Purpose. To assess the effectiveness of prisms in the management of diplopia in patients with incomitant, large, and combined strabismus. Methods. Data were collected retrospectively from the medical records of 64 patients who were prescribed prisms for symptomatic diplopia due to restrictive strabismus. The main outcome measure was resolution of diplopia (diplopia score 1 or 2). Data on the number of patients who continued wearing prisms versus those who opted for surgery were derived based on follow-up records. Results. Among 64 patients, 72% of patients reported complete or partial resolution of diplopia after prism use. In patients who were prescribed ≥10 PD (n=18) and those with oblique prisms (n=18), 67% and 50%, respectively, reported resolution of diplopia. More patients with vertical prism reported improvement in double vision symptoms (83%) than those who were prescribed horizontal prism (70%, p=0.04). During follow-up, 73% of the cohort continued using prisms while 23% of patients opted for strabismus surgery. Conclusions. Prisms are an effective modality and should be considered in the initial or interim management of patients with diplopia from complex ocular misalignments.
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