A comparison study between the Von Graefe and Maddox rod phoria techniques at far and nea

Harrier, Donald

Kautz, AlVerne S

English

CommonKnowledge

Pacific University 
CommonKnowledge 
College of Optometry Theses, Dissertations and Capstone Projects 
1-1960 
A comparison study between the Von Graefe and Maddox rod 
phoria techniques at far and near 
Donald Harrier 
Pacific University 
AlVerne S. Kautz 
Pacific University 
Recommended Citation 
Harrier, Donald and Kautz, AlVerne S., "A comparison study between the Von Graefe and Maddox rod 
phoria techniques at far and near" (1960). College of Optometry. 219. 
https://commons.pacificu.edu/opt/219 
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A comparison study between the Von Graefe and Maddox rod phoria techniques 
at far and near 
Abstract 
A comparison study between the Von Graefe and Maddox rod phoria techniques at far and near 
Degree Type 
Thesis 
Degree Name 
Master of Science in Vision Science 
Committee Chair 
D.T. Jans 
Subject Categories 
Optometry 
This thesis is available at CommonKnowledge: https://commons.pacificu.edu/opt/219 
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A COMPARISOn STUDY BETWEEN THE VON GRAEFE 
AND MADDOX ROD PHORIA TECHNIQUES AT FAR 
AND NEAR 
CLINICAL YEAR THESIS 
JANUARY 1960 
BY 
Donald Harrier 
and 
AlVerne s. Kautz 
We acknowledge the assistance given this study by 
Dr. D.T. Jans of t he Optometric faculty of the 
Pacific University College of Optometry . 
D.H. 
A.K. 
TABLE OF CONTENTS 
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 
Related Studies •••••••••••••••••••••••••• 
Apparatus • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 
Procedure • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 
Organization of Data ••••••••••••••••••••• 
Histograms • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 
Page 
1 
2 
4 
5 
8 
9-12 
Table I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • 13-15 
Su...'Tllnary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 
Bibliography • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 19 
INTRODUCTI ON 
This is a co~parison study between the phoria 
findings of the von Graefe and Maddox rod techniques 
at far and near through the habitually worn lens. 
This information may be valuable to enable the clin-
ician to change from one technique to the other or 
to use them interchangeably. 
RELATED STUDIES 
Scobeel, Hirsch and Bing2 , Hirsch3, and others have 
published f'indings concerning norms and expecteds using 
either one or both of the before mentioned tecl~iques 
without complete descriptions of' methods of' testing 
and/or the statistical data necessary for acceptable 
clinical usage . 
The reliability of each of the methods in this study 
has been established by Barnett and Sedwa~+, in their 
clinical study. Their study shows the levels of sig-
nificance at .05 at near and far for the von Graefe and 
Maddox rod phoria t echniques • 
. ·- . . . 
1. Scobee, R.G. and Green, E .L.- Tefst s for Heterophori a 
Reliability of the ·T.ests, Comparison Between Tests -
and Effect of Changing Testing Conditions: Trans. 
Amer. Acad. of Ophthalmology and Otol., · 1947 
' 2. Hirsch, Monroe and Bing, Lois - The Effect of Test-
ing Methods On Yalues obtained For Phoria at Forty 
Centimeters: A.me l"'. J. of 0 tometr"- and Arch. of 
Al:ner. Acad. of OP.tometry, Sept., 19, 
3. Hirsch, Monroe - flinical Investigation of a Method of 
Testing Phoria at Forty Centimeters; A..'ner. J. of 
Optometry. Octobe r , 1948 
4. Barnett, J.P., Sedway , M.M. - A Comparison of' the 
Reliabili ties of the Maddox rod and von Graefe 
Phoria Techniques: Ontometry Thesis June 1954 
2 
As one of the conclusions of the publication 
Phoria Norms5, it was suggested that the Maddox rod 
tends to indicate more esophoria than the von Graefe 
method. The conclusion is based on tests at far and 
cites many investigators who presented data t a ken 
under varying conditions. No concrete data is 
available for near point Maddox rod values or com-
parisons. 
