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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]
To measure the horizontal deviation, the Maddox rod is placed in front of the right eye (it is done on both eyes) with the cylinder horizontal, making the red line vertical. The patient is then asked whether the white light is superimposed on the red line, or if it is to the left or right of the red line.
The glasses are placed in the trial frames with the striations vertical, giving rise to two horizontal line images when viewing a spotlight. If the patient has a vertical deviation, the lines will be seen one above the other. If there is little or no vertical separation, vertical prism can be used to separate the lines.
When measuring horizontal fusion ranges, base in prisms assess fusional divergence while base out prisms assess fusional convergence. The vertical fusional vergence amplitude can also be measured with base up and base down prisms although the horizontal PFR is typically the main focus when testing.
Sample prescription. A prescription of −1.00 +0.25 × 180 describes a lens that has a horizontal power of −1.00 D and a vertical power of −0.75 D. Only ophthalmologists write prescriptions in + cylinder. An optometrist would write a prescription in - (minus) cylinder.
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). Experimental evidence for the effectiveness of the aligning prism came from a study of reading speed and corresponding preferences of prism eye glasses.