Fresnel prisms and their effects on visual acuity and binocularity.

1. The visual acuity with the Fresnel membrane prism is significantly less than that with the conventional prism of the same power for all prism powers from 12 delta through 30 delata at distance and from 15 delta through 30 delta at near. 2. The difference in the visual acuity between base up and base down, and between base in and base out, is not significantly different for either the Fresnel membrane prism or for the conventional prism. 3. For both Fresnel membrane prism and the conventional prism, the visual acuity when looking straight ahead. 4. Using Fresnel membrane prisms of the same power from different lots, the visual acuity varied significantly. The 30 delta prism caused the widest range in visual acuity. 5. When normal subjects are fitted with the higher powers of the Fresnel membrane prism, fusion and stereopsis are disrupted to such an extent that the use of this device to restore or to improve binocular vision in cases with large-angle deviations is seriously questioned. 6. Moreover, the disruption of fusion and stereopsis is abrupt and severe and does not parallel the decrease in visual acuity. The severely reduced ability to maintain fusion may be related to the optical aberrations, which, in turn, may be due to the molding process and the polyvinyl chloride molding material. 7. Through the flexibility of the membrane prism is a definite advantage, because of its proclivity to reduce visual acuity and increase aberrations its prescription for adults often must be limited to only one eye. 8. For the same reasons in the young child with binocular vision problems, the membrane prism presently available should be prescribed over both eyes only in powers less than 20 delta. When the membrane prism is to be used as a partial occluder (over one eye only), any power can be used. 9. The new Fresnel "hard" prism reduces visual acuity minimally and rarely disrupts binocularity, thus increasing the potential for prismotherapy to establish binocularity. This prism is currently available only for use as a trial set. Since the cosmetic appearance of the Fresnel "hard" prism is similar to that of the Fresnel membrane prism and it is easier to maintain, it would be the prism of choice (over all other types) for bilateral prescriptions in the young patient with emmetropia. The manufacturer is urged to make these prisms available to fit a special round adjustable frame, such as that developed in Europe for use with the wafer prism.