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If the eye was exotropic, covering the fixating eye will cause an inwards movement; and if esotropic, covering the fixating eye will cause an outwards movement. The alternating cover test, or cross cover test is used to detect total deviation (tropia + phoria).
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. It is used by ophthalmologists and orthoptists in order to measure the vertical and horizontal deviation and includes both manifest and latent components. [1]
The Worth Four Light Test is indicated for use when assessing the binocular functions, the ability of eyes to work in coordination, of an individual. It can be used to develop a diagnosis or to support or confirm an initial diagnosis.
Even when the double vision images are made to nearly overlap using optical means such as prisms, the irregular movements prevent binocular fusion. The name horror fusionis (Latin phrase literally meaning "fear of fusion") arises from the notion that the brain is, or at least appears to be, actively preventing binocular fusion.
Where appropriate, prismatic correction can be used, either temporarily or permanently, to relieve symptoms of double vision. In specific cases, and primarily in adult patients, botulinum toxin can be used either as a permanent therapeutic approach, or as a temporary measure to prevent contracture of muscles prior to surgery
The prism fusion range (PFR) or fusional vergence amplitude is a clinical eye test performed by orthoptists, optometrists, and ophthalmologists to assess motor fusion, specifically the extent to which a patient can maintain binocular single vision in the presence of increasing vergence demands.
Based on prism-FD curves (Fig. 3b), one can find the aligning prism sP 0 that nullifies the naturally prevailing fixation disparity sFD 0. This test procedure is typically made in near vision of 40 cm, e.g. with the Mallett-unit, the Disparometer, or the Wesson card (see above).
Incomitant strabismus cannot be fully corrected by prism glasses, because the eyes would require different degrees of prismatic correction dependent on the direction of the gaze.
Spectacle correction For those with large degrees of anisometropia, the wearing of standard spectacles may cause the person to experience a difference in image magnification between the two eyes ( aniseikonia ) which could also prevent the development of good binocular vision.
Prism spectacles with a single prism perform a relative displacement of the two eyes, thereby correcting eso-, exo, hyper- or hypotropia. In contrast, spectacles with prisms of equal power for both eyes, called yoked prisms (also: conjugate prisms , ambient lenses or performance glasses ) shift the visual field of both eyes to the same extent.