Ophthalmic Prism

Ophthalmic Prisms
Ophthalmic Prisms
 A prism
is defined as a portion of a refracting
medium bordered by two plane surfaces
which are inclined at a finite angle.
 Theangle between the two surfaces is called

the refracting angle or apical
angle of the prism.
 A line bisecting the angle is called the axis
of the prism.
 The opposite surface is called the base of

the prism.
 When prescribing prisms ,the orientation is

indicated by the position of the base , ‘base in’,
base up’, base down, base out.
 A prism consists of two angled
refracting surfaces.
 The simplest form of a prism is two flat
surfaces that come together at an angle at the
top. The point is called the apex of the
prism; the wider bottom of the prism is
called the base.
Ophthalmic Prisms
REFRACTION THROUGH PRISM
 Lightpassing through a prism obey snell’s

law at each surface.
 Theray is deviated towards the base of

the prism.
 This
causes objects to be displaced away
from the base of the prism towards its apex.
The net change in direction of the ray , angle D
is called the angle of deviation.
 Allvarieties of spectacle lens has the effect
of a prism when viewed through a point
away from the optical center.
 The further the away from the optical

center, the greater is the prismatic effect
 Fora prism in air ,the angle of deviation
is determined by three factors
1.The refractive index of the material of which

the prism is made.
2. The refracting angle of the prism
3. The angle of incidence of the ray
considered.
 Light rays entering and leaving a
prism are bent towards the base of
the prism.
 This causes objects to be displaced away from the
base of the prism towards its apex.
Base down prism - upward.
Base up prism
- downward
 To the right or left when seen through a base-out

or base-in prism
CHARACTERISTICS OF PRISM
 A prism has a thickest edge, the base and
a thinnest edge, the apex.
 A prism displaces the incident rays towards

the base of the prism.
 A prism displaces the image towards the

apex of the prism.
CHARACTERISTICS OF PRISM
 A prism does not change the vergence of
the rays.
 A prism does not magnify or minify the

image.
 A prism also disperses incident pencil rays

into its component colours.
Angle of Minimum Deviation
 For any particular prism, the angle of

deviation D is least when the angle of
incidence equals the angle of emergence.
Refraction is then said to be symmetrical
and the angle is called the Angle of
minimum deviation.
Image Formation
 The image formed by a prism is

Erect
Virtual
Displaced towards the apex of the
prism.
 Thereare two primary positions in which
the power of a prism may be specified
The position of minimum deviation
The prentice position.

Units of Prisms
 Thepower of a prism can be expressed
in various unit.
1. The prism dioptre
2. The centrad
The prism dioptre (Δ)
 A prism of one prism dioptre power produces
a linear apparent displacement of 1 cm ,of an
object O, situated at 1 m.
 Denoted by the symbol Δ.

The centrad
 This unit differs from the prism dioptre only
in that the image displacement is measured
along an arc 1m from the prism.
 The centrad produces a very slightly greater

angle of deviation than the prism dioptre,
but the difference ,in practice is negligible.
Refracting angle
 A prism may also be described by its

refracting angle.
DEVIATION PRODUCED BY PRISM
 The deviation so produced can be measured
by the Prentice’s Rule:
 Δ = cF
is commonly known as Prentice’s
c = image displacement in cm
F =lens power
PRISM ORIENTATION
 Prism can be oriented in front of the eye

using notations
Base-in
Base out
Base up
Base down
 All other base
directions
require 360°
PRISM ORIENTATION
PRISM ORIENTATION
Use of Prisms
 Diagnostic
prisms
 Therapeutic
prisms
Diagnostic prisms
 1. Assessment of squint and heterophoria
(a) Measurement of angle objectively by prism cover test.
(b) Measurement of angle subjectively by maddox rod.
(c)To assess likelihood of diplopia after proposed squint

surgery in adults.
(d) Measurement of fusional reserve.
(e) Four dioptre prism test. (microtropia)

 2. Assessment of simulated blindness
If a prism is placed in front of a seeing eye,
the eye will move to regain fixation.
Forms of prism used in diagnosis
 Single unmounted prisms
 The prisms from the trial lens

set
 Prism bars
These are bars composed of adjacent prisms of
increasing power.
Therapeutic prism
1. Convergence insufficiency
 commonest therapeutic use of prisms in
orthoptics,for building up the fusional reserve of patients
with C.I.
 Base out prisms are using in exercise periods.
 They are not wore constantly.

2 .To relieve diplopia in certain cases of squint
Include decompensated heterophorias,

small vertical squint and some paralytic squint with
diplopia in the primary position.
 Prisms are reserved for those patients for whom surgery is

not indicated.
Forms of therapeutic prism
 Temporary wear
prisms used in treatment include

clip- on spectacle prisms for trial wear.
Eg:-Fresnel prism (pronounced fre-nell')

prisms,)
Fresnel
Prism
 To understand how a Fresnel prism works,
imagine cutting off the tops of a large
number of equally powered prisms and
gluing them, one above the other, onto a thin
piece of plastic.
 A Fresnel prism is only 1 mm thick.

Fresnel Prism
 Itconsists of plastic sheet of parallel
tiny prisms of identical refracting angle.
 The overall prismatic effect is the same as

that of a single large prism.
 Thesheets are lighter than a glass prism

and can be stuck on to the patient’s glasses.
Fresnel prism
Advantages of a Fresnel Prism
 It is very thin and extremely lightweight.

