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--- prism_adaptation_for_esotropia [2016/06/23 01:53] – Scott Larson
+++ prism_adaptation_for_esotropia [2025/04/18 20:40] (current) – external edit 127.0.0.1
@@ Line 1: / Line 1: @@
+====== Prism Adaptation for Esotropia ======
+  * Prism Adaptation Study
+    * Randomized controlled trial
+    * Provides an evidence based paradigm for treatment
+===== Candidates =====
+  * Acquired Esotropia
+  * Partially Accommodative Esotropia
+  * Esotropia with Near > Distance
+  * Exotropia has not been investigated thoroughly with this procedure
+===== Procedure =====
+  * Add Fresnel prism to glasses
+  * Try to split prism equally with larger prism over eye with worse acuity if needed
+===== Possible Outcomes =====
+  * **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
+===== Surgical Dose Table =====
+^  Target Angle (PD)   ^  BMRc   ^  LRs (one eye)   ^
+| 12 - 15            | 3.0   | -              |
+| 16 - 20            | 3.5   | -              |
+| 21 - 25            | 4.0   | -              |
+| 26 - 30            | 4.5   | -              |
+| 31 - 35            | 5.0   | -              |
+| 36 - 40            | 5.5   | -              |
+| 41 - 45            | 6.0   | -              |
+| 46 - 50            | 5.0   | 5.0            |
+| 51 - 55            | 5.0   | 6.0            |
+| 56 - 60            | 5.0   | 7.0            |
+===== References =====
+  * [[http://archopht.jamanetwork.com/article.aspx?articleid=638654 | Prism adaption for Acquired Esotropia (6 months outcome data)]]
+  * [[http://www.aaojournal.org/article/S0161-6420(96)30586-1/abstract|One-Year Surgical Outcome after Prism Adaptation for Acquired Esotropia]]