. . . . .. 
!). Bureau of Visual Science- Phoria Norms, American 
Optical Company, 19~-1 
3 
APPARATUS 
American Optical 1Rx Master' refractor 
Bausch and Lomb projector 
Reduced Snellen Chart 
Near Maddox rod t arget 
Interpupillary eli stance millimeter rule 
Light meter 
4 
PROCEDURE 
The investigators worked vvith fifty two subjects, 
most of i:'Vhom were clinicians at Pacific University 
Optometric Clinic. Each subject was instructed to 
wear his habitual prescription during the testing, in 
case of a near a dd, the power of the add wa s put in 
the refractor for near tests. Each subject in this 
study was required to have 20/20 binocular acuity at 
far and near through his habitual prescription. 
I. von Graefe Diplopia technique 
A. At far - Target projected seventeen feet three 
inches from subject. 
O.D. - Prism base in 
o.s . - Prism base down 
Target - Snellen ~nart, 20/20 
Room illumination - full 
Target illu~nation - 12 c.p. 
B. At near - Target at sixteen inches from subject. 
O.D. - Pri.sm base in 
o.s. - Prism base dovn1 
Target - Reduced Snellen Chart, bottom line of 
20/20 letters. 
Room illumination - full 
Target illUL~ination - full 
5 ' 
II. Maddox rod technique 
A. At far - Target projected seventeen feet 
three inches. 
O.D. - Risley prism 
o.s. - Vfuite Maddox rod, axis 180 degrees 
to r;i ve a vertical line. 
Target - projected white dot and vertical 
·white line. 
Room illtmdnation - Dim 
Target illumination - 12 c.p. 
B. At near - Target sixteen inches from subject 
O.D. - Risley prism 
o.s. - White Maddox rod axis 180 degrees to 
g:t ve a vertical line. 
Target - 2.5 rmn. frosted glass pinhole 
illuminated from behind to give v\hite 
dot and white vertical line. 
Room illumination - Dim 
Target illumination - 12 c.p. 
INSTRUCTIONS TO SUBJECTS 
I. von Graefe Technique 
Far - "Please read the top line of letters to 
yourself and tell me when tm bottom line 
of letters passes directly undernea thu. 
6 
Near - nPlease read the bottom line of the top 
target to yourself and tell nB when the 
bottom target passes directly underneath". 
II. Maddox Rod Technique 
Far and :Near - 11 Please look at the white line 
and tell me when the Ymi te spot is directly 
on top of the line 11 • 
It was necessary to use eli fferent room illumination 
levels for thB two techniques. Full room illumination 
was used for the von Graefe technique to duplicate 
present clinical methods. Dim room illumina. tion was 
r•equired for the :Maddox rod technique to provide a visible 
vertical line. 
Three readings were taken f :t-om excessive base-in and 
three readings were taken from excessive base-out using 
each technique at each distance. '11he subjects were 
allowed to regain binocularity between techniques at each 
distance in an attempt to eliminate any effects of time 
of dissociation. The same examiner did all measu~ing to 
eliminate errors of examiner technique. 
7 
ORGANIZATION OF THE DATA 
Each subject's group of three findings was 
averaged to the nearest one-half prism diopter 
for each technique at far and near. The mean of 
these averages was then calculated as was the 
rredian, the mod~ and the standard deviation. 
The frequency distribution values were graphed 
in one-half prism diopter intervals at far and near. 
STATISTICAL METHODS 
Key 
o equals standard deviation 
X equals value of the variable 
X equals arithmetic mean 
Mdn. equals median 
M.ode equals mode 
N equals 52 subjects 
Formulae 
1. 6 ;; 
2. )( 
FINDINGS 
All sub ject da t~ used can be found on Table I. 
+ 
+ + 
•· ~ 
--
- -!-
! 
