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Ikhaya Ezempilo Ukwelashwa kokuphazamiseka Ukuphazamiseka Ukwelapha i-oi-Neha Ghosh ngu UNeha Ghosh ngoJulayi 22, 2020| Kubuyekezwe ngu Sneha Krishnan

Ukuba nombono ocacile, ocijile kubalulekile ukusisiza ukuthi sibone umbono ocacile womhlaba. Ukusuka ekubukeni izinto eziseduze nezikude ukuze siqiniseke ukuthi asiphuthelwa isinyathelo futhi siwe, amehlo ethu ahlala enyakaza ukunikeza ubuchopho ulwazi olusha mayelana nendawo esikuyo. Kepha, lapho umbono wakho uba mpofu futhi ufiphele futhi ungaziboni izinto ngokucacile, ungahle ube nombono ofiphele. Kulesi sihloko, sizoxoxa ngezimbangela, izimpawu, ukuxilongwa kanye nokwelashwa kokubona okufiphele.

Uyini Umbono Olufiphele?

Ukubona okufiphalisiwe kusho ukwehla kokubukhali kwamehlo, okwenza kube nzima ukubona imininingwane emihle. Inkinga kunoma iyiphi ingxenye yeso, njenge-cornea, i-retina noma i-optic nerve, ingaholela ekuboneni ukufiphala. Ukubona okufiphele nakho kungavela ngenxa yezifo ezithile zamehlo noma kungaba uphawu lwezimo eziningi zezokwelapha ezifana nesifo sikashukela noma isifo sohlangothi [1] , [okubili] . Imithi efana ne-chloroquine, umuthi osetshenziselwa ukwelapha umalaleveva unemiphumela engemihle njengokufiphala kwesikhashana kombono [3] .

Ngokuya ngesizathu, ukubona okungaqondakali kungenzeka iso elilodwa noma womabili amehlo.

Yini Ebangela Ukubona Okufiphele?

Zingaba khona izimbangela eziningi zokufiphaza, lokhu kufaka okulandelayo:

• I-Astigmatism - Ngokusho kwe-American Optometric Association, i-astigmatism yisimo semehlo esivamile esidala ukungaboni kahle. Kwenzeka ngenxa ye-cornea noma ilensi emise okungajwayelekile ngaphakathi kweso, evimbela ukukhanya ukuthi kungagxili kahle kwi-retina (indawo ezwela ukukhanya ngemuva kweso), okuholela ekuboneni okufiphele noma okusontekile [4] .

I-Astigmatism ivame ukwenzeka ngezinye izimo zamehlo ezifana ne-myopia (ukubona eduze) ne-hyperopia (ukubona kude). Futhi inhlanganisela yalezi zimo zamehlo ibizwa ngamaphutha e-refractive ngoba athinta indlela amehlo agobeka noma akhanye ngayo ukukhanya.

• I-Myopia (ukubona eduze) - Kuyisimo samehlo esivamile lapho ungabona khona izinto ezisondele kahle, kepha izinto ezikude zibukeka zilufifi. Abantu abane-myopia banobunzima bokubona izinto ngokucacile ngenkathi bebuka ithelevishini noma beshayela kaningi kubangela ukungaboni kahle [5] .

• I-Presbyopia - Ukukhubazeka kombono ohlobene nobudala okwenza kube nzima ukugxila ezintweni eziseduze, kubangele ukubona okufiphele.

• Hyperopia (ukubona kude) - Kungenye isimo seso esivamile, lapho ungabona khona izinto ezikude ngokucacile, kepha izinto ezisondelene zibukeka zilufifi.

• I-cataract - Kuyindawo enamafu emboza ilensi ecacile yeso. Imvamisa, ilensi (etholakala ngemuva kwe-iris) igxila ekukhanyeni ku-retina, ehambisa isithombe ngomthambo we-optic uye ebuchosheni. Kepha, uma ilensi ifuhlwe yi-cataract, iphazamisa ukukhanya okufinyelela ku-retina ngemuva kweso, okuholela ekuboneni okufiphele noma okufiphele [6] .

