HAPPY

NEW
YEAR
2014

PRISMS
&
ITS OPHTHALMIC USES
Dr. Rutvi R. Sadatia

Prism
Definition
It

is a piece of glass bounded by plane surfaces inclined

towards each other.

 REFRACTING/APICAL

ANGLE OF THE PRISM

The angle between the two surfaces
AXIS

OF THE PRISM
A line bisecting the angle

APEX
The

thin edge where the intersecting surfaces meet

BASE
The

opposite surface

Refraction by a prism
Light

passing through a prism obeys Snells law at each

surface.

Rays

base.

of light passing through prism are bent towards the

Angle of deviation (D)

The

net change in direction of the ray is called angle of

deviation

Determined

by 3 factors

1.the refractive index of the material of which the prism is

made
2.the refractive angle of the prism
3.the angle of incidence of the rays

Angle of minimum deviation

Angle

of deviation is least when the angle of incidence

equals the angle of emergence

The

angle of deviation equals half the refracting angle of

the prism

Image formation
If

we turn the light around, making the image the object,

and view the object through the prism, we will see a
virtual image of the object.

The object being viewed through the prism appears

displaced toward the apex of the prism.

Although
The

the light rays themselves bent toward the base

image formed by a prism is erect,virtual &

displaced towards the apex of the prism

 If

a prism is introduced into the path of convergent light,

all the light rays are bent towards the base of the prism,
and the image is also displaced toward the base of the
prism

In

this case, the image is real, and real images are

displaced toward the base of a prism

Positions
2

primary positions

1.

The frontal position---plastic prism

that is parallel to the infraorbital margin

2.

The prentice position---glass prism

the posterior face of the prism is perpendicular to
the line of sight

Notation
1.

Prism Diopter

.Prism

power defines the amount of light-ray deviation

produced as the light ray traverses a prism.

.One

prism dioptre power produces a linear apparent

displacement of 1 cm,of an object,situated at 1 m.

2.

Angle of apparent deviation

.The

apparent displacement of the object measured in

terms of the angle of apparent deviation

.2=1

3. The centrad
This

unit differs from the prism dioptre only in that the

image displacement is measured along an arc 1 m from
the prism

The

centrad produces a very slightly greater angle of

deviation than the prism dioptre

But

the difference in practice is negligible

Uses
1.Diagnostic
2.therapeutic
3.Instruments
4.Miscellaneous

Diagnostic
1.Assessment of squint & heterophoria

Measurement of angle objectively by prism cover

test,prism reflex test of Krimsky

Measurement of angle subjectively by maddox rod

To assess likelihood of diplopia after proposed squint

surgery in adults

Measurement of fusional reserve

4 D base out test

Forms of diagnostic prisms

Single

unmounted prisms
Trial lens set prisms
Prism bars

Prism bar cover test

Krimskys test
AC, Prisms,
baseout, of increasing
power are placed before
the fixating eye until
the light reflex is centered
on the cornea of the deviating
eye.
D, Optical principles of the
prism reflex test

Maddox rod test

A,

Maddox rod in testing position

for horizontal heterophoria.
B, Patient sees the line going
through the light: no horizontal
phoria is present.
C, The line is seen to the left of the
light (crossed diplopia): exophoria.
Add prisms, base-in, to OD until the
line is centered on the light. The
power of the prism is read and
equals the amount of phoria.
D, The line is seen to the right of the
light (uncrossed diplopia):
esophoria. Add prisms, base-out, to
OD until the line is centered.

 A,

Maddox rod in testing

position for vertical
phoria.
B, No vertical phoria is
present.
C, Right hypophoria
(usually left hyperphoria
also). Add prisms, basedown, to OS until the line
is centered.
D, Right hyperphoria. Add
prisms, base-up, to OS
until the line is centered.

