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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.
- BD: base down prisms - BU: base up prisms - BO: base out prisms - BI: base in prisms - eso: esotropia - exo: exotropias - L/R: left hypertropia or right hypotropia - R/L: right hypertropia or left hypotropia Double Maddox rod test. The double Maddox rod test can also be used to assess torsion and measure cyclotropias.
The prism base utilised. For example, Base in (BI), Base out (BO), Base up (BU) or Base down (BD). The angle of the deviation with the units in prism dioptres; Which eye is fixating and which eye is deviating; Whether the test was performed with or without an abnormal head posture; Examples of recording
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.
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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.
The Krimsky test is essentially the Hirschberg test, but with prisms employed to quantitate deviation of ocular misalignment by determining how much prism is required to centre the reflex [2] The Krimsky test is advisably used for patients with tropias, but not with phorias.
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.
Glasses, surgery [3] Frequency. ~2% (children) [3] Strabismus is a vision disorder in which the eyes do not properly align with each other when looking at an object. [2] The eye that is pointed at an object can alternate. [3] The condition may be present occasionally or constantly. [3]