The results of two-stage optico-functional rehabilitation of patients with refractive disorders and the risk of postoperative asthenopic syndrome after FemtoLASIK

Purpose. A comparative analysis of the results of two-stage optico-functional rehabilitation of patients with a high risk of postoperative asthenopic syndrome (AS).

Materials and methods. 36 patients (72 eyes) who had no binocular vision at a distance of 5 m and had a symmetrical position of the eyes, or a position close to symmetry, were randomly divided into 2 equal groups of comparison. Patients in both groups underwent functional treatment followed by the correction of refractive errors with FemtoLASIK technology. To eliminate accommodation dysfunctions, a medical device OXYS was used. Diploptic treatment was carried out using a Speckle-M laser apparatus and Bagolini raster glasses. To expand fusional reserves, a prism compensator (OKP-20, Russia) and a Speckle-M laser apparatus were used. The patients of the first group underwent a fast course of medical and functional rehabilitation for 5 working days (2 times a day with a break of 2–3 hours). As an additional pharmacological support, daily instillations of phenylephrine hydrochloride 2.5 % without preservatives were prescribed. The other group received the same functional treatment for 10 working days.

Results. After the fast and the standard rehabilitation courses, the patients revealed an increase in absolute accommodation and a decrease in the coefficient of micro fluctuations, an expansion of fusional reserves, an increase in stereovision acuity, and an increased number of cases of binocular vision. No statistically significant difference of clinical and functional parameters obtained as a result of the fast and the standard rehabilitation courses was revealed.

Conclusions. Functional and medicament treatment of patients with refractive disorders and the absence of binocular vision prior to FemtoLASIK is shown to be effective. This treatment reduces the risk of postoperative AS and increases the patient’s satisfaction with the results of the surgery. 

1. Doga A.V., Mushkova I.A., Karimova A.N., Kechin E.V. Comparative evaluation of visual and refractive results of correction of medium degree myopia by FemtoLASIC using various femtolaser devices. Vestnik Volgogradskogo gosudarstvennogo meditsinskogo universiteta. 2017; 1 (61): 92–4 (in Russian).

2. Doga A.V., Mushkova I.A., Kishkin U.I., et al. Sub-Bowmen femtokeratomileusis with tissue-preserving ablation: analysis of results and prospects of technology development for correction “extremely high myopia”. Vestnik Tambovskogo universiteta. 2015; 20 (3): 550–4 (in Russian).

3. Rozenblum Yu.Z., Feigin A.A., Kornyushina T.A. Ways of development of ophthalmoergonomics. Meditsinа truda i promyshlennaya ekologia. 2002; 6: 1–5 (in Russian).

4. Godts D., Tassignon M. J., Gobin L. Binocular vision impairment after refractive surgery. J. of Cataract and Refractive surgery. 2004; 30: 101-9. doi: 10.1016/S0886-3350(03)00412-7

5. Jimenez J., Villa C., Gonzalez-Anera R., Gutierrez R. Binocular visual performance after LASIK. J. Refract. Surg. 2006; 22: 679–88.

6. Kushner B.J., Kowal L. Diplopia after refractive surgery. Arch. Ophthalmol. 2003; 121: 315–21.

7. Shamsetdinova L.T., Mushkova I.A., Markova E.Yu., Maychuk N.V. On the issue of the etiopathogenesis of postoperative asthenopic syndrome in patients with medium and high degree myopia. Prakticheskaya meditsina. 2018; 3 (114): 204–10 (in Russian).

8. Mushkova I.A., Maychuk N.V., Karimova A.N., Shamsetdinova L.T. Detection of the risk factors for postoperative asthenopia in patients with refractive disorders. Ophthalmology in Russia. 2018; 15 (2S): 205–10 (in Russian). https://doi.org/10.18008/1816-5095-2018-2S-205-210

9. Ovechkin I.G., Pershin K.B., Pashinova N.F., Antoniuk V.D. Combined evaluation of the photorefractive surgery from the position of restoration medicine. Refrakcionnaya khirurgiya i oftalmologiya. 2004. 6 (2): 16–22 (in Russian).

10. Arutyunova O.V., Nazarova G.A. Evaluation of the effectiveness of restorative treatment in patients with refractive amblyopia who underwent excimer laser sight correction. Vestnik vosstanivitelnoy meditsiny. 2007; 4: 30–2 (in Russian).

11. Knyazeva S.V., Smirennaya E.V., Arutyunova O.V., Martirosova N.I. Rehabilitation treatment in patients with high degree myopia after excimer laser sight correction. Refrakcionnaya khirurgiya i oftalmologiya. 2008; 8 (2): 24–7 (in Russian).

12. Pisarevskaya O.V., Mikhalevich I.M. Patterns and mechanisms of changes in the structural and functional state of the visual system in patients with high degree of myopia after laser keratomileusis and binarimetry. Bulletin VSNTS SB RAMS. 2009; 5–6: 69–70 (in Russian).

13. Schukin S.Yu. Increase “quality of visual life” of patients after excimer laser correction of myopia. Vestnik meditsinskogo stomatologicheskogo universiteta. 2012; 2: 54–7 (in Russian).

14. Zharov V.V., Lyalin A.N., Korepanova O.A., Kutergina M.R., Evseev V.S. The effect of treatment by ophthalmomiotrainer “Vizotronik M3” on accommodative and sensomotor functions in patients with amblyopia. RMZH “Klinicheskaya Oftalmologiya”. 2013; 4: 173–5 (in Russian).

15. Day G. Binocular vision problems in refractive surgery patients: vision therapy case reports. Optometry Visual Performance. 2015; 3 (1): 58–69.

16. Koryakov S.V., Vykhodtseva O.G., Elunina L.A., Smirnova N.V. Ergonomic assessment of the use of Irifrin after refractive surgery. RMZH “Klinicheskaya Oftalmologiya”. 2007; 2: 70 (in Russian).

17. Airiani S., Braunstein R. Accommodative spasm after laser assisted in situ keratomilieusis (LASIK). Am. J. Ophthalmol. 2006; 141: 1163–4.

18. Kashchenko T.P., Kornyushina T.A., Bazarbaeva A.R., Magaramova M.D., Katsanashvili R.D. Method of restoration of binocular vision based on laser speckles in the diploptic treatment of concomitant strabismus. Vestnik oftalmologii. 2014; 5: 48–52 (in Russian).

19. Batmanov Yu.E., Makarov S.I. Irifrin 2.5 % — a stimulator for disacommodative muscles of the ciliary body. Novoe v oftalmlogii. 2003; 2: 30–1 (in Russian).

20. Zayani Nabil, Vorontsova T.N., Brzhesky V.V. Combined therapy of spasm of accommodation in children. Oftalmologicheskie vedomosti. 2011; 4 (1): 23–7 (in Russian).

21. Convergence Insufficiency Treatment Trial Study Group. Randomized clinical trial of treatments for convergence insufficiency in children. Arch. Ophthalmol. 2006; 126: 1336–49.