---y--·-,- •· 
FAR FREQUENCY DISTRIBUTIONS 
-- -t- .. 
VON GRAEFE FRO~J{ EXCESSIVE BASE IN 
.. 
--+-
6fi---5 1ti 4 rz 3 2;t 2 1-i 1 t 0 t 1 
PRISNI DIOPfERS I 
EXOPHORIA----ESOPHORIA 
---..+---- - ---+-- -fo- + -+-+ 
..........-.-~w----..... -..- ---,..~- .. - ..... ·-:~~--- _!,...._.. __ .,.. ~-- - ~-- ~ .!...-._ 
MADDOX ROD FROM EXCESSIVE BASE IN 
£ 
9 
8 
7 
6 
5 
4 
' 2-
l 
. -
__. -----4-·• --- -
..,. 
- _,__ 
------t-
4-5 1+~ 4 3-i 3 2i 2 lt 1 "~ 0 t 1 lt 2 2-i 3 ~ 4 4i5 5i 6 6-~ 
PRISM DIOPI'ERS 
----
EXOPHORIA-~--ESOPHO RIA 
--r -
... 
• 
' 
.... . 
+ 
,. 
---
---..i- ... --- -
. . 
-+-· 
.,. 
FAR FREQUENCY DISTRIBUTIONS 
VON GRAEFE FROM EXCESSIVE BASE OUT 
f 
9 
8 
7 
6 
5 
4 
5 
2 
1 n 
-. .............. ..::: ~ --- .-
2l2 1~k 1 t 0 t 1 ~- li 2 
PRIS!1_PIOP.rERS 
EXOPHORIA----ESOPHORIA 
·-- ·-- ... .,.__ - ~ 
MADDOX ROD FROM -EXCESSIVE BASE OUT 
f' 
9 
8 
7 
6 
5 
4 
5 
2 
1 
• - + 
·"·" "f 
n [1 -~ 
4~5~2*liOll* 2·;>~4~5~6~7 
PRIE!~ DIOPrERS 
EXOPHORIA----ESOPHORIA 
.;_10 
6 
5 
NEAR FREQUENCY DISTRIBUTIONS 
VON GRAEFE FROM EXCESSIVE BASE IN 
! ,i-"_Q~'~_,.,,s£b9~s 7'7 n ,..,.,.,~,-~,lJ ,Q.h!J __ £!_ 9 
4 
3 
f 
MADDOX ROD FROM EXCESSIVE BASE IN 
PRISM DIOFTERS 
--- ESOPHORIA 
EXOPHORIA--:= 
PRISM DIOPTERS 
EXOPHORIA--------- -ESOPHORIA 
7 
6 
5 
4 
3 
2 
1 
~ 
3 
2 
l 
NEAR FREQUENCY DISTRIBUTIONS 
VON GRAEFE FROM EXCESSIVE BASE OUT 
4 35 3 ;;'j· dl/ 6. I ~.;2~ 3 3$ 7~ f 
PRISM DIO PTEHS -ESOPHORIA 
EXOPHORIA-------- -
Fv'IADDOX ROD FHOM EXCESSIVE BASE OUT 
· ;,_· -
//las;o9r9 tf'~ '?7~~· 6 5 :J~-1~"/35" 3ds-~ 1~/ 
PRISM DI 0 PrERS ~, 
EXOPHORIA------------ - .~SOPHORIA 
13 
TABLE 1 
FAR FAR NEAR NEAR 
MADDOX ROD VON GRAEFE MADDOX ROD VON GRAEFE 
BI BO BI BO BI BO BI BO 
1. 2.5eso 4.5eso 2.0exo .5exo 1.5eso 3.5eso 5.5exo 1.5exo 
2. o.o o.o l.Oexo .5eso 9 • .5exo 8.5exo s.oexo 7.5exo 
J. 5.0exo 3.5exo 2 • .5exo 2.0exo 9.0exo 8._5exo 7.0exo 6.5exo 
4. 3.5e.so 3.5eso 2.5eso 2.5eso 8.0exo 7.5exo 6.oexo 6.oexo 
