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Measurement of Fixation Disparity
Mallett Units Most popular method in UK Does not measure physical disparity Measures amount of ∆ to reduce disparity to zero Used at distance and near
Ideal Parameters Normal visual environment Central and peripheral fusion locks Detect small disparities Monocular markers not easily suppressed Monocular markers close to central fixation point Detect horizontal and vertical disparities Easily understood by patients
Distance Unit
Distance Unit Red markers Foveal fixation 10 min arc Central lock OXO Peripheral lock room features Use with distance RX
Near Unit
Near Unit Green markers Foveal fixation 18 min arc Central lock OXO Peripheral lock text on page  Use with near Rx
Mallett Unit
Correcting Disparity Use ∆ before eye with slip Add enough ∆ to align markers with X Disparity can be altered using lenses
Treating the Disparity Only correct if patient has symptoms Add ∆ before eye with slip If ∆ too high split between eyes
Exo Disparity Weakest BI ∆ to eliminated slip Modify Rx in -ve direction Orthoptic exercises
Eso Disparity Weakest BO ∆ to eliminate slip Not possible to alter Rx at distance but may be possible at near Orthoptic exercises
Vertical Disparity Eliminate any horizontal slip Check optical centres on specs Check head position Any residual vertical slip use ∆
Objective Measure of FD Pickwell and Stockley 1960
Objective Measure of FD
Summary I Size of phoria not necessarily related to presence of FD Size of phoria not always related to symptoms FD not always related to symptoms Amount of ∆ not related to size of FD Use in conjunction with other tests of BV
Management of Heterophoria Oculomotor Measures Size of phoria Fusional reserves (blur, break, recovery) AC/A Fixation Disparity
Normative Data
Fixation Disparity Data Curve type Y intercept X intercept Slope
Phoria and FD
Frequency of Curve Type 7 3 IV 10 7 III 25 30 II 58 60 I Near Distance Type
Discriminative Value 89% correct 89% correct 90% correct Opposing Vergence Vergence Recovery Break Range Break Range Opposing Vergence Recovery Range Recovery Range X Intercept Opposing Vergence FDC Slope Y Intercept FDC Slope Phoria Sheards Sheards SOP XOP All Subjects
Treatment Vision Training Lenses Prisms Combination of above
Summary II FD Useful additional test Don’t FD use in isolation Too much emphasis on FD Clinical judgement required

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Mallet Unit

  • 2. Mallett Units Most popular method in UK Does not measure physical disparity Measures amount of ∆ to reduce disparity to zero Used at distance and near
  • 3. Ideal Parameters Normal visual environment Central and peripheral fusion locks Detect small disparities Monocular markers not easily suppressed Monocular markers close to central fixation point Detect horizontal and vertical disparities Easily understood by patients
  • 5. Distance Unit Red markers Foveal fixation 10 min arc Central lock OXO Peripheral lock room features Use with distance RX
  • 7. Near Unit Green markers Foveal fixation 18 min arc Central lock OXO Peripheral lock text on page Use with near Rx
  • 9. Correcting Disparity Use ∆ before eye with slip Add enough ∆ to align markers with X Disparity can be altered using lenses
  • 10. Treating the Disparity Only correct if patient has symptoms Add ∆ before eye with slip If ∆ too high split between eyes
  • 11. Exo Disparity Weakest BI ∆ to eliminated slip Modify Rx in -ve direction Orthoptic exercises
  • 12. Eso Disparity Weakest BO ∆ to eliminate slip Not possible to alter Rx at distance but may be possible at near Orthoptic exercises
  • 13. Vertical Disparity Eliminate any horizontal slip Check optical centres on specs Check head position Any residual vertical slip use ∆
  • 14. Objective Measure of FD Pickwell and Stockley 1960
  • 16. Summary I Size of phoria not necessarily related to presence of FD Size of phoria not always related to symptoms FD not always related to symptoms Amount of ∆ not related to size of FD Use in conjunction with other tests of BV
  • 17. Management of Heterophoria Oculomotor Measures Size of phoria Fusional reserves (blur, break, recovery) AC/A Fixation Disparity
  • 19. Fixation Disparity Data Curve type Y intercept X intercept Slope
  • 21. Frequency of Curve Type 7 3 IV 10 7 III 25 30 II 58 60 I Near Distance Type
  • 22. Discriminative Value 89% correct 89% correct 90% correct Opposing Vergence Vergence Recovery Break Range Break Range Opposing Vergence Recovery Range Recovery Range X Intercept Opposing Vergence FDC Slope Y Intercept FDC Slope Phoria Sheards Sheards SOP XOP All Subjects
  • 23. Treatment Vision Training Lenses Prisms Combination of above
  • 24. Summary II FD Useful additional test Don’t FD use in isolation Too much emphasis on FD Clinical judgement required