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These two right-angled prisms composed of double refracting surfaces like quartz or calcite are cemented to form a rectangular unit. An incident beam of unpolarized light emerges as two oppositely polarized diverging beams from the opposite end. This type of prism is used in keratometers.[38]

These are convex spherical lenses of powers ranging from +5 to +16D are prescribed as reading aids. These work on providing a magnified image, thus useful as low vision aids.[62]

This law is named after a famous optician Charles F. Prentice. As per this rule, the prismatic power of the lens at any point on its surface equals the distance from its optical center, measured in centimeters multiplied by the power of the lens in diopters. There is no prismatic power at the center of the lens. Thus, it is vital that to avoid any prismatic effect, the lens's optical center should be fitted directly in front of the pupil.

These are 15-30D base-down prisms in the form of recumbent spectacles, which allow bedridden patients to read or watch television comfortably in a lying-down position.[66]

Patients prescribed with prisms need to be followed up closely for compliance. Those prescribed prisms for exercise might experience an initial exacerbation of asthenopic symptoms and thus require the motivation to continue the exercise till the fusional reserves improve. Patients might experience confusion and practical difficulties with the use of prisms. Therefore, it is essential to review them closely and attend to the patients' issues.

The deviation of a light ray through prisms depends on not only the power of the prism but also the refractive index of the material it is made up of and the position in which the prism is held. Prisms can be held in three ways – position of minimum deviation, prentice position, and frontal position.[8]

A light ray passing through the prism obeys Snell's law.[6] The light ray deviates towards the base, and this causes the image displacement away from the base of the prism, i.e., towards the apex. The change of the direction of the ray is called the angle of deviation.[7] When a prism is placed in the air, the angle of deviation of the light ray is determined by three factors angle of incidence, refracting angle of the prism, and refractive index of the prism material.[8]

A few patients might show an increased angle of deviation with the prescribed prisms, and thus close monitoring is again vital in these cases. In patients presenting with long-standing palsies or partially accommodative esotropias, a decision might be taken to operate the residual squints. Thus, nurses and counselors need to motivate the patients and follow them closely after surgical intervention.[4]

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Prisms are an essential part of ophthalmology. These are the basics behind many instruments used routinely in ophthalmic practice, from basic investigations to the outpatient department to the operating theatre.[52] Prims are part of ophthalmic instruments like slit lamp biomicroscope, applanation tonometer, gonioscope, keratometer, pupillometer, phoropter, Haidinger brushes, ophthalmoscopes, operating microscope.[53] In the sub-specialty of strabismus and neuro-ophthalmology, prisms find their role as part of diagnostic and therapeutic interventions.[54]

Digital image showing a Fresnel prism of power 40 PD Contributed by Dr. Kirandeep Kaur, MBBS, DNB, FPOS, FICO, MRCS Ed, MNAMS

Rajak, D.K.; Kumar, A.; Behera, A.; Menezes, P.L. Diamond-Like Carbon (DLC) Coatings: Classification, Properties, and Applications. Appl. Sci. 2021, 11, 4445. https://doi.org/10.3390/app11104445

Prisms are used to measure the AC/A ratio by the fixation disparity method. Changes in fixation disparity induced by prisms and that induced by spherical lenses are noted, which indicates the AC/A ratio. The advantage is that fusion is maintained throughout the test.[61]

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Objectives: Describe the principle of prisms in ophthalmology.Summarize the clinical applications of prisms.Outline the different types of prisms and the basics of prisms dispending.Review the precautions and complications associated with prisms. Access free multiple choice questions on this topic.

A minus or a myopic lens behaves like two prism lenses stacked apex to apex. Thus, the refractive correction affects the measured deviation and must be born in the mind. The measured deviation will be lesser with a plus lens and more when measured with a minus lens in situ.

