Predictors of prism response during prism adaptation

Results of the Prism Adaptation Study (PAS) indicate that prism adaptation improves the success rate of strabismus surgery for patients with acquired esotropia. Patients who show a fusion response to the prisms benefit most from this preoperative treatment. This study analyzes the characteristics of those patients who were and were not prism responders in the PAS. Significant factors predicting a prism response included: patients who were older at the time of onset of their esodeviation (P = .007), duration of deviation less than 1 year (P = .04), alternating fixation (P = .003), fusion on the Worth four-dot test at near with prism neutralization (P = .008), and equal vision (P = .009). Demographic characteristics were similar for both responders and nonresponders except that non-Hispanic patients were significantly more likely to respond to prisms than Hispanic patients (P < .002). No test or characteristic was found which could reliably predict the prism response. Therefore, all patients with acquired esodeviations should be considered candidates for prism adaptation prior to strabismus surgery.