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The Maddox Wing test is performed at near with the instrument held in reading position, slightly inferior (approximately 15° depression and 33 cm away). The room or location of the test should be brightly illuminated and the patient's optical correction (e.g. glasses, bifocals, multifocals, contact lens) is required to be worn.
The test is based on the principle of diplopic projection. [1] Dissociation of the deviation is brought about by presenting a red line image to one eye and a white light to the other, while prisms are used to superimpose these and effectively measure the angle of deviation (horizontal and vertical).
The test is usually performed at near. The number and type of questions asked are contingent on whether the patient has binocularity present and the consequent responses to the testing questions. The patient is firstly asked about the number of lights visible and the position and number of lines seen.
Learning effect: new patients improve as more tests are performed due to understanding of the test conditions. Consider the third test as the baseline result [23] Potential for artefacts (i.e. uncharacteristic vision loss) (fig. 6). Below is a list of possible artefacts and a representation of how they may appear.
Young children with strabismus normally suppress the visual field of one eye (or part of it), whereas adults who develop strabismus normally do not suppress and therefore suffer from double vision . This also means that adults (and older children) have a higher risk of post-operative diplopia after undergoing strabismus surgery than young children.
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The test results are only useful in combination with other testing and results and not on their own; If performing the test twice, for example at near and at distance, the patient (especially children) may remember their previous answer and simply give the same answer from the last test, providing inaccurate results [1]
Diplopia is the simultaneous perception of two images of a single object that may be displaced in relation to each other. [1] Also called double vision , it is a loss of visual focus under regular conditions, and is often voluntary.