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
[Link] refractive index of the material of which the prism is
made
[Link] refractive angle of the prism
[Link] 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
[Link]
[Link]
[Link]
[Link]
Diagnostic
[Link] 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
[Link] insufficiency
[Link] 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
[Link] 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 [Link] 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 [Link] 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
[Link] spectacles
A prism of 8 dioptre is used with base towards the blind
side
[Link] 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
