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Related Experiment Videos

Re-evaluation of the four prism diopter base-out test.

K A Frantz1, S A Cotter, B Wick

  • 1Illinois College of Optometry, Chicago.

Optometry and Vision Science : Official Publication of the American Academy of Optometry
|October 1, 1992
PubMed
Summary

The four prism diopter base-out (4 delta BO) test shows high inter-observer agreement but lacks repeatability and exhibits many atypical responses, questioning its diagnostic value for binocular vision disorders.

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Area of Science:

  • Ophthalmology
  • Optometry
  • Vision Science

Background:

  • The four prism diopter base-out (4 delta BO) test is a commonly recommended objective assessment for binocular visual function.
  • It is frequently used in patients suspected of having microstrabismus or central suppression.
  • However, critical aspects of the test's reliability and validity remain largely unknown.

Purpose of the Study:

  • To evaluate the inter-observer agreement of the 4 delta BO test.
  • To analyze the types and prevalence of eye movements and responses in individuals with and without normal binocular vision.
  • To assess the repeatability of the 4 delta BO test results over time.

Main Methods:

  • Inter-observer agreement was assessed using 15 subjects and two examiners.

Related Experiment Videos

  • Response types and eye movements were documented in 212 children and 116 adults with normal binocular vision, and 14 individuals with abnormal binocular vision.
  • Test-retest repeatability was evaluated in 22 subjects.
  • An SRI Eye-tracker was used to record eye movements in 6 subjects (2 with strabismus, 4 with normal vision).

    • Main Results:

    • High inter-observer agreement was found for the 4 delta BO test.
    • Numerous atypical responses were observed in both children and adults, irrespective of their binocular vision status.
    • Awareness of diplopia did not reliably distinguish between individuals with normal and abnormal binocular vision.
    • The 4 delta BO test demonstrated poor repeatability of results.

    Conclusions:

    • The 4 delta BO test yields frequent atypical and variable responses, even in individuals with normal binocular vision.
    • The lack of repeatability raises concerns about its diagnostic reliability.
    • Clinicians should exercise caution when relying solely on the 4 delta BO test for diagnosing binocular vision abnormalities.