Prism Adaptation for Esotropia

Prism Adaptation Study
- Randomized controlled trial
- Provides an evidence based paradigm for treatment

Candidates

Add Fresnel prism to glasses
Try to split prism equally with larger prism over eye with worse acuity if needed

Non-Responder
- Orthotropic but no sensory response
  - Keep prisms on and check immediately before surgery
- Exotropia of any size
- Stop and do surgery for entry angle
Responder
- ≤ 8 Prism Diopers on Simultaneous prism cover test at distance and near and
- Peripheral fusion on Worth 4 Dot test or
- Stereo response on Titmus Stereo test
- Surgery for angle at response
Builder
- > 8 Prism Diopters on Simultaneous prism cover test
- Add more prism and recheck in a week