The efficacy of accommodative facility training as a method of treatment for meridional amblyopia (MA) in astigmatic children with amblyopia was studied. MA manifests itself as selective alterations in visual acuity (VA), with substantial differences in the ability to resolve contours of different orientations, and may cause impairments in mechanisms of integrated processing of visual stimulus, development of cognitive abilities in children and visual performance. Purpose: To assess the effect of optical-reflection method of accommodative facility training on vernier acuity in meridians (MVA) in the treatment of astigmatic children with amblyopia. Material and Methods: Twenty seven children aged 5 to 12 years, with both refractive amblyopia and with-the-rule hyperopic astigmatism were included in the study, and underwent an examination. The spherical component of refraction ranged from +0.5D to +5.5D, and the cylindical component, from 0.5D to 4.5D. Best-corrected visual acuity (Sivtsev Chart) was assessed. Accommodative facility training was performed monocularly by image defocusing with lenses of a variable power. A +0.5-D sphere was placed just in front of the best correction for the study eye in order to blur this line. The +0.5-D sphere was replaced by a -0.5-D sphere after the optotypes became clearly visible. Thereafter, the training cycle was repeated using a ±0.75-D sphere and, subsequently, a ±1.0-D sphere. Lens power was gradually increased until it could be compensated by accommodation. The treatment course consisted of one training session a day for 10 days. Special computer software was used to determine corrected MVA. Linear objects were presented on the computer screen, and the smallest lateral displacement of one line from another that can be detected by the examinee will characterize the level of MVA. Results: A new algorithm was proposed for assessing the efficacy of treatment of MA in astigmats, with refractive asymmetries and meridional asymmetries in vernier acuity considered as vector quantities. It was demonstrated that a group of amblyops with the same type of astigmatism was not homogeneous. It was found possible to split such a group of patients into three clusters that differ in the type of variation in meridional acuity in the orthogonal meridians compared to refractive asymmetries. One cluster had equal vernier acuities in the vertical and horizontal meridians, the second had vernier acuity in the horizontal meridian better than in the vertical meridian, and the third had vernier acuity in the horizontal meridian worse than in the vertical meridian. MVA was greater in magnitude in one of the orthogonal meridians than in another in the dominant eyes in 37% of study patients, and in the fellow eyes in 50% of study patients. MVA values in the orthogonal meridians were similar in 56.6% of study patients. There was a 15.1-percent increase, from 56.6% to 71.1% in the number of eyes with a similar vernier acuity in the orthogonal meridians after treatment. A positive effect was achieved thr...

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Objective. To investigate the influence of the optic-reflex method of accommodation training on the indices of the meridional separable visual acuity in the treatment of children with amblyopia and astigmatism. Material and methods. 24 children aged 5 to 12 years with refractive amblyopia and direct hyperopic astigmatism were examined. Accommodation training was performed by defocusing the image with optical glasses of variable optical power. The course of treatment lasted 10 days. Results. In the group with meridional amblyopia, 2 different clusters were identified: in one of them, the indicators of separable visual acuity were higher in the horizontal meridian and in the other - in the vertical. After treatment, the number of eyes with the same meridional visual acuity increased. Simultaneously with the elimination of the meridional asymmetry of visual acuity, the number of eyes in the category of patients with visual acuity of 0.75-0.8 according to the Sivtsev table increased by 8.52%. Conclusion. In the standard of assessment of visual functions in patients with astigmatism and amblyopia, it is necessary to introduce methods for determining the meridional visual acuity. Evaluation of the effectiveness of treatment of meridional amblyopia should be carried out in homogeneous clusters, which take into account the coincidence or discrepancy of the directions of meridional asymmetries of visual acuity with refractive. Preliminary data on the effectiveness of treatment of amblyopia by the method of accommodation training allows us to consider it as a method of treatment of meridional amblyopia.

Connection of the publication with planned research works.The work is part of the research project "To study the effect of photostimulation of the retina with static and dynamic patterns on selective indicators of visual acuity in patients with amblyopia and to develop a comprehensive method for treating meridional amblyopia." State registration number 0119U101212. Introduction.Refractive abnormalities are the most critical cause of monocular and binocular function disorders in children and adults. The most complex disorders in the mechanisms of binocular vision and visual perception are characteristic of patients with astigmatism. This is because the peculiarity of the structure of the visual analyzer causes the formation of two optical foci, and one or both do not coincide with the retina. As a result, two meridians simultaneously exist in the eye, one of which has a higher VA than the other. Refraction asymmetries associated with astigmatism can be the reason for developing a particular form of amblyopia -meridional amblyopia (MA) [1,2,3,4,5]. MA is manifested by a selective violation of VA when distinguishing the contours of objects of a certain orientation [3]. Experimental studies show that the loss of binocular neurons occurs after a decrease in their binocular stimulation due to a prolonged absence of normal monocular and binocular stimulation. Such neurons are structurally related to the right and left eye and are the basis for the mechanisms of binocular and stereoscopic vision [3,6]. MA can cause a violation of the monocular or binocular mechanisms of integral processing of visual stimuli and, The effectiveness of complex treatment using hardware techniques and accommodation training to treat meridional amblyopia (MA) in children with astigmatism was determined. MA is a selective violation of visual acuity (VA) when distinguishing the contours of objects of a certain orientation and is the cause of violations in the mechanisms of integral processing of visual stimuli, the development of cognitive abilities in children, and visual performance.Available sources highlight the effectiveness of optical correction and occlusion or penalization in the treatment of MA, while studies evaluating the effectiveness of pleoptic hardware treatments and the results of accommodative training in patients with amblyopia and astigmatism are less numerous. The difficulties of diagnosing meridional amblyopia and the lack of unified approaches in assessing meridional functional indicators make it more difficult to evaluate the results of one or another treatment method. Studying the effectiveness of the specified treatment methods and investigating the features of their impact on the visual analyzer can improve the quality of medical care for children with astigmatism and amblyopia and individualize treatment tactics. In this work, the author's approaches to the evaluation of meridional indicators of visual acuity before and after treatment with available and most common pleoptic techniques were used. The combination of mod...