Is adaptation to perceived interocular differences in height explained by vertical fusional eye movements?

PURPOSE To find out whether adaptation to a vertical prism involves more than fusional vertical eye movements. METHODS Adaptation to a vertical base-up 3 prism diopter prism was measured in a custom-programmed Maddox test in nine visually normal emmetropic subjects (mean age 27.0 ± 2.8 years). Vertical eye movements were binocularly measured in six of the subjects with a custom-programmed binocular video eye tracker. RESULTS In the Maddox test, some subjects adjusted the perceived height as expected from the power of the prism while others appeared to ignore the prism. After 15 minutes of adaptation, the interocular difference in perceived height was reduced by on average 51% (from 0.86°-0.44°). The larger the initially perceived difference in height in a subject, the larger the amplitude of adaptation was. Eye tracking showed that the prism generated divergent vertical eye movements of 1.2° on average, which was less than expected from its power. Differences in eye elevation were maintained as long as the prism was in place. Small angles of lateral head tilt generated large interocular differences in eye elevation, much larger than the effects introduced by the prism. CONCLUSIONS Vertical differences in retinal image height were compensated by vertical fusional eye movements but some subjects responded poorly to a vertical prism in both experiments; fusional eye movements were generally too small to realign both foveae with the fixation target; and the prism adaptation in the Maddox test was fully explained by the changes in vertical eye position, suggesting that no further adaptational mechanism may be involved.