Ophthalmologist Sergey Rykov: "You should not wait until the child overgrow the squint"

Ambulance "FACTS"


The most valuable thing in life should be kept like the apple of one's eye. The ancient instructive commandment has acquired in our days direct meaning: the eyes need increased attention and care. What visual impairments require emergency care? How should one treat children strabismus? When do I need an surgery treatment? What a threatens causes increased intraocular pressure? Why are myopic and far-sighted people more often suffer from glaucoma? These and other questions of our readers during the direct line of "FACTS" were answered by the main supernumerary ophthalmologist of the Ministry of Health of Ukraine, the head of The Kyiv Eye Microsurgery Center, professor Sergey Rykov, MD.

- Hello, Sergey Alexandrovich! My name is Lidia Mikhailovna, I am a grandmother of two-year-old twins. A granddaughter’s eyesight is all right, and a grandson's eye is slightly squint. The bride does not pay attention to this, she is says: "he will overgrow". And I'm afraid: what if a boy grows squint?

 - The squint, that is seen by relatives, neighbors, friends, in many cases is false. Do not take to heart the “benevolent” remarks: “Than your grandson is looks to the left, his eye also sinks to the left ...” This should be for young children have a special anatomical structure of the eye. The width  of the white shell from the center of the eye to the nose is very small, besides the subcutaneous fatty tissue is slightly swollen. Because of this, it creates the appearance that the eye squints.

The diagnosis of strabismus should be done by the ophthalmologist. In a dark room, he will expand the pupil to see the structure of the eye, to determine if there is a hyperopia or other visual impairment. If a father or mother suffered from strabismus as a childhood, they must come to the reception to a specialist when the child is one year old. To check the vision at an early age is also necessary for children if their parents have farsighted astigmatism or simply farsightedness.

- "FACTS"? Tatiana from Kyiv is disturbing you. My four-year-old daughter’s eye is slightly squint. Can this be corrected without surgery?

 - Yes, thanks to the unique technology of strabismus correction, which was developed by ophthalmologists together with the specialists of the Institute for Information Recording of the National Academy of Sciences of Ukraine. Using a set of special lenses (microprisms), you can train the eye to correctly perceive the image. But such a correction of strabismus, that allows to restore solid vision, is most effective until the child is six years old. Older children often need surgery. By the way, in preparing for it, we also use microprisms. This allows you to specify the diagnosis and make the operation, as they say, at one time. Previously, strabismus was operated in three stages: the growing proportions of the face of a growing child quickly change, so the doctor should make no mistake, stretching or weakening the muscles that hold the eye in the correct position.

- Where can I order such glasses?

 - Sphere-prismatic lenses cannot be ordered in a regular optics salon: they are made individually at the Institute for Information Recording. Glasses should ordered by well qualified doctor. Dr. Marina Shevkolenko deals with this in our center. We also began to train specialists all over Ukraine. Trainings have already been held in Kyiv.

- Good day! I’m Ekaterina Viktorovna, a resident of Kyiv, I call to you. Is it possible to correct strabismus for the adult? Our employee, a young man, squint for sure, and that the reason of his problems in personal life...

  - Often, strabismus of adults occurs as a result of trauma - then the conductivity of the nerve impulse is disturbed in the muscle. This is a purely cosmetic defect, and many get used to it. But I think that it is better not to put up with the problem and be consulted by a doctor. With the help, the person will improve quality of life and get rid of complexes.

- Straight line? You get call from the Cherkasy. My name is Sergey Antonovich. I noticed that in some people the eyes quickly run around. Is it a disease or some particular behavior?


- Normally, a healthy person’s eyes run, for example, when he tries to capture information from a large screen. But such a “liveliness” of a look can be a sign of pathology, and then nystagmus (the so-called disorder) should be treated. If the eyes run (right-left, up-down or in a circle), the person sees only 30-40 percent. The surgery is necessary to eliminate nystagmus. Strengthening one muscle and weakening the other, we will achieve a clearer fixation of the eye. You can try to correct the violation awith the help of glasses. In the case of nystagmus it is always broken the structure of the eye, and properly selected lenses can improve the appearance by a factor of two. There are cases that nystagmus is associated with neurological pathology, and then a neurologist must be involved in the treatment.