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Any refractive add for near or distance needs to be mentioned separately in the usual way of dispensing the spectacles.[48]

This test assesses fixation preference. A 10 to 15 D base up or down prism is placed over one eye, inducing vertical strabismus. For example, when a 12 D base-up prism is placed in front of the fixing eye, both the eyes will show an infraduction. But, when the same prism is placed in front of the non-fixating or the amblyopic eye, there will be no deviation of either eye.[60]

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They are composed of two 12 D lateral prisms and one 8D inferior prism. The apex of lenses is placed towards the central non-channel. The lens system is designed for various degrees of peripheral field loss. It is recommended for patients with glaucoma retinitis pigmentosa.[63]

Abstract: DLC coatings have attracted an enormous amount of interest for science and engineering applications. DLC occurs in several different kinds of amorphous carbon materials. Owing to the extensive diversity in their properties, DLC coatings find applications in mechanical, civil, aerospace, automobile, biomedical, marine, and several other manufacturing industries. The coating life of DLC is predominately influenced by its constituent elements and manufacturing techniques. Numerous researchers have performed multiple experiments to achieve a robust understanding of DLC coatings and their inherent capabilities to enhance the life of components. In this review, a wide range of DLC coatings and their classification, properties, and applications are presented. Their remarkable performance in various applications has made DLC coatings a promising alternative over traditional solitary-coating approaches. Keywords: DLC; coating; low friction; DLC applications; DLC properties; DLC classifications

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There are essential guidelines that need to be followed when considering the prescription of prism glasses to a patient. A few of the important ones include:

Rajak, D. K., Kumar, A., Behera, A., & Menezes, P. L. (2021). Diamond-Like Carbon (DLC) Coatings: Classification, Properties, and Applications. Applied Sciences, 11(10), 4445. https://doi.org/10.3390/app11104445

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It is expressed in millimeter (mm) units. A lens with a short focal length is a wide-angle lens and one with a long focal length is a telephoto lens. The angle ...

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Prisms are an effective way to relieve diplopia and improve vergence facilities. But some patients may experience side effects with prism glasses themselves.[51] A few fundamental problems associated with the use of prism glasses include:

These are made up of calcite crystal cut diagonally, and the two halves are cemented with Canada balsam or an optical cement with a low refractive index. The incident light is split into ordinary and extra-ordinary linearly polarized rays. These prisms are used in Haidinger brushes.[37]

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Patients with head or neck problems, such as severe ankylosing spondylitis, may benefit from prisms. For example, any patient with chin down posture bilateral equal power base up yoke prisms can improve straight-ahead vision and thus facilitate mobility.[65]

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These prisms have advantages over loose prisms as they are lighter, more comfortable to wear, cosmetically better acceptable by the patient, higher power can be prescribed compared to loose prisms.[42]

These are made of polyvinyl chloride material. Parallel tiny prisms are stacked with an apex of one adjacent to the base of the previous prism, which can be struck on the base surface of the spectacles. This provides an overall prismatic effect of a single prism. The Fresnel prism is placed so that the base of prisms is directed towards the side of the defect.[29]

Feature papers represent the most advanced research with significant potential for high impact in the field. A Feature Paper should be a substantial original Article that involves several techniques or approaches, provides an outlook for future research directions and describes possible research applications.

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Another unit of measurement of prism power is centrad. This is less frequently used as compared to prism diopters. Centrad unit is represented by the symbol Ñ. One centrad represents the deviation of light by 1 centimeter and perpendicular to the initial direction of the light ray on an arc of a circle 1 meter away from the prism.[4] Further, the deflection of the light ray after passing through the prism also depends on the refractive index of the material and the position in which the prism is held. It is essential to understand that the light ray passing through the prism deviates towards its base, but the image appears to be displaced towards the apex. Thus, the eye being tested will deviate towards the apex of the prism.[5]

Digital image showing prism bars showing prisms of increasing power with base out and base down Contributed by Dr. Kirandeep Kaur, MBBS, DNB, FPOS, FICO, MRCS Ed, MNAMS

