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The Four Prism Dioptre Reflex Test (also known as the 4 PRT, or 4 Prism Dioptre Base-out Test) is an objective, non-dissociative test used to prove the alignment of both eyes (i.e. the presence of binocular single vision) by assessing motor fusion.
If the patient saw a red line to the right and white light to the left, they are said to have esotropia or esophoria (uncrossed diplopia) in which base out (BO) prisms of increasing strength are used until the lines are superimposed.
Treatment options for esotropia include glasses to correct refractive errors (see accommodative esotropia below), the use of prisms, orthoptic exercises, or eye muscle surgery. The term is from Greek eso meaning "inward" and trope meaning "a turning".
If test prisms with increasing amount are placed in front of the observer’s eyes, the fixation disparity changes in the eso direction with base-in prisms and in the exo direction with base-out prisms (Fig. 3). These prisms force the eyes to change the vergence angle while the viewing distance remains unchanged.
Suppression of an eye is a subconscious adaptation by a person's brain to eliminate the symptoms of disorders of binocular vision such as strabismus, convergence insufficiency and aniseikonia. The brain can eliminate double vision by ignoring all or part of the image of one of the eyes.
For an abnormal result, based on where the light lands on the cornea, the examiner can detect if there is an exotropia (abnormal eye is turned out), esotropia (abnormal eye is turned in), hypertropia (abnormal eye higher than the normal one) or hypotropia (abnormal eye is lower than the normal one).
The prism cover test ( PCT) is an objective measurement and the gold standard in measuring strabismus, i.e. ocular misalignment, or a deviation of the eye. [1] It is used by ophthalmologists and orthoptists in order to measure the vertical and horizontal deviation and includes both manifest and latent components. [1]
Anisometropia is a condition in which a person's eyes have substantially differing refractive power. [1] Generally, a difference in power of one diopter (1D) is the threshold for diagnosis of the condition .
Dissociated vertical deviation (DVD) is an eye condition which occurs in association with a squint, typically infantile esotropia. The exact cause is unknown, although it is logical to assume it is from faulty innervation of eye muscles.
The test is indicated with the use of a presence of a prism in individuals with a strabismus and fusion is considered present if 4 lights are maintained, with or without the use of a prism. The W4LT can also be indicated when aiding a person to develop and strengthen their fusional capacities.