5. 2.5eso 3.0eso 1.5eso 2.0eso .5exo .5exo 2.5exo 2.5exo 
6. l.Oexo 1.5eso 2.5exo l.Oexo 4.0exo l.Oexo 5.0exo 4.0exo 
7. 1 • .5eso 1._5eso o.o l.Oeso 6._5exo 6.0exo 4.5exo 5.5exo 
8. 2.0exo 1._5exo 3.5exo 2.5exo lO.Oexo lO.Oexo 10.0exo 10 • .5exo 
9· 2.0exo 1._5exo 2.0exo 2.0exo 10 • .5exo 8.5exo 11.0exo 10.5exo 
10. 2.5eso 3.0eso 1.5eso 2.0eso 7.5exo 8.0exo 6.5exo 6.5exo 
:.1. • .Sese 1.0eso ._5exo .5exo 2.0exo 2.0exo 5.5exo 6._5exo 
12. 3.5exo 3.5eso 2.0eso 2._5eso s.oexo 7.5exo 9.0exo 8.0exo 
~ 3 
.J.. • 4.5exo 2.0exo 4.5exo 4.oexo 14.5exo 13.0exo 1~ ... 0exo 13.5exo 
14. 6.5eso 7.0eso 5.5eso 6.0eso 1.0eso o.o .5eso ._5eso 
15. 2.5eso 2.5eso 3.0eso 4.0eso 4.oexo • .5exo 1.0exo .,Sexo 
16. 2._5exo 2.0exo 2.5exo 2.0exo 17 • .5exo 16.5exo 14.oexo 12._5exo 
~7. 1 • .5eso 2.0eso .5exo o.o 9.0eso 8:•0eso 6 • .5eso 7 • .5eso 
18. 4.0exo .5exo 2.5exo • .Sese 7.5exo 5.5exo 6.0exo 4 • .5exo 
19. 1.0exo 2.0eso 2.5exo 1.5exo 11 • .5exo lO.Oexo l0 • .5exo l0.5exo 
20. o.o 2.0eso 2.0exo 1 • .5eso ~-.5exo 1.0eso 3.0exo 2.5exo 
21. o.o .5eso .5eso l.Oeso lO.Oexo 9 • .5exo 4.0exo 3 • .5exo 
~2. o.o 1.5eso r' .5exo s.oexo J~ .• 5exo 7 • .5exo 8.0exo .,::>exo 
23. 1 • .5exo o.o l.Oexo o.o 12.0exo lO.Oexo lO.Oexo J.O,•Oex.Q 
TABLE 1 (continued) 
FAR FAR NEAR NEAR 
MADDOX ROD VON GRAEFE MADDOX ROD VON GRAEFE 
BI BO BI BO BI BO BI BO 
24. 3.0ex.o 2.0exo 2.,5exo 2.0exo .5exo o.o 4 • .5exo ,5 • .5exo 
2.5. .,5exo o.o .,5exo • .5exo 5.5exo ~ .• 5exo 2.,5exo 1.0exo 
26. 2.5exo 1.5exo 3.5exo 2.5exo 3.0exo 2.5exo 5.0exo 3.5exo 
27. o.o 1 • .5e:so .,5eso 1.0eso 3.5exo .5exo 1 .5eso 3.0eso 
28. 3.5eso 3.5eso .,5exo 1.0eso 4.0exo 3 • .5exo 3.5exo 4.0exo 
29. 2.0eso 2.5eso .5eso 1.0eso 4.5exo 3.0exo .5exo l.Oexo 
30. o.o 1.5eso o.o 1.0eso 6.oexo 6.oexo 4 • .5exo 4.5exo 
31. .,5exo l.Oeso l.Oexo .5exo lO.Oexo lO.Oexo 6.0exo ?.Oexo 
32. .5exo • .5eso 1.5exo l.Oexo 3.0eso 3.0eso 5.0exo · 5.0exo 