- Sergey Aleksandrovich? I’m  pensioner Olga Stepanovna, the city of Kyiv. Interested in such a question (sorry if it seems ridiculous to you): how to properly pour out drop by eyes drop? For example, I drip into the inner angle of the eye, and my friend - into the outer...

 - This question is ussualle to be asked, and it is not funny at all. Rather, the answer may seem ridiculous: the main rule - a drop should definitely fall into the eye! It is not easy, if you have to pour out drop by drop in eyes of child. Parents in this case can be guided by the child's reaction: if he is screw up his eyes and discontentedly whimpered than the drop hit the destination. It is important to know that one large drop of medicine from the pipette (or eye dropper bottle) contains five so-called Pasteur drops, and the therapeutic effect is achieves ... with one. Do not be afraid that we are dripping five times as much than necessary. The eye reflexively pushes excess fluid if a person blinks, as the cornea immediately reacts to the drop in the eye.

- Can I talk to the doctor? This is Tatiana from Kyiv. I have myopia (already minus six). I'm afraid it’ll get worse, because I have use the computer a lot. I began to drip in the morning and evening vitamins for the eyes. It is right?

 - That's right, if you are sure that you are using the right medicament. Vitamin drops are different in composition: in some there are more enzymes, in others there are vitamins. I prefer to prescribe the last one to the patients, because they also prevent dry eye syndrome. It occurs in persons, those spend a lot of time with the computer and, concentrating on work, forgets to blink. After all, to protect the cornea from drying out, you need to blink 18 (!) once a minute. Canadian scientists recommend every two hours of work to use a drop of "artificial tear": it restores the integrity of the membrane that protects the cornea, and it remove irritate of eyes.

- Maybe I should take some other drug to support my vision, for example, pills with blueberries?

 - These funds are used for therapeutic purposes, and the doctor must prescribe them. The effect of a pill on a person weighing 50 kilograms and 100 kilograms will be completely different. Therefore, it is better to adhere to a high food culture. The human body is a perfect, complete system. If he does not interfere, he is able to take from the clean water and healthy food all that is healthy. You should agree that it does not require large expenses to cook for breakfast cereal, giving exercise to the intestines. The Queen of England, that had been laid to rest in the 101st year of her life, lived for a long time and in good health thanks not least to porridge.

- I drink coffee in the morning ...

 - I advise you not to do this, because drinking coffee in the morning "hits" on the pancreas. Such addiction can increase the risk of diabetes, cysts, cause cancer of this organ. If you like a coffee, drink a cup or two for a second breakfast - 10-11 hours.

- Good day! Sergey Alexandrovich, you got a call from Antonina Vladimirovna from Kyiv region. My friend found the initial stage of cataracts, and the doctor advised to exclude from the diet pork. It surprised me. What's the connection here?

 - Apparently, when examining a slit lamp, a specialist saw on the lens “remnants” of a chop patty, cholesterol plaques. This is a sign of atherosclerosis, and, as is known, it is dangerous for blood vessels. A person who develops atherosclerosis is threatened with myocardial infarction, stroke. To protect yourself, you need to control cholesterol in the blood, check for ultrasound vessels.

- Hello! I’m Ivan Denisovich. I live in Kyiv. I am 76 years old. Doctors suggest to operate a cataract. But I do not understand how you can remove your own lens, living and put an other obe. What will it give? How long will the artificial lens last? Can you consult?

 - Quality of the own organic lens is sometimes worse than quality of artificial one. If a high-quality artificial lens was born from birth, a person would have 300% vision and would see every star in the sky. Do not doubt the reliability and durability of the artificial lens. You need to be afraid of the fact that people of your age have already impaired vision, there are problems with vessels, retina. Optics of the eye (artificial lens) will be ideal but you cannot be sure about work of othe structures of the eye (for example, vessels), it depends on their condition. Although surgery for cataract is well established today, the risk of postoperative complications in the elderly is somewhat higher, especially with comorbidities. Write down the phone of the reception center of the Eye Microsurgery Center: 0 (44) 408-28-33, and they will tell you, that it is better to come for an examination.

