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Prism Adaptation Study Research Group

Arch Ophthalmol. 1990;108(9):1248-1256.

Abstract
• Prism adaptation, the preoperative use of prisms in acquired esotropia to determine the maximum angle of strabismus and to estimate fusional potential, has been suggested as a method of improving the results of initial surgery and minimizing the rate of reoperation. We performed a prospective, randomized, multicenter clinical trial of the effectiveness of prism adaptation. Two levels of randomization were used. Sixty percent of the patients underwent prism adaptation and 40% did not. Of those who responded to prisms with motor stability and sensory fusion, half underwent a conventional amount of surgery and half underwent augmented surgery based on the prism-adapted angle of deviation. Success rates were highest (54 [89%] of 61 patients) in prism adaptation responders who underwent augmented surgery and lowest (92 [72%] of 127 patients) in patients who did not undergo prism adaptation. Prism responders had better results with augmented surgery than with conventional surgery (54 [89%] of 61 patients vs 53 [79%] of 67 patients, P =.23). Our results indicated a significant beneficial overall effect of prism adaptation in patients with acquired esotropia (success rates, 83% vs 72%, P =.04). Although the process requires some additional time and effort, it appears to result in a higher rate of satisfactory alignment.

Footnotes
Accepted for publication June 29, 1990.

A complete list of the participants in this study appears on page 1256.

Reprint requests to University of Minnesota, Coordinating Centers for Biometric Research, Suite 200, 2221 University Ave SE, Minneapolis, MN 55414 (Dr Connett).

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