After the rod and the phorometer came into use and an opportunity
was presented to compare the results obtained by each, I made a
careful test of eighty pronounced cases of errors of refraction
accompanied by heterophoria. Of this number only nine showed a
persistent difference of deviation and in none of them a difference
greater than 1½°. But this was not always on the one side or the
other, as six out of the nine showed a higher degree of deviation by
the rod than by the phorometer. Eighty cases may not be enough upon
which to base an orthodox conclusion; but my experience with the rod
has been so satisfactory that I now seldom use the phorometer at
all. It appears quite possible practically to estimate the degree of
heterophoria as accurately with the one instrument as with the
other; and while it is true that a correction of the error of
refraction will commonly correct the deviation, still all cases of
optical defect should be tested with the rod or phorometer before
the lenses are prescribed.
WM. A. PHILLIPS.
MY DEAR DR. DEADY: Dr. Hubbell limits the discussion “to the
comparative value of the diplopia test, by Stevens’ phorometer” and
the Maddox rod test.
It would be interesting to follow out the idea with other
phorometers,—and with the Wilson phorometer my records do not show
quite such a marked difference in results,—but I have not taken
pains to get comparative results in any considerable number of
cases.
Dr. Hubbell says: “In the diplopia test, the dissociation is
effected by changing the visual axis of one eye by means of a prism.
The displacement of one image cannot be done without associating
with it, more or less, an impulse to some form of ocular effort....
In the obscuration test (Maddox rod) no such effort is invited, no
change of innervation takes place.” But in the rod test the light
seems nearer to the patient than in the prism test. This may account
for much of the difference in results and amount to “an extraneous
impulse to muscular contraction.”
Dr. Hubbell is entirely justified in his conclusion as made upon
experiments with the Maddox rod and the Stevens phorometer. I shall
watch cases along similar lines with the Wilson phorometer and
report later.
In the mean time the rod and the prism tests may well be taken in
each case and let judgment decide as to treatment.
THOS. M. STEWART.
I agree with the writer that the rod test is the more scientific
test for heterophoria, and of late years have virtually discarded
the prism test, except in special cases. The tables are interesting,
but their value would be materially increased if the author would
supplement them with tables showing the refraction, and inflammation
or its results.
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