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The prism Bar cover test (PBCT), is an objective measurement and the gold standard in measuring strabismus, i.e. ocular misalignment, or a deviation of the eye. It is used by orthoptists and ophthalmologists in order to measure the vertical and horizontal deviation and includes both manifest and latent components.
Manifest is defined by the eye deviating constantly or intermittently, whereas latent is where the deviation is normally controlled but becomes present when the eyes are dissociated. A PBCT reveals the total deviation and cannot distinguish between latent and manifest strabismus as you are using an alternate cover test.
Required instruments
A number of different instruments are required when performing a PBCT.
• Horizontal and vertical prism bars (or loose prisms).
• An occluder
• Near accommodative target. For example, near fixation stick
• Distance target. For example, most commonly a Snellen chart is utilised

In order to perform a PBCT, you must first perform a cover test as this gives an estimation of the size of the strabismus, thus an approximate starting point on the prism bar. You can also get an indication of presence and type of strabismus by observing the patients’ eye and observing corneal reflections, also known as Hirschbergs. It also shows whether the patient has a manifest or latent deviation. If a manifest deviation is present, it reveals which eye has the deviation or if it is alternating between both eyes.
The prism bar cover test must be conducted at near (33 cm), at distance (6m) and if necessary at greater than 6 metres. Before commencing the test, ensure the patient is sitting upright with their chin and head straight. Patients with a head tilt (abnormal head posture) are ‘not formally controlled by using a bite bar or chin rest’ and are always tested with their head tilt and then without their head tilt
The results leading on from the cover test will give you an indication of the type of deviation and which way you should hold your prism for the next stage of the test. Either BASE IN for an exodeviation (eye turned out), BASE OUT for an esodeviation (eye turned in), BASE UP for a hypodeviation (eye turned down) or BASE DOWN for a hyperdeviation (eye turned up).


Chapters
00:00 Start
01:00 Required instruments
02:59 Method
05:26 How To Record Findings
07:06 Considerations while doing PBCT
08:07 Indicated in
08:37 Not indicated in
09:08 Video Making
09:40 Video Credit

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