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Measurement of Strabismic Angle Using the Distance Krimsky Test

2013; Korean Ophthalmological Society; Volume: 27; Issue: 4 Linguagem: Inglês

10.3341/kjo.2013.27.4.276

2092-9382

Kwang Sic Joo, Hyun Koo, Nam Ju Moon,

Corneal surgery and disorders

The alternate prism cover test (APCT) is the most frequently used method to measure the angle of deviation in patients with strabismus, but it can only be used when both eyes have sufficient vision for fixation.In cases of sensory strabismus, severe amblyopia, and infantile strabismus, it is difficult to take measurements with the APCT due to insufficient vision or poor cooperation in these patients [1,2].In such cases, the Hirschberg test or Krimsky test, which use corneal reflection for measuring the strabismic angle, are commonly used.Although these methods are useful in measuring the near angle of deviation, their accuracy for Purpose: To evaluate the correlation of the distance Krimsky test and the alternate prism cover test (APCT) for the distance deviation in patients with horizontal strabismus.Methods: Forty patients with horizontal strabismus (20 esotropia and 20 exotropia) were included in this study.Patients with a variable angle of deviation, vertical angle over 5 prism diopters, impaired binocular vision, or poor cooperation were excluded.We instructed the patient to look a target 6 meters away, and applied a prism over the patient's dominant eye while flashing a light source 33 centimeters from the middle of both eyebrows.When the corneal light reflexes were located on the center of each cornea, we measured the angle of deviation.We defined this method as 'distance Krimsky test,' and the angle measured by this method was compared with the conventional Krimsky test and APCT at distance.We analyzed the accuracy and intraand inter-observer reliability. Results:The angle of strabismus measured by the distance Krimsky test showed a significant agreement and correlation with the deviation angle measured by the APCT.We elicited the correlation gradient between the angle measured by the distance Krimsky test and the APCT.In addition, the distance Krimsky test showed significant intra-and inter-observer reliabilities. Conclusions:The distance Krimsky test is expected to be more useful than the Krimsky test in measuring the distance angle of deviation for patients with strabismus in whom it is difficult to measure the angle of deviation using the APCT.The distance Krimsky test can be an accurate and useful test through the improvement of proficiency of examiners and the establishment of individualized normative data.