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07-Feb-11

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CROSS-CYLINDERTECHNIQUE
FORDETERMINING
ASTIGMATISM
NV1124
The cross-cylinder method
Another method of determining astigmatismsubjectively.
Consist of a sphero-cyl lensof about 40 mmin diameter
mounted in a metal or plastic holder with a handle
about 10 cmlong.
Pluscyl axis
Minuscyl axis Available as0.25D,
0.50D, 0.75Dand
1.00Dpowers.
0.50
Cross cylinder lens
The lens is effectively a pair of crossed
plano-cylinder lenses of numerically
equal powers but opposite sign, set with
their axes at plus and minus 45
0
to the
handle.
Cross cylinder lens
The figure shown on the handle isthe astigmatic
interval. If the astig interval is0.50, then the lens
isequivalent to a pair of 0.25D crosscyl. A -0.25
DC placed in contact with a +0.25 DC, their axes
perpendicular, resultsin a sphero-cyl equivalent
of either
-0.25 DS/ +0.50 DC or
+0.25 DS/ -0.50 DC
Examples : Rx +2.00/ +1.00 x 90
The focal linesare
behind the retina with
the eye
unaccommodated.
+2
+3
+2
+2
+1.00
Examples : Rx +2.00/ +1.00 x 90
The best sphere isfound as
sphere power + cyl power.
When VA recorded, it is
expected to be 6/ 12.
Hence, astig isestimated to be
1.00 to 1.50 D.
The best sphere is+2.50 DSand
the line foci are dioptrically
equi-distant fromthe retina with
the discof least confusion on the
retina.
-0.50
+0.50
+2
+2
+1.00
+2.50
+2.50
Unaccommodated
eye
best
sphere
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Examples : Rx +2.00/ +1.00 x 90
Choose a 0.25 D or 0.50 D cross-
cyl, that isan astig interval equal to
or lessthan the estimated cylinder.
Aimisto find the orientation of the
cross-cyl which will improve the
vision.
Cross-cyl isrotated in front of the
eye in 4 positions to approximately
locate the axissetting of the cross-
cyl.
-0.50
+0.50
+2
+2
+1.00
+2.50
+2.50
Unaccommodated
eye
best
sphere
Overcorrected by 0.50
Undercorrected by 0.50
Examples : Rx +2.00/ +1.00 x 90
Say, you use a 0.25 cross-cyl and
held with minusaxisat 180 and then
at 90, followed by 45 and then 135.
The -0.25 DCx 180 movesthe
anterior focal line backwardsand
the +0.25 DCx 90 movesthe
posterior focal line forwards, both
linesending up nearer the retina.
The disc of least confusion issmaller
and so the target appearsclearer.
-0.25
+0.25
+2.50
+2.50
Unaccommodated
eye
0.25
crosscyl
-0.25
cyl axis
+
0
.
2
5

c
y
l
a
x
i
s
(+0.25)
+2
+3
(-0.25)
(A)
Examples : Rx +2.00/ +1.00 x 90
With the cross-cyl positioned so
that it iseffectively -0.25 DC x
90 and +0.25 DC x 180, the
focal linesare further apart.
The disc of least confusion is
larger and so the target
appearsmore blurred.
-0.75
+0.75
+2.50
+2.50
Unaccommodated
eye
0.25
crosscyl
+0.25
cyl axis
-
0
.
2
5

c
y
l
a
x
i
s
(-0.25)
+2
+3
(+0.25)
(B)
Examples : Rx +2.00/ +1.00 x 90
The cross-cyl hasbeen moved
to a third position.
When the minusaxisof the
cross-cyl isat 45, the line foci
are asshown with their
orientationsalso indicated.
The size of disc of least
confusion ismidway.
-0.375
+0.375
+2.50
+2.50
Unaccommodated
eye
0.25
crosscyl
+0.25
cyl axis
-
0
.2
5

