散光 gif

Modern statistics depressing. More than half of the world's population suffers from visual impairment, the most common problems are myopia and hyperopia. But ophthalmologists often diagnose another disease, the name of which is unfamiliar to many. Astigmatism is a defect in the optical system of the eye when the sharpness of the image is asymmetric vertically and horizontally. And the parallel rays of light passing through the eye are focused not into a point, but into the “eight”. For a person, this means that the visibility of the image becomes unsharp, and this often applies to both distant and close objects. As a result, instead of a normal image, a person sees a distorted image, in which some lines are clear, others are blurred. An idea of ​​this can be obtained if you look at your distorted reflection in an oval teaspoon.

现代统计令人沮丧。 世界上超过一半的人口患有视力障碍，最常见的问题是近视和远视。 但是眼科医生通常会诊断出另一种疾病，很多人都不知道它的名字。 当图像的清晰度在垂直和水平方向上不对称时，散光是眼睛光学系统的缺陷。 通过眼睛的平行光线不是聚焦在一个点上，而是聚焦在“八个”上。 对于一个人来说，这意味着图像的可见性变得不清晰，这通常适用于远处和近处的物体。 结果，人们看到的是扭曲的图像，而不是正常的图像，其中一些线条清晰，另一些线条模糊。 如果您在椭圆形的茶匙中观察扭曲的反射，就可以得到一个想法。

Ophthalmologists say that almost two thirds of the world's inhabitants face such a problem. But since the degree of astigmatism may be small, many people practically do not feel any discomfort. It is difficult for doctors to identify a clear list of common symptoms indicating that a patient has astigmatism. In each case, they will differ. In the very early stages, it is often confused with tired eyes.

眼科医生说，世界上近三分之二的居民都面临这样的问题。 但是由于散光的程度可能很小，因此实际上许多人不会感到任何不适。 对于医生而言，很难识别出明确的常见症状表，表明患者患有散光。 在每种情况下，它们都会有所不同。 在早期，它常常与疲倦的眼睛混淆。

However, quite a few people need special treatment or correction of this disorder with the help of glasses, contact lenses or even surgery.

但是，相当多的人需要借助眼镜，隐形眼镜甚至手术来对这种疾病进行特殊治疗或矫正。

一般 (General)

АAstigmatism is a defect in the optical system of the eye. In this case, the refraction (or reflection) of the rays in different sections of the transmitted light beam is not the same.

А散光是眼睛光学系统的缺陷。 在这种情况下，在透射光束的不同部分中光线的折射(或反射)是不同的。

As a result, the image of objects becomes blurred, each point of the object is displayed with a blurred ellipse. And the whole picture turns into a so-called Sturm's conoid, as if in a “crooked mirror”. In practice, the main complaint is blurred vision at a distance, often vague near blurring, vagueness and division of objects.

结果，物体的图像变得模糊，以模糊的椭圆显示物体的每个点。 整个图片变成了所谓的Sturm圆锥形，就好像在“弯曲的镜子”中一样。 在实践中，主要的抱怨是远处的视力模糊，常常模糊不清，物体模糊不清和分裂。

The course of the rays in the eye with astigmatism looks like.散光的眼睛中的射线路线看起来像。

—我是那样出生的，或者毁了我的生活？ ( — I was born that way or ruined my life?)

This is the first question that patients ask when they hear this diagnosis for the first time.

这是患者首次听到此诊断时要问的第一个问题。

Astigmatism may be congenital or acquired, may be stable and progress.

散光可能是先天性的，也可能是后天性的，可能会稳定发展。

Quite often, astigmatism is a feature of the structure of the cornea at birth, it can even be inherited from parents. If its value affects visual acuity (as a rule, we are talking about astigmatism greater than 1 diopter), then it necessarily requires correction from an early age. Otherwise, the eye sees poorly and develops amblyopia — the “lazy” eye, which is no longer capable of high vision in adulthood. A child with astigmatism, by the way, will never complain to you about poor eyesight — he doesn’t know how to see this well. That is why early examinations by an oculist and wearing glasses, “as prescribed by a doctor”, are so important.

通常，散光是出生时角膜结构的特征，甚至可以从父母那里继承。 如果其值影响视敏度(通常，我们所谈论的是散光度大于1屈光度)，则必须从小就需要矫正。 否则，眼睛视力不好并发展为弱视，即“懒惰”眼睛，成年后不再具有高视力。 顺便说一句，有散光的孩子永远不会向你抱怨视力不好-他不知道怎么看清楚。 这就是为什么眼科医生和“根据医生的处方”戴眼镜进行早期检查如此重要的原因。

It often happens that a grown-up person is surprised to find out that he has, as it turns out, astigmatism, this is in the case of those not examined in childhood.

