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Co to jest niedowidzenie? Jak postepować?
Z wymienionych powyżej przyczyn  zez stanowi jedno z najczęstszych źródeł niedowidzenia u dzieci. Oko zezujące, zwłaszcza o dużym kącie, na skutek nieprawidłowej korespondencji siatkówkowej i często fiksacji ekscentrycznej  ogranicza (tłumi) bodźce płynące z tego oka , aby zredukować podwójne widzenie. Dzieje się tak szczególnie w zezach jednostronnych, ponieważ oko nieużywane (w 90%) staje się po pewnym czasie niedowidzące. (Litwin, Bryg, 2005). Nie mniej jednak nie należy bagatelizować zezów naprzemiennych, gdyż w tych przypadkach występowanie niedowidzenia jest także częste.
    Nierzadko również przyczyną zeza  i niedowidzenia jest  obuoczna wysoka wada refrakcji  (powyżej 5 dioptrii), oraz różnowzroczność (różnica w wadzie refrakcji między oczami wynosząca co najmniej 3 dioptrie). Zatem dziecko, u którego na prawym oku refrakcja wynosi +1.00 Dptr, a na lewym +5,00 Dptr będzie objęte ryzykiem niedowidzenia. Dzieję się tak  z uwagi na wpływ nieprawidłowych (różnych) obrazów na rozwój ostrości widzenia, a częściowo w skutek występującego między obojgiem oczu współzawodnictwa oraz hamowania. Bywa również tak, że niedowidzenie rozwija się na skutek braku bodźców wzrokowych, jest to tak zwane niedowidzenie deprywacyjne. Owa deprywacja może być związana z wrodzonymi wadami lub  wcześnie nabytymi zmętnieniami ośrodków optycznych. (Grałek M. red., 2004) Ten typ amblyopii jest najrzadszy i zarazem najtrudniejszy do leczenia. Starając się ustalić przyczynę niedowidzenia, podczas  anamnezy przeprowadzanej z rodzicami,  nie można pominąć pytań typu: Czy w rodzinie występowały przypadki niedowidzenia, zeza, ciężkich chorób oczu?  Czy poród przebiegał prawidłowo i nastąpił o czasie? Czy miały miejsce jakieś wypadki, urazy głowy dziecka? Należy zaznaczyć, że u pacjentów amblyopijnych dno oka jest zazwyczaj prawidłowe, mogą pojawić się  niewielkie zmiany w okolicy plamki. Często również wytwarza się fiksacja pozaplamkowa (ekscentryczna) oraz nieprawidłowa korespondencja siatkówkowa. Istotny jest fakt, iż ostrość widzenia gwałtownie spada w  miarę oddalania się od centralnej części siatkówki (plamki).  Już obraz wytworzony w części siatkówki przylegającej do plamki jest gorszy 10 krotnie od obrazu tworzonego w samej plamce. (Wolter – Czerwińska, 1988)
    Niedowidzenie powstaje do 3, najpóźniej do 6 r.ż. Często, jak wspomniano,  obniżeniu ostrości wzroku, towarzyszy zez, a im wcześniej on powstaje tym większy stopień niedowidzenia.   
W zależności od ostrości wzroku, badanej na tablicach do dali  niedowidzenie (za Bangerterem) określa się w trzech stopniach.
·                                 duży  (ostrość wzroku 5/50 lub mniej); 0,1 lub mniej
·                                 średni (ostrość wzroku 5/50 – 5/15); od 0,2 do 0,3
·                                 mały (ostrość wzroku 5/15 – 5/8); 0,4 do 0,8
Terapia niedowidzenia to proces  bardzo skomplikowany z uwagi na to, że wszelkie  funkcje  z tym związane dotyczą  mózgu. Rehabilitacją dzieci z zaburzeniami widzenia obuocznego (niedowidzeniem, zezem) zajmują się ortoptyści prowadzący ćwiczenia w gabinetach pleoptyczno – ortoptycznych, we ścisłej współpracy z lekarzem okulistą i/lub strabologiem.
Należy wspomnieć, że skutki braku kontrolnych badań okulistycznych w pierwszych miesiącach życia, zbyt mała wykrywalność wad refrakcji, zeza, niedowidzenia, oraz (niestety) częsta ignorancja rodziców, są bardzo negatywne. 
Drodzy Rodzice pamiętajcie o badaniach przesiewowych, zabiegajcie o nie, nie czekajcie, aż dziecko "wyrośnie z  zeza"!  Wasza czujność może uchronić przed poważną dysfunkcją wzroku.
*Zgodnie z decyzją Rady Języka Polskiego została przyjęta pisownia rozłączna słowa: „słabo widzący”. 
opracowanie: mgr Ewa Witowska
Żródła: informacje szczegółowe znajdują się w dziale: Biblioteka


 
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