Rajak DK, Kumar A, Behera A, Menezes PL. Diamond-Like Carbon (DLC) Coatings: Classification, Properties, and Applications. Applied Sciences. 2021; 11(10):4445. https://doi.org/10.3390/app11104445

This test helps in small-angle strabismus to measure the tropia without dissociating the phoria. The Hirschberg test measures the size of tropia, and a prism of the estimated amount is placed in front of the non-fixing eye to neutralize the tropia. The fixing eye is covered simultaneously with an occluder to prevent fusion. The process is repeated with increasing or decreasing prisms' powers until no refixation movement is noted on removing the occlude.[58]

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A prism is a transparent, triangular refracting surface with an apex and a base.[1] The two nonparallel surfaces intersect at an angle called the apex, and the surface opposite to the apex forms the bottom of the prism. The light rays refracted through the prism bend towards the base. The amount of deviation of the path of refracted light from the incident light depends on the power of the prism measured in "prism diopters."[2]

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While preparing glasses, it is essential to understand the prismatic effects of spherical lenses and Prentice's rule for prisms. The prismatic effect of the spherical lens is essential whenever the patient being evaluated has an underlying refractive error. A plus or a hyperopic lens behaves like two prism lenses stacked base to base.[49]

Rajak, Dipen Kumar, Ashwini Kumar, Ajit Behera, and Pradeep L. Menezes. 2021. "Diamond-Like Carbon (DLC) Coatings: Classification, Properties, and Applications" Applied Sciences 11, no. 10: 4445. https://doi.org/10.3390/app11104445

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Charles Prentice was the first to introduce the term prism diopters to describe the intensity of prism. One prism diopter represents the deviation of light by 1 centimeter and perpendicular to the initial direction of the light ray on a plane placed 1 meter away from the prism. The power of the prism in prism diopters is represented by the symbol D. Thus, a prism of 2 prism diopters would deviate a light ray by 2 centimeters, perpendicular to the direction of the initial light ray, measured 100 cm beyond the prism.[3]

The prescription of prisms is complex and requires expertise. Optometrists, orthoptics, and ophthalmologists need to work in coordination and understand the underlying pathology causing symptoms to treat it. Patients may present with complaints of headache, eye strain, or other asthenopic symptoms to anyone involved in eye healthcare. Thus it is essential to understand the basics for evaluation and prescription of prims.

The technique of dispensing prisms depends on the disparity of single binocular vision. It is advisable to prescribe the smallest amount of relieving prism that neutralizes the distinction. The prism base should be oriented based on the deviation being corrected. The bottom of the prism is placed in the direction opposite to the deviation.[50]

A prism is a triangular refracting surface with an apex and a base. The incident light ray passing through the prism is refracted so that it is bent towards the base. Thus the image is shifted towards the apex. The amount of light refracted through the prism depends on the power of the prism defined in prism diopters. Prisms play an essential role in orthoptics and are invaluable in an ophthalmologist's clinic as they have definitive optical, therapeutic, and diagnostic uses. Prisms are used in many ophthalmic devices such as slit lamp biomicroscope, applanation tonometer, gonioscope, and operating microscope. The diagnostic uses include measurement of squint by prism cover test (Krimsky, modified-Krimsky method), simultaneous prism cover test, Maddox rod, measurement of fusional reserve amplitudes, tests for microtropia, and abnormal retinal correspondence. Therapeutic uses include treatment for convergence insufficiency, divergence insufficiency, to relieve diplopia, and use in nystagmus patients. This activity reviews the importance of prisms in evaluating and treating patients with squint and diplopia. It highlights the interprofessional team's approach of the interprofessional team in assessing and treating these conditions.