• Ukwehla kwe-macular okuhlobene nobudala - Lesi sifo sithinta i-macula, etholakala eduze nendawo ye-retina ebhekele umbono obukhali ophakathi nendawo. Lapho ukuwohloka kwe-macular okuhlobene nobudala kuthuthuka, umbono ophakathi uyawohloka ubangela ukufiphala nokulahleka kombono [7] . Ukwehla kwe-macular okuhlobene nobudala kulapho ukulahleka kombono kuqhubeka kancane futhi ukwehla okumanzi okuhlobene nobudala kuyindlela esheshayo futhi enzima yokulahleka kombono.

• I-Glaucoma - Iqembu lezimo zamehlo ezilimaza imizwa ye-optic. Kwenziwa ucwaningo ezigulini ezingama-99 ezitholwe zinezinhlobo ezahlukahlukene nezigaba ze-glaucoma. Bagcwalise uhlu lwemibuzo olukhombisa ukuthi zonke iziguli, kufaka phakathi iziguli ezine-glaucoma yokuqala noma elinganiselayo zathola isidingo sokukhanya okuthe xaxa nokufiphala, okwabikwa njengezimpawu ezivame kakhulu [8] .

• Isilonda -Iritis, eyaziwa nangokuthi i-acute anterior uveitis, ukuvuvukala kwe-iris (ingxenye enemibala yeso) futhi kuthinta nengxenye engaphambili yeso phakathi kwe-cornea ne-iris (igumbi langaphakathi). I-uveitis engapheli neyangemuva ibangela izimpawu ezinjengokubona okufiphele [9] .

• Ukuhlukaniswa kwe-retinal -Kwenzeka lapho i-retina yakho ikhala isuka ngemuva kweso lakho futhi kuncipha ekunikezelweni kwegazi. Ngokuya ngocwaningo olushicilelwe kwiCommunity Eye Health Journal, izimpawu ezijwayelekile zokuxhunywa kwe-retinal ukubona okufiphele noma ukulahleka kombono kungazelelwe, okungenabuhlungu esweni elithintekile. Ezinye iziguli ezinengxenye ethize ye-retinal zizobhekana nokulahleka kwensimu (ukulahleka kombono engxenyeni eyodwa yenkambu ebonakalayo) [10] .

• Ukuvaleka kwe-vein yokubuyisa - Yisifo sesibili se-retinal esivame ukubangela ukulahleka kombono ezigulini ezindala. Kunezinhlobo ezimbili zokuvaleka kwe-vein retinal: ukuvalwa kwegatsha le-retinal vein (BRVO) kanye ne-central retinal vein occlusion (CRVO). Iziguli ezine-central retinal vein occlusion zivame ukuzwa umbono wokufiphala esweni elilodwa okwenzeka ngokuzumayo, okuzoba buhlungu [ishumi nanye] .

• I-Hyphema - Kubonakala ngokunqwabelana kwedamu elikhulu legazi egumbini langaphakathi elenzeka ngemuva kokuthola ukuhlukumezeka esweni. Iziguli zithola ukwehla okungazelelwe noma ukulahleka kombono. Ukulahleka kombono kuncike ezingeni leziguli ze-hyphema microhyphema ezingaba nombono ojwayelekile noma ukubona okungacacile [12] .

• Isifo sikashukela seMellitus - Abantu abanesifo sikashukela bangathola ushintsho embonweni wabo. Ucwaningo lukhombisile ukuthi iziguli ezinesifo sikashukela zivame ukuba nezimpawu zokungaboni kahle ngesikhathi se-hyperglycemia (amazinga aphezulu kashukela egazi), okungahle kube ngumphumela wezinguquko zesikhashana ezibuyiswayo ngenxa yezinguquko kwi-lens noma ku-retina [13] .