c
y
l a
x
is
+2
+3
(+
0
.2
5
)
76.7
166.7
(C)
Examples : Rx +2.00/ +1.00 x 90
The position of the line foci
and their orientationswhen
the minusaxisof the cross-
cyl isat 135. -0.375
+0.375
+2.50
+2.50
Unaccommodated
eye
0.25
crosscyl
-0.25
cyl axis
+
0
.2
5

c
y
l a
x
is
+2
+3
(-
0
.2
5
)
103.3
13.3
(D)
Examples : Rx +2.00/ +1.00 x 90
Thissituation providesthe
eye/ lensescombination with the
least astigmatism, the disc of
least confusion alwaysbeing on
the retina in all 4 cross-cyl
positions, the patient will choose
position (A) asthe best setting
for a minuscylinder axis. That is
at 180.
-0.25
+0.25
+2.50
+2.50
Unaccommodated
eye
0.25
crosscyl
-0.25
cyl axis
+
0
.
2
5

c
y
l
a
x
i
s
(+0.25)
+2
+3
(-0.25)
(A)
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Examples : Rx +2.00/ +1.00 x 90
Place the best result in front
of the eye, i.e. with the
cross-cyl power +0.25DS/ -
0.50DC x 180.
-0.25
+0.25
+2.75
+2.75
Unaccommodated
eye
working cyl
(0)
+2
+3
(-0.50)
(A)
+0.25
+0.25 +
-0.50 -0.25
+0.25
-0.25 x 180
and
+0.25 x 90
To determine correct axis for working cylinder
sphere
cyl
cross-cyl
+2.75
-0.50
Cross-cyl handle parallel to the
working cyl axis
If the cross-cyl handle isheld parallel to the axisof the
-0.50 DCworking cyl in front of the eye, it will introduce a
-0.50 DCat either 45 or 135.
Bothwill produce equal blur thus
indicating that the present
working cyl axisiscorrect.
With the axisdetermined, now find the correcting
cyl power.
The cross-cyl isheld successively in 2 positionswith
the cross-cyl axesparallel to the working cyl axis.
The patient isasked to choose the better of the 2
positionsof the cross-cyl.
To determine correct power for
working cylinder
The cross-cyl minusaxisheld
parallel to the working
cylindersaxis(180). The
result iszero astigmatism. +2.75
+2.75
Unaccommodated
eye
working cyl
(0)
+2
+3
(-0.50)
-0.25
+0.25 +
-0.50 -0.75
+0.25
To determine correct power for
working cylinder
+0.25
cyl axis
-0.25
cyl axis
cross-cyl
The cross-cyl plusaxisheld
parallel to the working
cylindersaxis(90). The
astigmatismisincreased.
+2.75
+2.75
Unaccommodated
eye
working cyl
(0)
+2
+3
(-0.50)
+0.25
-0.25 +
-0.50 -0.25
-0.25
To determine correct power for
working cylinder
-0.25
cyl axis
+0.25
cyl axis
cross-cyl
+0.50
-0.50
Hence, we have added a +0.25
DS/ -0.50 DC x 180 cyl to the
best sphere of +2.75 DSand
wprking cyl of -0.50 x 180.
The correcting lensistherefore
+3.00 D horizontally and +2.00
D vertically, which can be
expressed as:
+3.00/ -1.00 x 180
or
+2.00/ +1.00 x 90
+2.75
+2.75
Unaccommodated
eye
working cyl
(0)
+2
+3
(-0.50)
To determine correct power for
working cylinder
+0.25
cyl axis
-0.25
cyl axis
cross-cyl
+0.25
-0.50 -0.25 +2.75
+2.75
+ +
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Determining cylinder power
Throughout the cross-cyl routine, the
duochrome test isused to maintain the disc of
least confusion on the retina.
For each -0.50 DC change of lens, the sphere
should be changed by +0.25 DS, and vice-
versa to maintain the disc of least confusion on
the retina.