- Straight line? This is Victoria from Nezhin, Chernihiv region. I went to order glasses (since childhood I suffer from long-sightedness), and they told me that my left eye does not respond to diopters. What does it mean?

 - First of all the disease was “missed” in childhood. A “lazy” eye is hard to get to work in adulthood. With the help of a red laser, you can try to improve your eyesight by ten percent. Come to us for an examination. You should know that farsightedness can cause other problems. A normal eye in length reaches 24 millimeters, and a far-sighted one is somewhat shorter, so the angle of the front camera is more obtuse. The probability of an attack of glaucoma increases every five. I advise you to check intraocular pressure regularly, at least once a year. Watching TV should be combined with top or side lights in the room. The pupil in the dark greatly expands and can block the filtration zone, and the violation of the outflow of fluid will raise the intraocular pressure. Avoid saunas with a high temperature (90 degrees), hard physical work, active sex.

- How to determine that the eye pressure has increased?

 - Increased intraocular pressure often does not manifest itself. Therefore, every person, regardless of whether he has a complaint, after 40 years, needs to come to the doctor for a checkup every three years. Due to the increased pressure, the nerve endings gradually die off, and the patient only has a tubular field of view over time: he sees one hundred percent in the center and nothing at the periphery. If glaucoma is not treated, in eight to ten years, complete blindness threatens. For therapy eye drops are used to reduce intraocular pressure and improve nutrition of the optic nerve.

Unfortunately, not all patients neatly perform appointments. This is dangerous because a persistent increase in intraocular pressure leads to an accelerated loss of vision. We conducted a small research, such showed that, on average, our patient only ... 122 days a year is treated as prescribed. For the rest of the time, he either forgets to drip his eyes, or is unable to: the drops have run out, and the new ones are not affordable.

Calculations show that drugs for a person with a diagnosis of glaucoma cost a little more than two thousand hryvnia per year. If we manage to find this money (we have submitted our proposals to the draft state program “Health of the National. Ukrainian Virus”), every patient who has been registered by the dispensary will be provided with drugs. I think in this case, many patients will be able to remain sighted, and 35, and 40 years.

- Straight line? It’s  Oksana Vasilyevna from the city of Poltava. I suffer from nearsightness of high degree. The doctor said that glaucoma in my case is more usual effect than for other people. Is that true?

 - Yes, nearsightness (myopia) of a high degree is considered preglaucoma. The eye is extended, and the muscle responsible for the production of intraocular fluid is also stretched, as is the angle of the anterior chamber of the eye. You need to constantly monitor your intraocular pressure, so as not to miss its increase.

- I heard that glaucoma can be with normal pressure...

 - Moreover, it happens with reduced pressure. Increased pressure is one of the symptoms of glaucoma, but far from the only one. The pressure may be normal (for example, 18 millimeters of mercury), but for hypotonic nerve cells this level is high. To clarify the diagnosis of glaucoma in this case, you can use computer perimetry. The doctor examines the visual field, determines the sensitivity of the cells of the nerve fibers and the violation of the nerve endings in the retina.

But you should know: near-sighted people more often have cataracts. This happens due to the fact that the circular muscle of the eye and the lens itself are too tight, their nutrition is broken. For the same reason, the retina also suffers - it weakens and becomes thinner. We often have to save sight to patients who have had retinal detachment. We do this with the help of laser coagulation method. The main thing is that the patient should ask for help in time.

- What is the reason for the appearance of "lightning" before my eyes?

 - This is most often a symptom of pre-fracture of the retina. Surgeons sometimes say that they see the "snail track": there are areas on the retina where there are no vessels at all as if the snail crawled. In this case, it is necessary to urgently “weld” the retina with a laser.

- How to strengthen the retina with a high degree of myopia?


- This can be done, as already mentioned, with the help of a yellow laser. The technique is considered very conciliate, because the area of laser cauterization is very small, and the surgeon can operate with a laser even in the region of the central part of the eye. We also use the surgical method. The essence of the scleroplastic operation is to “repair” the retina with the help of heavy silicone, which is fixed by special “studs”.

Prepared by Natalia SANDROVICH, "FACTS"