• Unhlangothi - Ngemuva kokushaywa unhlangothi, izinkinga zombono ezijwayelekile zivamile futhi izimpawu zibandakanya ukungaboni kahle phakathi kwabanye. Ucwaningo lwenziwa phakathi kweziguli ezingama-915 ezineminyaka engama-69. Kuzo iziguli ezingama-479 zazilahlekelwe insimu ebonakalayo, iziguli ezingama-51 azitholanga zimpawu ezibonakalayo, isigamu seziguli ezinesifo sasilahlekelwe yinsimu yokubuka kuphela kanti esinye isigamu sabona ukufiphala, ubunzima bokufunda, idiplopia, nobunzima bokuqonda [14] .

• Isigaxa sobuchopho - Kukhula kwamaseli angajwayelekile ebuchosheni. Ukubona okufiphele kuwuphawu oluvamile lwesimila sobuchopho.

• I-Multiple sclerosis - Kuyisifo esihlasela isimiso sezinzwa esiyinhloko esithinta izinzwa ze-optic, ubuchopho nomgogodla. Cishe ikota eyodwa yeziguli ezine-multiple sclerosis ezitholwe zine-unilateral noma yamazwe amabili INO (ukuphazamiseka kwamehlo) zivame ukuba nombono wokufiphala nezinye izimpawu [ishumi nanhlanu] .

• I-Myasthenia gravis - Yisifo esingalapheki se-neuromuscular esibangela ukuba buthakathaka kwemisipha ebusweni nasemehlweni. I-Ocular myasthenia gravis ithinta imisipha yamehlo namajwabu amehlo, okudala izimpawu ezivamile njengokufiphalaza nokubona amajwabu amehlo.

• I-retinopathy yesifo sikashukela - Kuyinkinga yenkinga yesifo sikashukela ethinta amehlo. I-retinopathy yesifo sikashukela yenzeka lapho kukhona ukulimala kwemithambo yegazi ku-retina. Izimpawu ukungaboni kahle, ukungaboni kahle ebusuku kanye nokukhubazeka kombala phakathi kwabanye.

• Migraine - I-Migraine yisifo esivamile sekhanda esidala ikhanda elibuhlungu elingaqala lize noma lihambisane nezimpawu ezihlukile zokubuka. Izinkinga zombono ezibangelwa i-migraine zingasukela ekufiphaleni noma ekuboneni inkungu, ukulahleka kombono kwelinye noma womabili amehlo nokuphikelela kwezithombe [16] .

• Ukuhuzuka kwe-Corneal - Ukuhuzuka kwe-Corneal kwenzeka lapho izinto ezincane zingena esweni lakho futhi zingadala umonakalo ebusweni be-cornea. I-cornea inemicu eminingi yezinzwa, ezwelayo ukuthintwa nokulimala, ngakho-ke lapho into yangaphandle efana nenhlamvu yesihlabathi noma isinambuzane esincane ingena esweni lakho, iqala ukunisela futhi ibuhlungu. Ngenxa yalokho, uzoqala ukubhekana nokungaboni kahle nokuzwela ekukhanyeni [17] .

• I-conjunctivitis yokungezwani komzimba - I-Allergic conjunctivitis yizinhlobo ezintathu: i-acute, yonyaka futhi engapheli. Ukutheleleka okunamandla noma i-GPC (i-giant papillary conjunctivitis), i-hay fever conjunctivitis yonyaka noma ifomu le-vernal kanye namafomu angapheli. Izimpawu ze-conjunctivitis yonyaka zivame ukungaboni kahle, ubuhlungu, njll. [18] .