通常情况下，一个成年大人惊讶地发现自己患有散光，这是在童年时期未接受检查的情况下发生的。

Astigmatism may appear already in adulthood as a result of corneal diseases, such as keratoconus, inflammation, trauma and operations.

由于角膜疾病，例如圆锥角膜，炎症，外伤和手术，散光可能已经在成年期出现。

In any case, it does not appear from working at the computer.

无论如何，它在计算机上都不会出现。

—散光时有什么损坏？ ( — What is damaged during astigmatism?)

First of all, the cause of astigmatism can be two optical systems of the eye — the cornea and lens. When pick up glasses or lenses, then take into account the resulting optical power of these two systems. Please note, usually patients are aware of frequent corneal astigmatism, but they forget about the lens — it can make a difference, for example, in cataracts, when irregularities appear in the lens. “The cornea is flat, but there is astigmatism” — this is it. Often the patient and the optometrist do not bother at all with what is the cause. When selecting points, it is important to correct the rays of light onto the retina using correction. And with surgical correction — this is important.

首先，散光的原因可能是眼睛的两个光学系统-角膜和晶状体。 拿起眼镜或镜片时，请考虑这两个系统产生的光功率。 请注意，通常患者会意识到频繁的角膜散光，但他们会忘记晶状体-例如，在白内障中，当晶状体出现不规则现象时，晶状体会有所作为。 “角膜是平坦的，但是有散光”-就是这样。 患者和验光师通常根本不理会原因。 选择点时，使用校正来校正入射到视网膜上的光线非常重要。 通过手术矫正-这很重要。

For a simplified understanding of the essence of the problem, I often explain to patients that the optics of the eye with astigmatism is not like a sphere (a football), but an oval (a rugby ball).

为了简化对问题本质的理解，我经常向患者解释，散光的眼睛的光学效果不是球形(橄榄球)，而是椭圆形(橄榄球)。

—散光的大小，形状和内容有何不同？ ( — How is astigmatism different in size, shape and content?)

First, the value of astigmatism matters — conditionally up to 1 diopter, astigmatism is considered physiological, weak. That is, as a rule, it does not require correction. But in case he even lowers his vision, alas, he needs to be corrected. The average degree — up to 2 diopters, high — 2-3 diopters and more than 3 diopters — this is a very high astigmatism. There are other classifications, but this one best reflects the effect on defocus.

首先，散光的价值很重要-有条件地达到1屈光度，散光被认为是生理性的，微弱的。 即，通常不需要校正。 但是，如果万一他降低了视力，a，他需要得到纠正。 平均度数-高达2屈光度，高-2-3屈光度和3屈光度以上-这是非常高的散光。 还有其他分类，但是这一分类最能体现散焦效果。

Secondly, there are two types of corneal astigmatism: regular and irregular.

其次，角膜散光有两种类型：规则的和不规则的。

With regular astigmatism, there are two main refractive perpendicular cross-sectional planes, within which the optical power does not change — weak and strong. In such optics there is at least some regularity, even if the axes are skewed or there is a big difference in their optical power.

对于常规的散光，有两个主要的折射垂直截面，在该截面内，光焦度不会改变-弱和强。 在这种光学系统中，即使轴偏斜或它们的光功率有很大差异，也至少存在一些规律性。

Regular astigmatism — in this case, we can distinguish two parts, where the cornea has a different degree of refraction. This type of astigmatism can be corrected with glasses with cylindrical glasses or soft contact lenses.

定期散光-在这种情况下，我们可以区分角膜屈光度不同的两个部分。 这种类型的散光可以通过配戴圆柱眼镜或软性隐形眼镜的眼镜来矫正。

Irregular astigmatism — in this case, two parts cannot be distinguished, since there are many optical axes. This type usually develops as a result of corneal damage, for example, during an accident (scar tissue is formed), or due to uneven corneal protuberances (keratoconus). Irregular astigmatism is usually poorly corrected, sometimes hard contact lenses or laser effects on the cornea can be useful.

不规则散光-在这种情况下，由于存在许多光轴，因此无法区分两个部分。 这种类型通常是由于例如在事故(形成疤痕组织)过程中角膜受损或由于角膜突起不均匀(圆锥角膜)而形成的。 不规则散光通常不能得到很好的矫正，有时可以使用硬性隐形眼镜或对角膜施加激光效果。

Third, the type of astigmatism depends on the location of the strong axis. If the strong axis is vertical or no more than 30 degrees deviates from the vertical — direct astigmatism. If the strong axis is horizontal ± 30 degrees — astigmatism is reversed. If between — astigmatism with oblique axes. Direct astigmatism slightly increases the depth of focus, the reverse — more impairs visibility, but these both options are corrected well. But the correction of astigmatism with oblique axes with glasses and lenses is worse performed.

