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BINOCULAR BALANCING
Methods
Alternate Occlusion
Prism Dissociated Blur Balance
Duochrome or Bichrome (Prism Dissociated Red-Green) Balance
ALTERNATE OCCLUSION
Procedure:
– ADD plus lenses binocularly till Px barely sees 20 /50 line(6/18) over the Rx you just
achieved from the monocular subjective refraction
– examiner performs slow alternate occlusion
– Px compares of letters between 2 eyes
– “I know this is blurry, I want you to tell me which image is clearer, or are they both
equally blurred.”
END POINT
– end point is equal acuity b/w 2 eyes
– If one eye clearer than
– Plus lenses added in + 0.25DS steps before clearer eye to equalize the blur
–
PRISM DISSOCIATED BLUR BALANCE
Procedure
– The two eyes will be dissociated by using the prisms in the technique
– Same amount of fog as last technique +1.00
– Same isolated line used 20/50
– Keep the prisms of 3 or 4 Δ BD in OD and 3 or 4 Δ BU in OS
– Equal and opposite
– BD prism will cause image to be higher (top)
– The image will be displaced towards the apex (point) of the prism Δ
– BU prism will cause image to be lower (bottom)
– BD for OD and BU for OS, therefore;
– EGNU5 seen by OD
– EGNU5 seen by OS
Patient instructions: “I know these images are blurred, I want you to take a few seconds and
look at the image on the top, and then take a few seconds and look at the image on the
bottom, tell me is one image clearer or are they equally blurred?”
– If the patient reports the top image clearer, add +0.25DS to the OD and repeat the
question
– If the patient reports the lower image clearer add +0.25DS to the OS and repeat the
question
– Now Px report both eyes see blur it means we balance the accommodation with
+0.25DS
– At the end remove prism and fog lenses that are use for the balancing and correct the
lenses
Duochrome or Bichrome (Prism Dissociated Red-
Green) Balance
• Bichrome test or Duochrome test
- Based on eye’s natural chromatic aberration
- Uses distance VA chart with black letters, splitted equally into two halves
- Letters on one half on red background
- Letters on other half on green background
- Similar to dissociated blur balance except fogging lenses are not added
- Instead of seeing two blurred charts, patient will see two relatively clear charts, with
each chart half red and half green
- Method of choice when maximum acuities for two eyes differ by several letters
-
-
Procedure
• Patient views the full size split R-G chart with 6/6 letters on the bottom
• Occlude both eyes and dissociate the chart using 3 ∆ BD in RE and 3 ∆ BU in LE
• The patient must be capable of perceiving diplopia
• Attention first on upper chart (seen by right eye )
• Asked to report which those on red or green side ; appear sharper , blacker or more
distinct
• Sufficient plus power is placed in RE till letters on red side are clearer
• Reduce plus power in 0.25 DS steps until both sides are equally clear (equality) OR
Green side first is clear (first green)
• Repeat the process for lower chart (left eye)
• The balance is complete when the patient reports the same red-green end point for
each eye (i.e. if the criterion used for lower chart is appearance of first green, same
criterion should be used for upper chart)
• It is not necessary for the upper and lower charts to be equally clear as long as both
have the same end point

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binocular balancing by optom faslu muhammed

  • 1. BINOCULAR BALANCING Methods Alternate Occlusion Prism Dissociated Blur Balance Duochrome or Bichrome (Prism Dissociated Red-Green) Balance
  • 2. ALTERNATE OCCLUSION Procedure: – ADD plus lenses binocularly till Px barely sees 20 /50 line(6/18) over the Rx you just achieved from the monocular subjective refraction – examiner performs slow alternate occlusion – Px compares of letters between 2 eyes – “I know this is blurry, I want you to tell me which image is clearer, or are they both equally blurred.” END POINT – end point is equal acuity b/w 2 eyes – If one eye clearer than – Plus lenses added in + 0.25DS steps before clearer eye to equalize the blur – PRISM DISSOCIATED BLUR BALANCE Procedure – The two eyes will be dissociated by using the prisms in the technique – Same amount of fog as last technique +1.00
  • 3. – Same isolated line used 20/50 – Keep the prisms of 3 or 4 Δ BD in OD and 3 or 4 Δ BU in OS – Equal and opposite – BD prism will cause image to be higher (top) – The image will be displaced towards the apex (point) of the prism Δ – BU prism will cause image to be lower (bottom) – BD for OD and BU for OS, therefore; – EGNU5 seen by OD – EGNU5 seen by OS Patient instructions: “I know these images are blurred, I want you to take a few seconds and look at the image on the top, and then take a few seconds and look at the image on the bottom, tell me is one image clearer or are they equally blurred?” – If the patient reports the top image clearer, add +0.25DS to the OD and repeat the question – If the patient reports the lower image clearer add +0.25DS to the OS and repeat the question – Now Px report both eyes see blur it means we balance the accommodation with +0.25DS – At the end remove prism and fog lenses that are use for the balancing and correct the lenses
  • 4. Duochrome or Bichrome (Prism Dissociated Red- Green) Balance • Bichrome test or Duochrome test - Based on eye’s natural chromatic aberration - Uses distance VA chart with black letters, splitted equally into two halves - Letters on one half on red background - Letters on other half on green background - Similar to dissociated blur balance except fogging lenses are not added - Instead of seeing two blurred charts, patient will see two relatively clear charts, with each chart half red and half green - Method of choice when maximum acuities for two eyes differ by several letters -
  • 5. - Procedure • Patient views the full size split R-G chart with 6/6 letters on the bottom • Occlude both eyes and dissociate the chart using 3 ∆ BD in RE and 3 ∆ BU in LE • The patient must be capable of perceiving diplopia • Attention first on upper chart (seen by right eye ) • Asked to report which those on red or green side ; appear sharper , blacker or more distinct • Sufficient plus power is placed in RE till letters on red side are clearer • Reduce plus power in 0.25 DS steps until both sides are equally clear (equality) OR Green side first is clear (first green) • Repeat the process for lower chart (left eye)
  • 6. • The balance is complete when the patient reports the same red-green end point for each eye (i.e. if the criterion used for lower chart is appearance of first green, same criterion should be used for upper chart) • It is not necessary for the upper and lower charts to be equally clear as long as both have the same end point