Purpose: To evaluate the applicability of the prism under cover test (PUCT) to quantify manifest deviation in horizontal strabismus with alternate fixation when simultaneous prism and cover test (SPCT) is not feasible.
Methods: Children aged 4-11 years, with alternate fixation horizontal strabismus and alternate prism and cover test (APCT) distance deviation (DD) up to 25 PD were eligible. In group 1 of the study, SPCT was not feasible (n = 18), whereas in group 2, it was feasible (n = 24). Refraction, PUCT, APCT, central/peripheral fusion, and stereoacuity were measured. Repeatability of PUCT, agreement between PUCT and SPCT, and Pearson correlations between variables were studied.
Results: In group 1, mean DD was 15.6 and 9.5 PD using APCT and PUCT, respectively (intraclass correlation, ICC: 0.90). Mean stereoacuity was 201.1 arc seconds. PUCT was better correlated with stereoacuity than APCT, but not significantly (p = 0.12). Coefficient of repeatability for PUCT was 3.4 PD. In group 2, mean DD was 17.6, 14.1, and 12.5 PD using APCT, PUCT, and SPCT, respectively. Mean stereoacuity was 285.9 arc seconds. Correlations APCT-PUCT (0.87), APCT-SPCT (0.82), and SPCT-PUCT (0.95) were significant. APCT did not show as good correlation with stereoacuity (0.58) as SPCT and PUCT (0.74 and 0.78, respectively). Concordance correlation coefficient between SPCT and PUCT was 0.91, and Bland Altman agreement between the two variables was also good.
Conclusions: PUCT is a procedure with good repeatability, of interest in children to estimate manifest deviation when SPCT is not feasible, and in support of the diagnosis of monofixation syndrome.
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