Measuring the effect of eyeglasses on determination of squint angle with Purkinje reflexes and the prism cover test

Abstract

The alternating prism and cover test is the conventional test for the measurement of the angle of strabismus. The error induced by the prismatic effect of glasses is typically about 27-30%/10 D. Alternatively, the angle of strabismus can be measured with methods based on Purkinje reflex positions. This study examines the differences between three such options, taking into account the influence of glasses. The studied system comprised the eyes with or without glasses, a fixation object and a device for recording the eye position: in the case of the alternate prism and cover test, a prism bar was required; in the case of a Purkinje reflex based device, light sources for generation of reflexes and a camera for the documentation of the reflex positions were used. Measurements performed on model eyes and computer ray traces were used to analyze and compare the options. When a single corneal reflex is used, the misalignment of the corneal axis can be measured; the error in this measurement due to the prismatic effect of glasses was 7.6%/10 D, the smallest found in this study. The individual Hirschberg ratio can be determined by monocular measurements in three gaze directions. The angle of strabismus can be measured with Purkinje reflex based methods if the fundamental differences between these methods and the alternate prism and cover test, and if the influence of glasses and other sources of error are accounted for.