33. • .5exo 1 • .5eso 1 • .5exo 1.5exo 3.0exo 1.5exo 6.5exo 5.5exo 
3L~. 3.0e.x.o 1.,5exo l.Oe.x.o .5exo 9.5exo 7.5exo 8 • .5ex6 9.0exo 
35. 1.5eso 3.0eso l.Oeso l.Oeso 1 • .5exo .5exo 1.5eso 1.,5eso 
36. 1 • .5eso 2.5eso 1.5eso 2.0eso lO.Oexo 8 • .5exo 6. ,5exo 6.oexo 
37. l.Oexo o.o J.Oexo l.Oexo 10.5exo s .oexo ?.Oexo ?.Oexo 
38. l.Oexo o.o 2.5exo l.Oexo 6.0exo 6.5exo 6.0exo 5.5exo 
39. 6.0eso 6 .5eso 6 • .5eso 6.oeso 3.0eso 3.0eso 3.5eso J.Oeso 
4o. 2. Oeso J.Oeso 2.0eso 2.0eso 4.oexo J.Oexo J.Oexo 3.5exo 
41. .,5eso .5eso 2.0exo l.Oexo ?.Oexo ?.Oexo 5.5exo ,5.,5exo 
L~2. 2.0exo 1.5exo 3.5exo 3.5exo 12.5exo ll .Oexo 6.0exo 5.5exo 
1+3· l.Oeso 2.5eso .5exo 1 .5eso .5.0exo 4.oexo .5exo .5exo 
L~~. 2.5eso L~.5eso .5eso l.Oeso o.o o.o 2.0exo 1.5eso 
45. l.Oexo 1.5eso l.Oexo l.Oexo 2.0exo J.Oexo J.Oexo L~ .Oexo 
L~6. l. _S' e.x.o .,5exo 1.5exo l.Oexo 8 .0exo 6.oexo 4 .0exo J.Oexo 
47. 
48. 
4-9· 
5o. 
51. 
52. 
TABLE 1 (continued) 
FA.."R FAR NEA.."R NEllli 
MADDOX ROD VON GRAEFE· MADDOX ROD VON GRAEFE 
BI BO BI BO BI BO BI BO 
1.5exo l.Oexo 2.5exo l.Oexo 5.5exo 5.5exo 6.oexo 5.5exo 
2.0exo ""' 1.5exo 1 .5exo 7.5exo 6.5exo 8.5exo 9.0exo •.?eXO 
3.5eso 5.0eso 3.0eso 3.0eso o.o 2.5eso .5exo .5exo 
6.5exo .5exo 3.5exo 2.0e:xo 12.0exo 7.5exo 9.5exo 9.5exo 
2.0eso 2.0eso l.Oexo l.Oeso 2.0eso 2.0eso .5eso l.Oeso 
2.5exo 2.0exo 2.5exo 2.0exo 16.oexo lq .• ;)exo lO.Oexo l O.Oexo 
STATISTICAL RESULTS 
von Graefe from exce s sive base in _at far: 
Iv1addox rod from excess i ve base in at far: 
von Graefe from excessive bas~ ou.t at far: 
X == .1058 / ... esc. 
Tvidl1• ::.5o"' eso to .50 ''exo • 
Mo'de, b:fr:modal : ,.75 "eso to 1.5<f eso; 
a'=l . 95" 
.75 4 exo to 1.5ifexo. 
Maddox rod from excessive base out at far: 
- .t, X -;::1.135 eso 
Mdti : .75..t.eso to 1 .54 eso. 
Mode ~ .5o4eso to • .so •·exo 
0"" 2.11A 
von Gr aef a from excessive base in at near: 
i=5.030 exo 
Mdn.-:::_Ef •. 25.11e.xo to 7 .o.aexo. 
Mode ::. !5 . 25 trexo to ?. OA ex.o .. 
