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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".
Monofixation syndrome ( MFS) (also: microtropia or microstrabismus) is an eye condition defined by less-than-perfect binocular vision. [1] It is defined by a small angle deviation with suppression of the deviated eye and the presence of binocular peripheral fusion. [2]
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.
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 .
If the residual esotropia is small, or if the patient is unfit or unwilling to have surgery, prisms can be incorporated into their glasses to provide more permanent symptom relief. When the deviation is too large for prismatic correction to be effective, permanent occlusion may be the only option for those unfit or unwilling to have surgery.
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.
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).
Bagolini Striated Glasses. Pen torch or a distant light source. Alternatively, trial frames and lenses or a lorgnette can be used. In some cases, the use of prisms is necessary to measure a deviation and test for the presence of binocular functions.