第三，散光的类型取决于强轴的位置。 如果强轴是垂直的，或者偏离垂直方向的角度不超过30度，则直接散光。 如果强轴为水平±30度，则散光会反转。 如果在之间-斜轴散光。 直接散光会略微增加焦深，反之亦然-更大程度地损害可见度，但是这两种选择都可以正确校正。 但是配戴眼镜和镜片的斜轴矫正散光效果较差。

n astigmatic eyes, there are two perpendicular to the section plane with the greatest and the smallest refractive power.在散光眼中，有两个垂直于剖面的折光力分别最大和最小。

Fourthly, depending on how the focus relates to the retina, astigmatism is divided into myopic (myopic), long-sighted (hypermetropic) and mixed — when one part of the image falls in front of the retina and the part behind the retina. For example, minus two and minus four — then this is complex myopic astigmatism, plus two and plus four — complex long-sighted astigmatism, plus two and minus four — mixed.

第四，根据图像的焦点与视网膜的关系，当图像的一部分落在视网膜前面而部分在视网膜后面时，散光又分为近视(近视)，远视(远视)和混合。 例如，负二和负四-则是复杂的近视散光，再加上二和正四-复杂的远视散光，再加上二和负四-混合。

Nearsighted astigmatism is indicated by the sign “-”, long-sighted — by the sign “+”, when mixed in the eye there are “+” and “-”.

近视散光由符号“-”表示，远视散光由符号“ +”表示，当混入眼中时有“ +”和“-”。

—我如何怀疑散光？ ( — How can I suspect astigmatism?)

Symptoms of astigmatism are a decrease in vision, sometimes the vision of objects is bent, their split, rapid eye strain at work, headache. Often you may not even suspect that there is such a problem, complaints are so typical — poor vision for distance or near, or at all distances.

散光的症状是视力下降，有时物体的视线弯曲，它们分裂，工作时眼睛快速疲劳，头痛。 通常，您甚至可能都不怀疑存在这样的问题，投诉如此典型-远距离或近距离或全距离的视力不好。

—散光需要什么样的诊断。 ( — What kind of diagnosis is needed for astigmatism.)

Since astigmatism is a defect in optics, then, firstly, the optics of the eye are carefully examined. And the correct conclusion will only ophthalmologist. To do this, we have a number of tests: an autorefractoraketometer study, an aberrometer, a phoroptera with the selection of test lenses to determine visual acuity with maximum correction. A very interesting radiant figure gives an idea of ​​how much astigmatism is present — if you look at the center of the figure from below, some of the lines will be clearer, and some will «blur» with those who have astigmatism.

由于散光是光学器件的缺陷，因此，首先要仔细检查眼睛的光学器件。 而正确的结论只有眼科医生。 为此，我们进行了许多测试：自动折光率计研究，像差仪，验光仪，并选择测试镜片来确定视力并进行最大矫正。 一个非常有趣的辐射图给出了多少散光的想法-如果您从下面看图的中心，有些线条会更清晰，有些会与那些有散光的人``混淆''。

In the phoropter tests, an ophthalmologist in the arsenal also has a number of techniques to clarify the presence of astigmatism, its axis and size. And this process is always quite time consuming — this can be confirmed by those patients who have done with us, for example, SMILE. Verification of tests with “fogging, cross-cylinders with power and axial samples” for a period of 20-30 minutes.

在验光仪测试中，武库中的眼科医生还拥有多种技术来阐明散光的存在，其轴和大小。 这个过程总是很耗时-可以由与我们合作的那些患者来证实，例如SMILE。 使用“带有动力和轴向样本的雾化，交叉圆柱体”验证测试20-30分钟。

So, when it is determined that there is still astigmatism, it is necessary to determine “who is to blame” — the cornea or the lens.

因此，当确定仍然存在散光时，有必要确定“谁该负责” —角膜或晶状体。

A cornea examination should include keratotopography — a study of the relief and optical power of the cornea over its entire area, optical coherent tomography, which determines the thickness, morphology and geometry of the cornea also over the entire area, the study of the posterior surface of the cornea using the Shimflug camera to determine the irregularities of the anterior and posterior cornea, confocal microscopy — the study of the posterior layer of the cornea (endothelium). According to the results of this survey, we can already conclude how healthy the cornea is.