• Uhlobo lwamehlo edijithali (i-computer vision syndrome) - Ngokwe-American Optometric Association, uhlobo lwamehlo lwedijithali lubangela izinkinga eziningi ezihlobene namehlo nezokubona futhi lubonakala kakhulu kubantu abasebenzisa umakhalekhukhwini, ikhompyutha nethebhulethi isikhathi eside. Esinye sezibonakaliso ezivame kakhulu zohlobo lwedijithali ukubona ngamehlo.

• I-keratitis yebhaktheriya -Kukutheleleka kwe-cornea okubangelwa amagciwane afana no-S. Aureus, coagulase-negative staphylococci, S. pneumoniae kanye ne-pseudomonas aeruginosa. I-Pseudomonas aeruginosa uhlobo oluvame kakhulu lwama-bacteria oluthinta abaphathi belensi yokuxhumana. Iziguli ezine-bacterial keratitis zivame ukuba nezimpawu ezinjengokungaboni kahle, i-photophobia nobuhlungu [19] .

• Imithi - Imithi ethile ingaba nemiphumela emibi esweni futhi idale ukungaboni kahle. Izidakamizwa zokungasebenzi kahle kwe-Erectile zikhonjisiwe ukuthi zibangele ukubona okungahambi kahle nokwandisa ukuzwela kokukhanya [amashumi amabili] . Izidakamizwa ezingezona-steroidal ezilwa nokuvuvukala njenge-indomethacin lapho zisetshenziswa isikhathi eside zingadala ukungaboni kahle [amashumi amabili nanye] . Futhi i-chloroquine, umuthi olwa nomalaleveva ungadala ukungaboni kahle.

Izimpawu Zombono Ofiphele

Ngokuya ngesizathu, ukungaboni kahle kungahle kuhambisane nezinye izimpawu, lokhu kufaka:

• Ukuzwela okukhanyayo

• Ubuhlungu bamehlo

• Izikhukhula noma amabala phambi kwamehlo akho

• Ukucindezela kwamehlo nokukhathala

• Ububomvu

• Ukubona kabili

• Ukoma nobuhlungu bamehlo

• Ukukhishwa kwamehlo

• Izimpawu zokuhlukumezeka esweni

• Ukuphathwa yikhanda nesicanucanu

• Ukuluma

• Umfundi omhlophe

Lapho Uzobona Udokotela

Kufanele ufune usizo lwezokwelashwa ngokushesha uma unombono ofiphele ngokungazelelwe futhi unalezi zimpawu ngemuva kokubona okufiphele, njengekhanda elibuhlungu, ubunzima bokukhuluma, inkathazo yokubona, ukudonsa ebusweni, ukungahambisani nobuthakathaka ebusweni, emlenzeni noma imisipha yezingalo.

Ukuxilongwa Kombono Ongaqondakali

Udokotela uzohlonza imbangela yombono wakho ofiphele ngokubuza imibuzo enjengokuthi ‘Uqale nini ukubona ukufiphala?’, ‘Yiziphi ezinye izimpawu onazo ngombono ofiphele?’ neminye imibuzo efana nokubuza ngomlando wakho wezokwelapha nomlando womndeni wezimo zamehlo. Lokhu kuzosiza udokotela ukuthi aqonde kahle ukuthi isiguli sizwa ini ngoba iziguli eziningi zingachaza ukubona okufiphele njengokulahlekelwa isinyathelo noma ukungakwazi ukubona kahle noma ukufunda incwadi.

Udokotela angaqhubeka enze ukuhlolwa kwe-acuity visual, ukuhlolwa kwamehlo okubheka ukuthi ungayibona kahle kangakanani imininingwane yencwadi noma uphawu kusuka ebangeni elithile. Ngokufanelekile, ukuhlolwa kwe-acuity visual kwenziwa ngokusebenzisa ishadi elijwayelekile eliphrintiwe le-Snellen nesiguli esimi amamitha ayisithupha kude noma kusetshenziswa ishadi lamehlo eligcinwe cishe ngamasentimitha angama-35. Iso ngalinye liyahlolwa ngenkathi elinye iso limbozwe ngento eqinile. Uma isiguli sigqoke izibuko zebanga kufanele sigqokwe ngesikhathi sokuhlolwa. Ezigulini ezineminyaka engaphezu kwengu-40 ezigqoke izibuko ezihlukene, ishadi lamehlo kufanele lisetshenziswe kuma-intshi angu-14.

