The base-to-base induced-tropia prism test for detection of amblyopia: a pilot study

To investigate the accuracy of the base-to-base prism test (BBPT), which entails inducing an esotropia with the use of base-in prisms before each eye, in the diagnosis of amblyopia.

Participants were consecutive patients recruited from a pediatric ophthalmology practice who were able to perform logMAR acuity testing. All participants underwent an orthoptic examination, including logMAR visual acuity testing, and a sensorimotor evaluation. Patients with an interocular difference of 2 or more lines were considered to have amblyopia. Fixation preference was assessed by use of both the vertical fixation test and the BBPT. The agreement between the BBPT and visual acuity was analyzed and compared with the agreement between the vertical fixation test and visual acuity.

Fifty-one consecutive patients aged 4 to 17 (mean, 9.8 years; SD ± 3.4) were included, of whom 11 were diagnosed with amblyopia. Kappa analysis showed moderate but significant agreement between the BBPT and logMAR (κ = 0.453, p = 0.001), whereas the vertical fixation test demonstrated only a fair agreement (κ = 0.254, p = 0.061). The overall sensitivity for the BBPT was 72.7% (95% confidence interval [95% CI], 43.4%-90.3%) but only 40% for the vertical fixation test (95% CI, 16.8%-69.7%). For the BBPT, specificity was 80% (95% CI, 65.2%-89.5%); for the vertical fixation test, 78% (95% CI, 63.3%-88.0%).

The BBPT appears to be more sensitive than the vertical fixation test for detecting amblyopia in our patient population. The 2 tests had similar specificity.