角膜检查应包括角膜地形图-研究角膜在整个区域的浮雕和光焦度，光学相干断层扫描(确定该区域整个角膜的厚度，形态和几何形状)以及后表面的研究使用Shimflug相机确定角膜的前，后角是否不规则，共聚焦显微镜—对角膜后层(内皮)的研究。 根据这项调查的结果，我们已经可以得出结论，角膜有多健康。

This is how the examination on the Scheimflug-camera + Placido rings looks like.这就是对Scheimflug相机+ Placido环的检查的样子。

Sometimes astigmatism is associated with the lens — its form, the presence of various opacities in it or a change in its position in space, such astigmatism is called lens-shaped. And it happens that the cornea is irregular and the lens is distorted, then the resultant will affect the final optics as a whole.

有时，散光与晶状体有关-晶状体的形状，其中存在各种不透明性或其空间位置的变化，这种散光称为晶状体。 碰巧角膜不规则并且晶状体变形，那么结果将影响整个最终的光学器件。

We can also study the anterior segment of the eye using ultrasound biomicroscopy in order to examine the parts of the eye that are inaccessible to other methods and measure them.

我们还可以使用超声生物显微镜研究眼睛的前段，以检查其他方法无法进入的眼部并进行测量。

Yes, by the way, for children there is such a pediatric autorefractometer, which can measure the optics of an eye in a child, without contact, when there is no need to press anything on his forehead and everything happens at a distance of 1.5-2 m. This is important, since children in general are naughty and look badly (or refuse to look at all) to where the ophthalmologist asks. There are not all clinics, as it is expensive. Of course, we have it, called PlusOptix. And late diagnosed astigmatism leads to serious consequences.

是的，顺便说一句，对于儿童来说，这种儿童自动验光仪可以在无需接触前额的情况下测量孩子眼睛的光学状况，而无需接触，并且一切发生在1.5- 2米 这很重要，因为儿童通常是顽皮的，并且对眼科医生的要求视而不见(或根本不看)。 由于价格昂贵，并非所有诊所都可以。 当然，我们拥有它，称为PlusOptix。 延迟诊断的散光会导致严重的后果。

This survey with PlusOptix使用PlusOptix进行的这项调查

A, has not yet named the old antediluvian method of skiascopy — tracking the movement of the shadow of the reflex from the fundus when the luminescence is inverse with the ophthalmoscope and moving the ruler with lenses. Our grandmothers were diagnosed this way, by the way, quite successfully, if you know how to do it.

A，尚未命名为旧的前视镜检查方法-当用检眼镜反光时跟踪眼底反射阴影的运动并用镜片移动标尺。 顺便说一句，如果您知道怎么做，我们的祖母就被成功诊断了。

Method skiascopy.方法skiascopy。

—散光与圆锥角膜如何相关 ( — How is astigmatism associated with keratoconus)

One of the main symptoms appearing in keratoconus is astigmatism. When we diagnose a patient with astigmatism, we must always exclude the latent (forme fruste) or the initial form of keratoconus.

圆锥角膜上出现的主要症状之一是散光。 当我们诊断患者患有散光时，我们必须始终排除圆锥角膜的潜伏性(前角)。

At the beginning of the disease, you may not even suspect about it, even astigmatism may be quite small — 0.5 — 0.75 diopters, however, changes in the cornea are already there and are available only by special methods of examination. Therefore, if you are offered to examine the cornea for its health, this is not a commercial “cheat”, it is worth doing, since the treatment in the initial stages is much more effective than in developed and distant ones.

在疾病开始时，您甚至可能不会怀疑，甚至散光可能很小(0.5屈光度至0.75屈光度)，但是角膜的变化已经存在，并且只能通过特殊的检查方法才能获得。 因此，如果提供检查角膜健康的方法，那不是商业上的“骗子”，而是值得做的，因为在初期阶段的治疗比在发达阶段和远处的治疗有效得多。

With keratoconus, it is just about irregular astigmatism, which is bad in advanced stages amenable to correction.

对于圆锥角膜，这只是不规则的散光，在可校正的晚期阶段是不好的。

This is the keratotopogram at the initial keratoconus.这是初始圆锥角膜的角膜地形图。

And in the next post I will talk about how to correct astigmatism, both surgical and non-surgical, as well as what is most important in astigmatism in childhood and adulthood.

在下一篇文章中，我将讨论如何纠正手术和非手术散光，以及在儿童和成人期散光中最重要的矫正方法。

翻译自: https://habr.com/en/company/klinika_shilovoy/blog/511076/

散光 gif