Ngemuva kwalokho, isiguli sicelwa ukuthi sifunde izinhlamvu ezincane nezinkulu eshadini lamehlo. Uma isiguli singakwazi ukufunda zonke izinhlamvu ngisho nakude kakhulu, umhloli ube esecela isiguli ukuthi senze ukubala kweminwe ukubona ukuthi isiguli singazibala kahle yini. Uma ukubalwa kweminwe kungenzeki, umhloli uvivinya ukuthi isiguli siyakwazi yini ukubona ukunyakaza kwesandla. Uma lokhu kungasebenzi, ukukhanya kukhanya esweni ukubona ukuthi isiguli siyakubona yini ukukhanya.

Uma isiguli singenazo izibuko zaso, umgodi wesipikili ubanjwa eduze kweso, okuyindlela ephumelelayo yokuthola amaphutha wokuphikisa.

Ezigulini ezisencane, eziphonswe inselelo noma ezingafundile, ishadi leSnellen lisetshenziswa nezithombe noma ezinye izimpawu kulo [22] .

Olunye uvivinyo lwamehlo olufana nokuhlolwa kwesibani esinqunyiwe kanye ne-ophthalmoscopy kuyenziwa.

Ukuhlolwa kwesibani se-slit kwenziwa ngokusebenzisa i-microscope enokukhanya okukhanyayo. Udokotela wamehlo uzoqala anwebe abafundi bakho ngamaconsi avulekayo. Futhi-ke udokotela uzobhekisisa kahle izakhiwo ezahlukahlukene ngaphambili nangaphakathi kweso lakho. Kuzosiza ekutholeni imbangela ngqo yombono ophuthelwe.

I-Ophthalmoscopy okunye ukuhlolwa kwamehlo okwenziwa ngokusebenzisa i-ophthalmoscope ukubheka ngemuva kwamehlo akho. Ngayo udokotela uhlola i-retina, i-optic nerve nemithambo yegazi. Ukuhlolwa kwamehlo kusiza udokotela ukuhlola izifo nezinye izinkinga zamehlo.

Ukwelashwa Kombono Olufiphele

Ngokuya ngesizathu sokungaboni kahle, ukwelashwa kuyenziwa. Sibhale phansi ezimbalwa:

• I-Astigmatism - Ukuhlolwa kwamehlo okuphelele kungasiza ukuxilonga i-astigmatism futhi kungalashwa ngosizo lwezibuko zamehlo, amalensi wokuxhumana, i-orthokeratology kanye nokuhlinzwa kwe-laser.

• Ukwehla kwe-macular okuhlobene nobudala - Ukuhlolwa okuphelele kwamehlo nezinye izivivinyo zokuxilonga kuzosiza ekutholeni ukonakala kwe-macular okuhlobene nobudala. Ukwelashwa kokuwohloka kwe-macular okuhlobene nobudala kufaka phakathi ukwelashwa kokudla okunomsoco kanye nezithasiselo kanye nokwehla okumanzi okuhlobene nobudala okubandakanya i-anti-VEGF (vascular endothelial growth factor) therapy.

• I-Glaucoma - Kuhlolwa ngokuphelele iso ukuze kutholakale i-glaucoma. Amaconsi wamehlo nokuhlinzwa kwelaser kusetshenziselwa ukwelashwa kwe-glaucoma.

• Unhlangothi - Kuya ngohlobo lwesifo sohlangothi, ukwelashwa kuyenziwa.

• Migraine - Imithi kanye namakhambi athile asekhaya angaletha ukukhululeka ekhanda le-migraine.