Rajak DK, Kumar A, Behera A, Menezes PL. Diamond-Like Carbon (DLC) Coatings: Classification, Properties, and Applications. Applied Sciences. 2021; 11(10):4445. https://doi.org/10.3390/app11104445

This test measures the total deviation, including the latent phoria. The first Hirschberg test estimates the tropia, followed by an alternate cover test to estimate the total deviation, i.e., tropia plus phoria. A prism of the estimated amount by an alternate cover test is placed over one eye to neutralize the deviation. An alternate cover test is repeated, and prism power increases or decreases until no refixation movement is noted.[56][57]

This test is helpful in patients with partially accommodative esotropia. Patients wearing full hyperopic correction are advised to press on base out prisms and review every two weeks. If the esotropia has increased further, additional power prisms are prescribed till a stable angle is achieved. The surgeon then operates on the full prism-adapted angle; this helps in reducing the chances of under correction.[55]

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One way to order prisms is by specifying the amount of prism required along with the direction of the prism's base. Example:

Rajak, D.K.; Kumar, A.; Behera, A.; Menezes, P.L. Diamond-Like Carbon (DLC) Coatings: Classification, Properties, and Applications. Appl. Sci. 2021, 11, 4445. https://doi.org/10.3390/app11104445

An alternative method is to mention the direction of the prism using a 360-degree notation, where 0 is positioned towards the left of the lens, 90 superiorly, 180 right, and 270 inferiorly. So, the same prescription can be mentioned as:

The optometrists and orthoptists should check the fusional vergences in any patient complaining of asthenopic symptoms despite wearing correct refractive power. Vision therapy exercises should be prescribed to patients with any underlying fusional weakness. Patients complaining of double vision need a complete detailed evaluation by the ophthalmologist. Appropriate referrals should be made to a physician or neurologist to rule out underlying associations.

The orthoptists, optometrists, and ophthalmologists are all actively involved and expected to understand the basics of prisms, the effects of prism in glasses, and the prismatic effect created by glass displacement in spectacles. After a detailed evaluation, it is essential to give the correct prescription and dispense the prisms with or without refractive correction.[47] There are two different notations used while ordering prisms.

These are measured using a prism bar. Fusional convergence amplitudes are measured by placing the prism bar with the base in front of one eye in increasing steps until the patient reports double vision or inability to fuse. Similarly, fusional divergence amplitudes are measured with base in prism bar by increasing prism powers in steps till the patient reports double vision or failure to fuse.[59]

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Systemic conditions like myasthenia gravis Graves disease can often present to the ophthalmologist first, and thus detailed examination and a high index of suspicion can lead to the correct diagnosis. Neurological lesions may present with gaze palsy, skew deviation, or internuclear ophthalmoplegia. Thus it is essential to evaluate the patient thoroughly and refer the patient to the radiologist for necessary investigations. Opinions from neurologists or neurosurgeons can be lifesaving in some emergency conditions, and a lower threshold should be used for the same.[3]

Though prisms have found a wide place in orthoptics' diagnostic and therapeutic world, there are no strict contraindications for prism prescription.[29] Still, we need to be careful about adaptation issues cost factors involved and check for suitability in the clinic before the final prescription. It is crucial to avoid or take extra precautions when prescribing prisms in the following situations.

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This is a type of reflection prism used to alter the orientation of the image, i.e., the image traveling through the prism is rotated by 180 degrees. These prisms are used in slit lamps. The net effect of a beam passing through this prism is a parallel displaced image rotated by 180 degrees.[39]

These are based on the principle of image relocation. Prisms are added to the glass prescription to produce image relocation to the presumed retinal locus. The effect is probably created by the facilitation of oculomotor function resulting from the reduction of fixation instability.[64]

The prisms are used in ophthalmology for diagnostic as well as therapeutic purposes. Prisms are made of glass or plastic material. These are available in different models such as loose prisms, prism bar, trial set prisms, or Fresnel prism. Prisms of different powers are available in different models. Prisms in a trial set range from ½ to 12 D. Prism bars range from 1 to 40 D. Fresnel prisms range from 1 to 40 D. Loose prisms range from 1 to 60 D.[11]

Digital image depicting prism trial box containing prisms from 0.5 D to 50 D Contributed by Dr. Kirandeep Kaur, MBBS, DNB, FPOS, FICO, MRCS Ed, MNAMS

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