This document discusses various tests used to evaluate strabismus and retinal correspondence, including Bagolini's striated glasses test, Worth's four dot test, synaptophore testing, and progressive prism adaptation testing. It also describes techniques for stimulating the retina of a deviated eye, such as macular massage and bi-kinetic retinal stimulation, with the goal of achieving normal retinal correspondence. Surgical correction of strabismus is not recommended until tests confirm the development of normal correspondence and some degree of fusion.

1. F.ALIASGER
Lecturer, SPIO ( a unit of Dr. Agarwal’s eye
hospital , chennai )
Fakhruddin Aliasger

2.  Bagolini’s striated glasses
 Worth’s four dot test
 Synaptophore
 Prism Bar Cover Test(PBCT)
 After image test
 Progressive prism adaptation test(PPAT)
Fakhruddin Aliasger

3.  Bagolini’s lenses are lens with fine grating
of lines placed at 135 and 45 degrees in
right and left eye
 In unilateral strabismus if the lens before
the deviated eye produces a streak that
appears to go through the spot of light it
indicates harmonious ARC
 If the lens before the deviated eye produces
a streak that does not go through the spot
of light then it indicates presence of
UNHARC
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4. Harmonious ARC Homonymous diplopia
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5.  In the Worth 4-dot test, a red glass is worn in
front of 1 eye and a green glass in front of
the other
 The Worth 4-dot test can produce a diplopic
response in non-suppression heterotropic
NRC and either a diplopic or a fusion
response in ARC
 As mentioned earlier, this test must be
performed in conjunction with cover testing
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6. Fakhruddin Aliasger

7. Fakhruddin Aliasger

8.  Make the patient sit on the synaptophore
 Alternate flashing is done infront of both the
eye and then type of deviation is noted
 Then objectively angle of deviation is noted
 Objective angle of deviation is neutralized by
moving the arms inward or outwards
 The angle of deviation is known as objective
angle of deviation
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9.  With SMP slide inside the tube the patient is
asked whether slides are percived
simultaneously as single object
 If slides are not percived simultaneously then
the patient is asked to move the arm such
that slides are percieved as single object
 The angle at which patient percieves single
object is known as Subjective angle
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10.  Incase of HARC the subjective angle is unity
 Incase of UNHARC the subjective angle is not
same as objective angle
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11.  There are two slides available one with a
vertical slit & the other with a horizontal slit
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12.  The objective angle of deviation is measured
with synoptophore
 The tubes are set at zero & the slides are
inserted
 The current is switched on when the patient
is ready for test to start
 Each eye is stimulated for about 20 second
 After each eye has been stimulated ,the after
image slides are removed & the automatic
binocular flashing device is switched on
 Then the patient is asked to draw the after
image positions
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13.  A patient with NRC will see the after image as
a symmetrical cross
 A right esotropic patient with ARC will draw
vertical image to the left of horizontal image
 A right exotropic patient with ARC will draw
vertical image to the right of the horizontal
image
 A patient may draw only vertical or only
horizontal image in the presence of
Suppresion
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14. NRC/HARC RET RXT
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15.  Over correct esodeviation
 let patient sit for 30-45 min.
 Do the ACT
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16. Result of ACT
Esodeviation(positive PAT) Exodeviation
(negative PAT)
repeat the procedure
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17.  The principles of treatment were those used to
restore the normal sensory relationship of the
two retinae
 In the majority of strabismus cases, ARC is
considered beneficial, and is therefore not
treated
 The exception is if surgery is to be carried out
with a chance of obtaining BSV
 However, great care should be taken so as not
to produce diplopia
 In general the cases considered for treatment
will be of mixed correspondence.
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18.  In unilateral strabismus, occlusion is
maintained on the fixing eye until the squint
had become alternating
 It is then changed each day from one eye to
the other in order to maintain the visual
acuity in each eye, and to discourage the
anomalous sensory relationship
 The same procedure is adopted if the squint
was already alternating
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19.  On synoptophore following exercises are
given to stimulate the fovea of the deviated
eye
 Macular massage
 Bi- kinetic retinal stimulation
 Flashing
 After image test
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20.  These were given using the after-image
technique as a control
 The giving of the after-image depended on
alternative foveal stimulation,
 Each fovea was subjected in turn to a stimulus
which varied slightly for each eye
 With the tube of the major synoptophore
adjusted to the objective angle of strabismus, the
stimulus, in a linear form, produced by a
specially-constructed slide, was first inserted
into the right hand tube so that the beam of light
was vertical
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21.  A bright light was turned on behind this slide for
approximately 20 seconds and the patient was
instructed to observe a red fixation point in the
centre of the bar of light so produced
 The illumination was then turned on behind a
horizontally placed slide in front of the left eye
for a further 20 seconds, after which the slides
were removed and flashing illumination was
commenced in order to stimulate the formation
of the after-image
 While flashing was in progress the patient was
asked to describe the after-image seen projected
into space and to indicate the image form by
holding two pencils in the appropriate position
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22.  It was usual, at the beginning of the course of
treatment, to find the afterimages uncrossed
 However, with daily treatment on the major
synoptophore, encouraging the patient to bring
the lines together, it was found that, in many
cases, the two lines would gradually come to
form a cross
 This appeared only fleetingly at first, but later the
cross occurred more permanently
 With further treatment, the after-images would
form a cross without the aid of flashing
illumination
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23.  When the after-images showed, by the
formation of a symmetrical cross, that normal
retinal correspondence had developed, one of
a pair of simultaneous perception slides was
inserted; when the picture was centred on the
cross, the second slide of the pair was
inserted
 The two slides were only allowed to remain if
the pictures were correctly superimposed,
and provided that the cross was still visible
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24.  An operation to restore the eyes to a normal
position was not contemplated until the
after-image test showed that normal
correspondence was fairly constant and that
some range of fusion was possible on the
synoptophore
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