Prism Use in Adult Diplopia

Kammi B. Gunton; A'sha Brown


Curr Opin Ophthalmol. 2012;23(5):400-404. 

In This Article


Patients have good success with long-term use of prisms. In one study, through the follow-up period of 2 months to 6 years, 86% of the patients continued with prism use, whereas 14% of patients opted for surgical intervention.[2] Although the patients with larger deviations in primary position were less satisfied, surprisingly, 80% still had mostly satisfactory use of the prism. Patients older than 65 years were more likely to be satisfied with prism in this study. Sex, strength of prism, duration of diplopia, or follow-up was not statistically associated with successful use of prism.[2]

Successful use of prism requires correction of the entire deviation in cases of vertical deviations such as acquired fourth nerve palsy in order to achieve satisfaction for patients. Prism is least likely to successfully control symptoms in convergence insufficiency. Realistic patient expectations of prism usage, frequent follow-up of patients to ensure control of symptoms, and modification of prism improve patient satisfaction.