Journal of Ophthalmic Medical Technology

Volume 2, Number 2
June 2006
www.JOMTonline.com

The Maddox Rod Test

Suzanne Hansen, COMT

Instructor,
College of Health Related Professions
Department of Ophthalmic Technologies
Harvey & Bernice Jones Eye Institute
University of Arkansas for Medical Sciences

The Maddox Rod Test is a type of dissimilar image test for ocular alignment. This
subjective test requires one Maddox rod to be placed in front of the patients eye. Bar or
loose prisms can be used to quantitate a horizontal or vertical deviation. It is important to
remember that this test will not differentiate between the presence of a phoria or tropia;
only the cover-uncover test can determine if a phoria or tropia is present.
1


The COMT Performance Areas lists the Maddox Rod Test as one of the potential skills a
candidate may be required to perform for the COMT Performance Test.
2

When measuring a phoria using a Maddox rod and bar or loose prisms, the direction of
the red line viewed by the patient is perpendicular to the direction of the red cylinders.

If Maddox rod is held horizontally a vertical line results (use this orientation to
measure for esophoria and exophoria)



OD OS


If Maddox rod is held vertically a horizontal line results (use this orientation to
measure for hypophoria and hyperphoria)



OD OS






Steps:
3,4
1. Patient wears best corrected Rx
2. Maddox rod is held in front of patients eye (select to measure the horizontal or
vertical deviation first)
3. Transilluminator is focused on the midline of the patients face
4. Explain to patient: You will see a red line and a white dot. Is the dot
superimposed on the red line?
- If the patent answers Yes, the dot is superimposed on the line, then no
deviation is present (proceed in checking the other orientation)
- If the patent answers No, the dot is not superimposed on the line, then a
deviation is present (proceed with identifying and quantifying the deviation by
holding up loose prisms in the proper orientation until the dot is superimposed on
the line)


How do you determine which direction to hold your prisms to quantify the horizontal
deviation? (Assume Maddox rod is placed over patients OD.)

OD OS





If your patient sees: = No deviation
the white light superimposed on the red line



If your patient sees: = Exo deviation (use BI
the red line to the left, white light prism to quantify)
on right side




If your patient sees: = Eso deviation (use BO
the red line to the right, white light prism to quantify)
to the left side








How do you determine which direction to hold your prisms for vertical deviation?
(Assume Maddox rod is placed over patients OD.)
OD OS




If your patient sees: = No deviation
the white light
superimposed on the red line


If your patient sees: = Rh deviation (use BD OD
red line is above the white light prism to quantify, may be
recorded as LH deviation)


If your patient sees: = RH deviation (use BU
red line is below the white light prism to quantify)


Once the deviation is identified, bar or loose prisms are held in front of the Maddox
rod until the line is centered on the light. This prism power equals the amount of
phoria or deviation present.
4
Results should be recorded with this prism diopter
amount and the ocular deviation identified. Example: 10

RH (by Maddox Rod Test),

a 10 prism diopter right hyperphoria is found when the subjective test is performed at
near or 33 cm (the prime indicates the test is performed at near). The test can be
performed at 6 m and at 33 cm. The patients visual acuity must be sufficient to see
the light with one eye and the line with the other eye to perform test.
4
This test also
requires good patient cooperation for adequate results.

Clinically, this test is rarely performed and not the preferred method for quantifying
ocular misalignment as some of the objective cover tests such as the prism alternate
cover test. However, this test may be very helpful for quickly verifying prescribed
prism for glasses.


References:

1
Basic and Clinical Science Course: Pediatric Ophthalmology and Strabismus.
American Academy of Ophthalmology, 2005.

2
Criteria for Certification & Recertification. Joint Commission on Allied Health
Personnel in Ophthalmology, Inc., 2005.

3
Stein, HA, et. al. The Ophthalmic Assistant: A Guide for Ophthalmic Medical
Personnel. 7
th
ed., Mosby, Inc., 2000.

4
Von Noorden, Gunter. Atlas of Strabismus. C.V. Mosby Company, 4th edition,
1983.