Effectiveness of pupillography for assessing the state of autonomic nervous system and the choice of treatment for accommodative disorders in children

Abstract

Purpose For the first time, the values of indices of accommodation, direct and friendly pupillary reactions were determined – the maximal (Smax) and minimal (Smin) area of the healthy children aged 6 to 18 years depending on their age and tone of the autonomic nervous system (2016).

Methods 269 healthy children, 130 children with spasm of accommodation and 79 children with accommodation weakness were obsovered. We used the computer pupillography OК-2 for registration of direct, consensual and accommodative convergent-pupillary reaction.

Results Difference between Smax values in children with accommodation spasm (23.94 ± SD 5.5 mm2, DI 95% 22.8–25.0) and with accommodation weakness (49.3 ± SD13.8 mm2, DI 95% 47.1–51.6) was revealed, that can be considered as a criterion for choosing the type of treatment. In accommodation spasm, the pupil area (Smax) in the range 22.8–25.0 mm2 and the general vagotonia (according to the Kerdo index) treatment by mydriatics should be appointed. In weak accommodation, Smax in the range of 47.1–51.6 mm2 and general sympathotonia, transcranial electrical stimulation and phosphenelectrostimulation are indicated. Phosphenelectrostimulation (FES) and ETRANS had unidirectional influence – an increase in the uncorrected visual acuity at a distance of 33% and 49% respectively, an improvement in accommodation reserves of 2.8–4.1 D in patients with accommodative dysfunctions.

Conclusions The mechanisms of action of electrostimulation, where one of the key roles is the improvement of conduction of nerve fibers. In accommodation spasm and the general vagotonia treatment by mydriatics should be appointed.