Measurement of fusional reserve

Increasingly

powerful prisms are placed before one eye

until fusion breaks down.
This is very useful in assessing the presence of BSV in
children under 2 years old
Vergence with
prisms

Distance (6m) in
D

Near(33 cm) in D

Convergence

14-20

35-40

Divergence

5-8

15-20

Vertical vergence

2-4

2-4

4 D base out test

Test

for microtropia
4 D placed base out before the deviating eye causes no
movement as the image remains within the suppression
scotoma
When placed before the normal eye,movement occurs

Therapeutic
1.Convergence insufficiency
2.To relieve diplopia

Convergence insufficiency
The

commonest use of prisms in the orthoptic

department

Done

on synaptophore

Pt.s eyes

are exposed to fusion slide pictures and pt is

made to fuse them by gradually moving the arms of
synaptophore by which power of base out prisms is
gradually increased

 Exercise

may be continued at home

Pt

is given 4 D with which to practice for a week &

augmenting by 2 prisms at weekly intervals

Exercise

may be done for distance & near

To relieve diplopia
In

cases of decompanseted heterophorias,small vertical

squints & some paralytic squint in the primary position

Prisms

are reserved for those pts for whom surgery is

not indicated

Forms of therapeutic prisms

1.Temporary wear
Clip

on spectacle prisms for trial wear

Fresnel

prisms:

It

is a series of small side-by-side prisms that act as a

single large prism.

It

is typically used to avoid the weight and some of the

aberrations of conventional prisms.

The Origin of Fresnel Lenses

The

French physicist, AugustiJean Fresnel is credited with

the invention of the concept of
this form of lens. Their initial
use was primarily to replace
the very thick lenses used in
lighthouses. To obtain lenses
powerful enough for
lighthouses, massive heavy
lenses were required. By
designing the lens as a series
of small segments, rather than
one large lens, the great
weight could be removed.

The first Fresnel lens was

placed in the Cordouan
Lighthouse at the mouth
of the Gironde estuary in
1823. Augusti-Jean
Fresnel lived only to age
39, but did important
work in diffraction
optics and polarization.

 The

most popular form of Fresnel

prism is a membrane molded from
clear polyvinyl chloride.
Known as a Press-On prism
it

is applied with water to the back surface of an ordinary

spectacle lens.

Press-On

prisms are available in a variety of powers. Visual

acuity is reduced because of light scattering at the groove
edges, but the chromatic aberration of the prism themselves
produces most of the visual decrement

 The

advantages of these prisms far outweigh the

disadvantages, and they are widely used in the fields of
strabismus and orthoptics

Because

of their ease of application and lower expense

Press-On prisms are especially useful for patients

whose strabismus is changing (eg, patients with thyroid
eye disease)

Fresnel lenses are also available with concentric groove

construction to approximate spherical lenses

 Prism Aberrations
Chromatic

aberration produces colored fringes at the

edges of objects

Asymmetrical

magnification and curvature of field

2. permanent wear

Permanent

incorporation of a prism into a pts spectacles can

be achieved by decentring the spherical lens.

Rays

of light incident upon a lens outside its axial zone are

deviated towards (convex lens) or away from(concave lens)
the axis.Thus the peripheral portion of the lens acts as a
prism.

The

refracting angle between the lens surface grows larger as

the edge of the lens is approached.Thus the prismatic effect
increases towards the periphery of the lens
.

 Use

of non axial portion of a lens to gain a prismatic

effect is called decentration of the lens

P=FD
P=

the prismatic power in prism diaoptres

F=the lens power in dioptres
D=the decentration in cm

Priscription of prisms
The

correction is split between the 2 eyes

To correct
convergence-base

out
Divergence-base in
Hypertropia-base down
Hypotropia-base up

Instruments
1. Applanation tonometer
2. Indirect ophthalmoscope
3. Slit lamp microscope
4. Keratometer
5. Operating microscope
6. Synaptophore
7. Haidingers brush
8. Koppes goniolens

Forms of intrumental prisms

1. Right angle prism
Deviation 90
2. Porro prism
Deviation 180
Image inverted but not transposed left to right
3. Dove prism
No deviation
Image inverted but not laterally transposed

Miscellaneous
1. recumbent spectacles
To allow a pt lying in bed to keep the reading matter on
his chest
2.hemianopic spectacles
A prism of 8 dioptre is used with base towards the blind
side
3.low visual aids
Base in prisms are incorporated in binocular magnifier

References
Clinical

optics-Andrew R Elkington & Helena J

Frank
American academic of ophthalmology 20122013
Strabismus simplified-pradeep sharma
Refraction & optics- N C Singhal