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Related Experiment Video

Updated: Jul 6, 2026

Comparison of Agreement and Accuracy using Binocular Wavefront Optometer with Autorefractor and Phoropter
05:14

Comparison of Agreement and Accuracy using Binocular Wavefront Optometer with Autorefractor and Phoropter

Published on: September 16, 2025

Do dissociated or associated phoria predict the comfortable prism?

Joanna M N Otto1, Miriam Kromeier, Michael Bach

  • 1Universitäts-Augenklinik, Killianstr. 5, 79106 Freiburg, Germany.

Graefe'S Archive for Clinical and Experimental Ophthalmology = Albrecht Von Graefes Archiv Fur Klinische Und Experimentelle Ophthalmologie
|April 2, 2008
PubMed
Summary

Dissociated and associated phoria measurements may not accurately predict the comfortable prism needed for natural vision. These phoria tests may introduce viewing condition artifacts, questioning their use in prescribing therapeutic prisms.

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Area of Science:

  • Ophthalmology
  • Optometry
  • Vision Science

Background:

  • Dissociated and associated phoria are clinical measures of latent strabismus.
  • These phorias are assessed under artificial viewing conditions.
  • The study investigates their predictive value for comfortable prism under natural viewing.

Purpose of the Study:

  • To determine if dissociated and associated phoria predict the comfortable prism.
  • To evaluate the reliability of current phoria measurements for prism prescription.

Main Methods:

  • Utilized a Mallett test-like configuration for associated phoria.
  • Employed modified Mallett tests for dissociated and comfortable prism determination.
  • Twenty non-strabismic subjects adjusted counterrotating prisms to find their comfortable setting.

Main Results:

  • Significant differences were observed between phoria measurements and the comfortable prism values.
  • On average, phoria values were shifted towards the eso direction compared to the comfortable prism.
  • Individual phoria parameters varied considerably from the comfortable prism settings.

Conclusions:

  • Artificial viewing conditions in phoria tests likely induce artifacts.
  • Current textbook recommendations for using phoria to guide prism prescription are questionable.
  • Patients' self-determined comfortable prism under natural viewing conditions is recommended.