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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.
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).
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.
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).
It can be used to establish whether a patient has the ability for the eyes to fuse the light that is received from each eye into 4 lights. 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 ...
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.
Prism adaptation is a sensory-motor adaptation that occurs after the visual field has been artificially shifted laterally or vertically. It was first introduced by Hermann von Helmholtz in late 19th-century Germany as supportive evidence for his perceptual learning theory (Helmholtz, 1909/1962). [1]
It is considered particularly useful for patients who have the potential for binocular vision; success rates are higher for treating postoperative esotropia than for treating postoperative exotropia.