 It is flexible and can be applied to an
existing spectacle lens.
 Itcan be cut to any shape with scissors or

a razor blade.
 Reduce magnification differences
considerably.
Disadvantages
 Theyare harder to clean than

conventional lenses.
 Fresnelprisms also cause a slight loss of

visual acuity caused by reflections for prisms
greater than 10Δ.
WHEN ARE FRESNEL PRISMS USED?
 High Amounts of
Prism
 Use and Reuse
 Sectorial Application
 Slowing of Nystagmus
Permanent wear
 Prism can be mounted in

spectacles permanently .
Vector addition of prisms
 Sometime a patient requires a prismatic correction in

both the horizontal and vertical directions.
 This can conveniently be achieved by using one

stronger prism mounted at an oblique angle. This is
calculated by vector addition, either graphically or
mathematically.
Risley prism
 There is an application of obliquely

crossed prisms that is used on a regular
basis in ophthalmic practice.
 Thatapplication is called a rotary or

Risley’s prism
 A rotary prism is a combination of two
prisms.
 These prisms are placed one on top of the

other. Initially, their base directions are exactly
identical, but as the prisms are rotated, their
bases move by equal extents in opposite
directions.
 For example, suppose two prisms of
10Δ each are placed on top of one
another base-to-base. The total
prismatic effect is 20Δ .
 But if they are placed base-to-apex, then their
total prismatic effect is zero
Risley
Prism
Interpretation of Orthoptic reports
1 prism dioptre = ½ degree
 eg:20 degree = 40 prism

diopter
Prescription of Prisms
 Generally when prescribing prisms, the

correction is split between the two
eyes.
 The apex of the prism must always be

placed towards the direction of deviation of
the eye.(apex towards deviation )
 Convergence or eso deviation
Base out prism ,e.g. 8 prism diopter base out R

and L.
 Divergence or exo deviation
Prisms must be base -in , e.g. 6 prism diopter

base in R and L.
Vertical deviation
 To correctvertical deviation the orientation

of the prism is opposite for the two eyes.
2 base - down RE
2 base – up for R hypertropia
Prisms in Optical Instruments
 Slit
lamp bio
microscope
 Applanation
tonometer

keratometer
 Right angle
prism
 Porro
prism
 Dove
prism
DETECTION OF PRISM IN AN OPTICAL LENS
 Hold the glass up between the eye and an
object which forms a straight line.
 Ifthe continuity of the line in broken as seen in

Figure ,it implies that the prism is present and
since the line appears to be deviated towards the
apex, we know the direction of apex of the prism.
 The amount of displacement produced is the

strength of the prism, and can be measured by
neutralising.
•To do so put the prism lens of known strength in
contact with the lens under checking with its
apex in opposite direction.
•The prism lens with which the continuity of the
lens is again established, represents the strength
of the prism.
Lensometer
 Lensometer can also be used to detect the prism
dioptre. To check this get the best focus point of the
target image and read the prismatic power.
 An additional accessory called ‘prism compensator’

is to be attached to the lensometer for higher dioptre
of prism.

Ophthalmic Prism

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Ophthalmic Prisms

 Theangle between the two surfaces is called

 The opposite surface is called the base of

 When prescribing prisms ,the orientation is

 Lightpassing through a prism obey snell’s

 Theray is deviated towards the base of

 The further the away from the optical

1.The refractive index of the material of which

 To the right or left when seen through a base-out

 A prism displaces the incident rays towards

 A prism displaces the image towards the

 A prism does not magnify or minify the

 A prism also disperses incident pencil rays

 For any particular prism, the angle of

 The image formed by a prism is

The position of minimum deviation

The prentice position.

1. The prism dioptre

 Denoted by the symbol Δ.

 The centrad produces a very slightly greater

 A prism may also be described by its

 Prism can be oriented in front of the eye

(b) Measurement of angle subjectively by maddox rod.

(c)To assess likelihood of diplopia after proposed squint

(d) Measurement of fusional reserve.

(e) Four dioptre prism test. (microtropia)

 The prisms from the trial lens

 Base out prisms are using in exercise periods.

 They are not wore constantly.

Include decompensated heterophorias,

 Prisms are reserved for those patients for whom surgery is

prisms used in treatment include

Eg:-Fresnel prism (pronounced fre-nell')

 A Fresnel prism is only 1 mm thick.

 The overall prismatic effect is the same as

 Thesheets are lighter than a glass prism

 It is very thin and extremely lightweight.

 Itcan be cut to any shape with scissors or

 Theyare harder to clean than

 Fresnelprisms also cause a slight loss of

 Use and Reuse

 Prism can be mounted in

 Sometime a patient requires a prismatic correction in

 This can conveniently be achieved by using one

 There is an application of obliquely

 Thatapplication is called a rotary or

 These prisms are placed one on top of the

1 prism dioptre = ½ degree

 eg:20 degree = 40 prism

 Generally when prescribing prisms, the

 The apex of the prism must always be

Base out prism ,e.g. 8 prism diopter base out R

 Divergence or exo deviation

Prisms must be base -in , e.g. 6 prism diopter

 To correctvertical deviation the orientation

 Ifthe continuity of the line in broken as seen in

 The amount of displacement produced is the

 An additional accessory called ‘prism compensator’

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