6' ::3.82 
15 
Maddox from excessive base in at near: 
- 5 .e. X = • 701 . exo. "' 
Mdn = 5.25"exo to 7 .o 
Mode, trimoda1~3 .0'" to 
6:.: 5.16 
exo. ~ A ~ A A ~ 7•0 exo; 1.0 to 9.0 exo; 9.0 to 11.0 exo 
von Graefe from excessive base out at near 
X'=.4. 64o W!1 exo. 
Mdn :=. 5 .25 "' ~o · 7 .oo .6 ~ exo. 
Mode ": 5.25 t o 7.00 exo. 6'=4 .• 12 
i. 
Maddox from excessive base out at near: 
X - 4 0 6 . ..... • exo . 
Mdn. ':::" 5.2.5/.i exo to 7.0.n exo. 
Mode ::= 7 .2rf/ 'exo to 9 .·O tl e.xo~ 
6'=4.8o 
SUMWiARY 
The results of this study indicate that the far Maddox 
rod from base in phoria is .10 prism diopters eso, standard 
deviation plus or minus 2.36 prism diopters. The far 
von Graefe from base in phoria norm is .615 prism diopters 
exo, standard deviation plus or minus 1.98 prism diopters. 
The far Maddox rod from base out phoria norm is 1.14 
prism diopters eso, standard deviation plus or minus 2 .. 11 
prism diopters. The far von Graefe from base out phoria 
norm is .106 prism diopters eso, standard deviati... on plus 
or minu.s 1.95 prism diopters. 
At near the Maddox rod from base in phoria ncr m is 
5. 70 prism diopters exo, standard de via ti on plus or minus 
5.16 prism diopters. The near von Graefe fr•om base in phoria 
norm is 5.03 prism diopters exo, standard deviation plus or 
minus 3.82 prism diopters. 
The near Maddox rod from base out .phoria norm is ~-.00 
prism diopters exo, standard deviation plus or minus 4. 80 
prism diopters. The near von Graefe from base out phoria 
norm is Ljc .64 prism diopters exo, standard deviation :plus 
or minus h.l2 prism diopters. 
It is t h e authors' opinion that t here is little or no 
clinically significant difference between the von Graefe 
phoria findings and those phorias taJcen v'li. th the IYiaddox 
rod --- at far or near. 
17 
This study indicates that the use of acuity material 
at near to posture convergence closer to the plane of 
regard is apparently not accomplished by use of the reduced 
Snellen. It was not in the scope of this study to suggest 
changes of standard target designs now in use, but it is 
now mentioned as an area of investigation. 
1he authors' suggest that further study be made with 
the Maddox rod phorias a t the near cross cylinder levels 
and a t the recovery levels of the positive and negative 
relative accommodation findings. 
18 
BIBLIOGRAPHY 
1. Scobee, R.G. and Green, E .L. - Tests for Heterouhoria-
Re1iability of the Tests, Comparison Between Tests and 
Effect of Changing Testing Conditions; Trans. Amer. 
Acad. of Ophthalmology and Otol., 1947. 
2. Hirsch, Monroe and Bing, Lois - The Effect of Testing 
Methods on Values Obtained for Phoria at Forty Centi-
meters; Amer. J. of Optometry and Arch. of Amer. Acad. 
of Opta:.-netry , Sept., 19h8. 
3. Hirsch, Monroe - Clinical Investigation of a. Method of 
Testing Phoria at Forty Centimeters; Amer. J. of 
Optometry, October 1948. 
4. Barnett J.P. and Sedway PII.M. - A Comparison of the 
Reliabilities of the Maddox Rod and von Graefe Phoria 
Techniques; Optometry Thesis. June , 1954. 
5. Bureau of Visual Science - Phoria l~OI'ms, American 
Optical Company, 1941. 
19 


A comparison study between the Von Graefe and Maddox rod phoria techniques at far and near

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A comparison study between the Von Graefe and Maddox rod phoria techniques at far and near

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