• I-cataract - Ukuhlolwa kwamehlo okuphelele kwenziwa ukuthola i-cataract. Futhi i-cataract ingasuswa ngosizo lokuhlinzwa kwe-cataract.

• Isifo sikashukela - Kuya ngohlobo lwesifo sikashukela ukwelashwa kwenziwa futhi lokhu kubandakanya ukudla okunempilo, ukuqapha ushukela wegazi, ukuvivinya umzimba, i-insulin nemithi yomlomo.

• Ukuhuzuka kwe-Corneal - Amaconsi wamehlo noma amafutha okugcoba angasiza ekwelapheni i-corneal nemihuzuko.

Ukuvimbela Umbono Olufiphele

• Yiya kohlolwa iso njalo

• Gqoka izibuko zelanga ukuvikela amehlo akho emisebeni ye-UV.

• Yidla ukudla okunothe uvithamini C, uvithamini E, i-beta-carotene, i-zinc, i-lutein, i-zeaxanthin ne-omega 3 fatty acids njengoba lezi zakhi zomzimba zinciphisa ingozi yezifo zamehlo ezihlobene nobudala [2. 3] .

• Sebenzisa izigqoko zokuphepha uma wenza umsebenzi oyingozi.

• Gwema ukuchitha amahora amaningi kukhompyutha yakho, amaphilisi noma omakhalekhukhwini.

• Yeka ukubhema [24]

• Lawula amazinga kashukela egazini lakho.

Imibuzo evame ukubuzwa

U. Yini engabangela umbono ophuthumayo ongazelelwe?

TO . Ukuhlukaniswa kwe-retinal, isifo sohlangothi, ukonakala kwe-macular kanye nokulimala kwamehlo yizimbangela eziphezulu kakhulu zokufiphaza okungazelelwe.

U. Ingabe umbono ofiphele ngokuzumayo uyisimo esiphuthumayo?

TO. Funa ukunakekelwa kwezokwelapha ngokushesha, uma uhlangabezana nokulahlekelwa okungazelelwe kokubona okucijile.

U. Ingabe umbono ofiphele ungahamba?

TO. Ukubona okufiphele okwesikhashana kungaphela ngosizo lwezibuko zamehlo, noma kunjalo, uma kuyisibonakaliso sesimo esiyisisekelo xhumana nodokotela wakho.

U. Ingabe ukufiphala kwamehlo kuwuphawu lokwehla emzimbeni?

TO. Ukwehla kwamanzi emzimbeni kubangela ukukhathazeka kwamehlo okungaholela ezimpawu ezinjengokubona okufiphele.

U. Ingabe ukungalali kungadala ukungaboni kahle?

TO. Ukuntula ubuthongo kungadala amehlo omile futhi lokhu kungadala ukuzwela okukhanyayo, izinhlungu noma ukubona okufiphele.

U. Ingabe izingcingo zingadala ukufiphala kwamehlo?

TO. Yebo, izingcingo nezinye izinto zobuchwepheshe zingadala ukufiphala.

U. Kungani umbono wami uvele ufiphele ngeso elilodwa?

TO. Ukubona okunamafu ngokuvamile kuyisibonakaliso se-cataract, isimo samehlo esibangela indawo enamafu kuleso leso.

U. Ingabe isikhathi sesikrini esiningi kakhulu singenza amehlo afiphele?

TO. Yebo, isikhathi esiningi sesikrini singenza amehlo akho afiphale.

U. Ngingawavimba kanjani amehlo ami ukuba angafiphali?

TO. Qiniseka ukuthi awakhathazi amehlo akho ngokweqile, uthole ubuthongo obuningi, uphuze amanzi amaningi futhi udle ukudla okuzosiza ekugcineni ukubona kwakho kuphilile.

Sneha KrishnanImithi EjwayelekileMBBS Yazi kabanzi