Case history: Vision care of Paul, infant-at-risk.
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In this paper, formulas are derived to determine the accommodative and vergence stimuli for any target or patient in a Brewster type stereoscope. Using these formulas, tables have been prepared that will allow the clinician to quickly determine the stimuli to accommodation and vergence for any given patient and target situation.
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BACKGROUND: Diabetic retinopathy (DR) remains the leading contributor to severe vision loss in the United States among persons 20 to 70 years of age. Despite advances in disease management and treatment, patients with vision loss from DR continue to constitute a significant portion of patients served in vision rehabilitation service (VRS) settings. These patients present special challenges to VRS providers because of early onset, fluctuations in and the complex nature of vision loss, unique visual demands of disease management, and associated multi-system losses. CASE REPORTS: After introductory epidemiologic review, a case presentation format is used to illustrate solutions a multidisciplinary VRS can offer the special visual challenges of the person with diabetes with vision loss from DR. Four patients are presented--ages 30 to 70 years--with varying degrees and types of vision loss, with different lifestyle demands and disease management needs. The cases address vocational issues, vision fluctuation, coordinating adaptive solutions to complex visual losses, and meeting diabetic needs to measure medication, insulin, and blood glucose levels, to maintain skin care, diet, exercise, transportation, family roles, and support systems. CONCLUSIONS: The unique and complex needs of people with diabetes who experience vision loss can be well addressed through timely and ongoing VRS consultations, in conjunction with medical/ocular disease management.
A new modification of an AT-1 device for training of the ciliary muscle is described and the results of individual treatment by this device are analyzed. The device was used by 110 patients (220 eyes) aged 8-20 years with slight and medium myopia (group 1, 71 patients) and with slight hypermetropia with an accommodation spasm (group 2, 39 patients). After training visual acuity without correction improved in 71.5% cases in group 1 and in 95.6% in group 2. The relative accommodation reserves improved in 78.6 and 98.5% cases, respectively. The device is simple and reliable and easy to use, which recommends it as a trainer for maintenance therapy at home and as a component of multiple-modality treatment in an inpatient setting.
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Objective parameters of accommodation (amplitude, time of response, and stability) were evaluated in patients with myopia aged 7-22 years on an AA-2000 Nidek accommodographer. A decrease in accommodation response depended on age and degree of myopia. Rapid accommodation parameters were in high correlation with the relative accommodation reserve. Three groups of patients with different efficiency of accommodation training were distinguished: with positive effect (77.1%), no effect, and paradoxical effect.
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