Worth four dot test
The Worth four dot test assesses fusion and suppression. The patient wears red-green glasses, red over the right eye and green over the left, and views four lights: one red at the top, two green at the sides and one white at the bottom. The patient reports how many lights they see:
Four lights: flat fusion. The bottom light looks white, pink or green depending on eye dominance.
Two red lights: the left eye is suppressed.
Three green lights: the right eye is suppressed.
Five lights: diplopia. Red to the right of green is uncrossed diplopia, an eso deviation. Red to the left is crossed diplopia, an exo deviation. Red above green is a left hyper deviation; red below green is a right hyper deviation.
More detail
A four-light response in a patient with a manifest esotropia can reflect anomalous retinal correspondence rather than normal fusion, so the result is read alongside the cover test.
Sources (15)
- Cacho-Martínez, P., García-Muñoz, Á. and Ruiz-Cantero, M.T. (2014). Is there any evidence for the validity of diagnostic criteria used for accommodative and nonstrabismic binocular dysfunctions?. Journal of Optometry, 7(1), pp.2-21.
- Eskridge, J.B., Amos, J.F. and Bartlett, J.D. (1991). Clinical Procedures in Optometry. Philadelphia: Lippincott.
- Rutstein, R. and Daum, K. (1997). Anomalies of Binocular Vision: Diagnosis & Management. St. Louis: Mosby.
- Scheiman, M. and Wick, B. (2014). Clinical Management of Binocular Vision. 4th ed. Philadelphia: Lippincott Williams & Wilkins.
- macgill.com: worth-4-dot-test-red-green-glasses-and-flashlight.html
- American Academy of Ophthalmology: bcscsnippetdetail.aspx?id=6774bb15-13b5-45a5-b00e-281de94787
- PubMed Central: PMC7396169
- PubMed Central: PMC3520466
- prairielightsbooks.com: 9781795686228
- innovamed.com: good-lite-worth-4-dot-attachment
- Taylor and Francis: 0065955X.1981.11982528
- ScienceDirect: pdf?md5=ae9942b42b32b4ce1523155b7f1a7773&pid=1-s2.0-S0161642
- snucm.elsevierpure.com: validity-of-the-worth-4-dot-test-in-patients-with-red-green-
- Wolters Kluwer journal: validity_of_the_worth_4_dot_test_in_patients_with.11.aspx
- ScienceDirect: S0161642096305162
Reviewed October 2026
Related terms
Nearby in the glossary
- Wheatstone stereoscope
- Worth four dot test