Diagnosing a Specific Muscle Case

Assuming, for example, a specific case where six degrees of exophoria was determined in the binocular test that the muscle findings in the duction test show right adduction of twenty-four degrees, with an accompanying abduction of eight degrees; likewise a superduction and subduction of two degrees for each eye. With the aid of a chart or diagram—which should be made in every case—a comparison of these figures would indicate an exophoria of approximately six degrees, with a corresponding weak left internus ([Fig. 24]). This not only shows the muscle pull of each eye individually, but a comparison of the two eyes as indicated by the dotted lines. Thus the relationship of the two eyes, and their corresponding muscles is quickly indicated.

Fig. 24—Duction chart should be made in every case. Above readily shows existence of muscular imbalance and proves subduction and superduction for both eyes are equal; otherwise hyperphoria would be disclosed. Also note abduction for both right and left eye are equal, otherwise esophoria would be disclosed. Also note adduction for right eye is 24° while left is but 18°, proving a case of 6° of exophoria with a left weak internus.

A glance at the above diagram discloses the following three important facts, all of which should be known to the refractionist before a single thought can be devoted to the correcting of the case:

1. 6° exophoria is the amount of the insufficiency.

2. 18° adduction (which should be 24°).

3. Left weak internus.

As previously stated, the power to converge is normally rated 3 to 1, or 8 to 24, as shown above, while the power of the eye to look upward, is equal to the power to look downward. The diagram accordingly proves that the muscles of the right eye are in perfect balance, having equal muscular energy.

A comparison of the left eye shows adduction of 18 degrees with an abduction of 8 degrees, proving a lateral insufficiency because the ratio is less than 3 to 1; and the muscles of the left eye are at fault. The power of 2 degrees superduction and 2 degrees subduction, proves that no weakness exists in the vertical muscles.

After making the duction test for each eye individually, a comparison of both eyes in relationship to each other may be more readily determined by following the dotted lines ([Fig. 24]).

As previously stated, it is the inability of the two eyes to work together that causes the imbalance, so that if both eyes were normal, the adduction, abduction, superduction and subduction of the two eyes would agree.

The duction chart ([Fig. 24].) also shows that the corresponding muscles of each eye agree—with the exception of the adduction of the right eye and the left eye. This proves that the left internus is weak, measuring only 18 degrees instead of 24 degrees; it further proves the 6 degrees of exophoria in the monocular test, as was quickly and more readily determined in the binocular test.

Likewise, in cases of esophoria, hyperphoria, or cataphoria, the making of definite muscle measurements independently through the prescribed method would show through the merest glance at a similar diagram which muscle or muscles were relatively out of balance. Heterphoria of almost any type, or tendencies other than normal, may be fully investigated by making a thorough and separate test of each muscle.

Where an imbalance exists, a rapid test may be employed to distinguish a pseudo or false condition from a true condition. This is accomplished by first placing the two Maddox rods (both the red and white) so that the rods lie in a vertical position. If the two lines fuse, we have determined the existence of a false condition caused by a possible error of refraction or nerve strain. If the lines separate, we have determined a true muscular condition, and then only should the second method of muscular treatment follow.

Ski-optometer Model 205

Same as Model 215 but Automatic Cylinder Arrangement omitted.

Embodying Spherical Lenses Combined with Appliances for Testing and Correcting Muscular Imbalance.

Chapter IX
FIRST METHOD OF TREATMENT
OPTICAL CORRECTION

The mere determination of the degree of an imbalance, or even the diagnosis of a patient’s trouble, is not sufficient. If relief is to be secured, something more must be accomplished.

As previously stated, muscular imbalance may be corrected through one of the four following rules or methods, each explained in their relative order: