiovascular—after which a total score is calculated, reflecting the level of autonomic dysfunction.

[0016] The assessment of psychofunctional regulation is carried out using the eight-color Luscher test, according to the results of which the vegetative coefficient (VK) is determined.

[0017] Based on the collected data, an analysis of quantitative indicators of three functional areas—ophthalmological, autonomic, and psychofunctional—is conducted. Deviations in the threshold values ​​for each area are considered a criterion for an unfavorable prognosis for PINA and a high risk of its progression to myopia.

[0018] Table 1 presents the threshold values ​​of ophthalmological, autonomic and psychofunctional indicators.

[0019]

[0020]

[0021] According to Table 1, habitual excessive accommodation strain is confirmed when the difference between the manifest and cycloplegic refraction is greater than 0.5 D. A decrease in accommodation function is established when the accommodation amplitude is less than 8.6 D, the relative accommodation reserve is less than 1.5 D, and when the flexibility of the accommodative response is reduced relative to the age norm.

[0022] Autonomic dysfunction based on heart rate variability data is defined as SDNN less than 30 ms, RMSSD less than 25 ms, and LF / HF ratio greater than 2.0.

[0023] In pupillometry, the diagnostic criterion for autonomic dysfunction is a decrease in the amplitude of accommodative miosis of less than 0.5 mm, which indicates a deficiency of parasympathetic activation.

[0024] A COMPASS-31 questionnaire score of more than 30 points is also considered a sign of severe autonomic dysfunction.

[0025] Pronounced psychofunctional deviations according to the Luscher test are established with a VK of more than 1.8.

[0026] A decrease in accommodative function and objective signs of autonomic imbalance based on cardiointervalography and pupillometry, as well as significant psychofunctional abnormalities, are considered criteria for an unfavorable prognosis for the course of PINA and a high risk of its progression to myopia. A decrease in accommodative parameters is a mandatory prognostic factor, while abnormalities in autonomic and psychofunctional regulation are additional prognostic factors that refine the prognosis and allow one to determine the severity of the risk of myopia progression.

[0027] Implementation of the invention.

[0028] The invention is illustrated by the following specific examples.

[0029] Example 1.

[0030] A 10-year-old child complains of rapid fatigue during visual exertion and periodic blurred distance vision. Ophthalmological examination revealed manifest refraction of -0.25 D, cycloplegic refraction of +0.50 D, the difference between them was 0.75 D, which corresponds to habitual excessive accommodation tension (HAET). The accommodation amplitude is 7.8 D, the relative accommodation reserve is 1.25 D, and the flexibility of the accommodative response is reduced relative to the age norm. According to heart rate variability, SDNN is 26 ms, RMSSD is 20 ms, LF / HF is 2.5, indicating a predominance of sympathetic tone and a decrease in the adaptive reserve. Pupillometry showed an accommodative miosis amplitude of 0.4 mm, indicating a parasympathetic activation deficit. The COMPASS-31 questionnaire revealed a score of 36 units. The Luscher test revealed a VK of 1.9.

[0031] The combination of abnormalities in three functional areas—ophthalmological, autonomic, and psychofunctional—allowed us to predict an unfavorable course of PINA and a high risk of progression to myopia. The child is recommended to undergo correction of visual and autonomic impairments with dynamic monitoring every 6 months.

[0032] Example 2.

[0033] A 14-year-old child studies at a specialized lyceum with a high academic workload. Complaints of decreased visual acuity in the evening, pain in the eye area, and difficulty concentrating. Ophthalmological examination revealed: manifest refraction of -0.75 D, cycloplegic +0.25 D, difference of 1.0 D. Accommodation amplitude is 8.0 D, relative accommodation reserve is 1.3 D, flexibility of the accommodative response is reduced. Heart rate variability indicators: SDNN - 28 ms, RMSSD - 23 ms, LF / HF - 2.3 - indicating sympathetic dominance and instability of the regulatory systems. Pupillometry: accommodative miosis amplitude is 0.45 mm - a marked decrease in parasympathetic reactivity. COMPASS-31 - 32 units. According to the Luscher test: VK - 2.0.

[0034] The combination of deviations of indicators from threshold values ​​reflects pronounced tension of the accommodative apparatus, imbalance of autonomic regulation and psychofunctional overstrain, which allows us to predict an unfavorable course of PINA with a high risk of myopia progression.

Claims

1. A method for predicting the unfavorable course of habitual excessive accommodation strain in school-age children, including an ophthalmological examination, characterized in that the amplitude of accommodation, the reserve of relative accommodation, and the flexibility of the accommodative response are additionally determined; at the next stage, heart rate variability indices are recorded with the calculation of the standard deviation of successive cardiointervals SDNN, the root mean square deviation of successive cardiointerval differences RMSSD, and the LF / HF power ratio; pupillometry is performed in four functional modes with the determination of the amplitude of accommodative miosis; a survey is conducted using the COMPASS-31 scale with the calculation of the total score;then, psychofunctional testing is performed using the Luscher eight-color test to determine the vegetative coefficient, then an assessment of the quantitative values ​​of the studied indicators is carried out, and if there are deviations from the threshold values ​​of the studied indicators, an unfavorable course of habitually excessive accommodation tension and a high risk of its transition to myopia are predicted.

2. The method according to paragraph 1, characterized in that pupillometry is carried out at rest with accommodation, under the influence of a directed light stimulus, under an accommodative load, and under conditions of pharmacological cycloplegia.

3. The method according to paragraph 1, characterized in that the threshold values ​​of the indicators are: accommodation amplitude less than 8.6 diopters, relative accommodation reserve less than 1.5 diopters, decreased flexibility of the accommodative response relative to the age norm.

4. The method according to paragraph 1, characterized in that the threshold values ​​of the indicators are: SDNN < 30 ms, RMSSD < 25 ms, LF / HF > 2.0, accommodative miosis amplitude < 0.5 mm, total score according to the COMPASS-31 scale > 30 units, vegetative coefficient according to the Luscher test > 1.8.

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