Diagnostic occlusion and clinical management of latent hyperphoria

Occasionally in patients who have symptoms suggestive of a vertical heterophoria no deviation is found, even on careful examination. Six days of occlusion have been recommended for uncovering such "latent" vertical deviations. We investigated prolonged monocular occlusion (Part I) and found that vertical deviations of varying amounts manifested on symptomatic and asymptomatic subjects. Thus, results of prolonged occlusion can be difficult to interpret. Nonadaptive vertical vergence systems have been implicated in development of symptoms. Therefore, it may be that diagnostic monocular occlusion is not appropriate unless patients have symptoms of vertical imbalance. We used (24 h) occlusion and associated phoria measurements (Part II) to determine vertical prism prescriptions which eliminated symptoms of seven symptomatic patients who did not show significant vertical heterophoria on routine clinical testing. We present data and case reports which elucidate the efficacy of this procedure.