Subjective Refraction Technique

for Astigmatism
Fatimah D

Refraction & Contact Lens Sub Division

Opthalmology Department of
Diponegoro University, Kariadi General Hospital
 Astigmatic Eye

AAO 2010-2011, Section 3

Kaimbo D . Astigmatism – Definition, Etiology,
Classification, Diagnosis and Non-Surgical Treatment.
 Astigmatic Eye
• Astigmatism occurs when incident light rays
do not converge at a single focal point. (AAO-
2007)
• Total astigmatism can be divided into corneal
(or keratometric) astigmatism, lenticular
astigmatism, and retinal astigmatism.
• Type of Astigmastism :
– Regular
– Irregular
Astigmatic Eye

WWW.alboutvision.com
 Subjective Refraction Technique
Principle Of Astigmatism Correction:
1. Refine axis
2. Refine power

Technique Astigmatism Subjective Refraction

1. Astigmat Dial Technique
2. Cross Cylinder Technique
3. Stenopaic Slit
AAO 2010-2011, Section 3
Ledford J, Daniels K. Optics, Retinoscopy and Refractometry. 2006
 Astigmat Dial Technique
1. Obtain best visual acuity using sphere only.
2. Fog the eye to about 20/50 by adding plus
sphere.
3. Note the blackest and sharpest line of astigmatic
dial.
4. Add minus cylinder with axis perpendicular to
the blackest and the sharpest line until all
appear equal.
5. Reduce plus sphere (or add minus) until best
acuity is obtained with the visual acuity chart
AAO 2010-2011, Section 3
Ledford J, Daniels K. Optics, Retinoscopy and Refractometry. 2006
Astigmat Dial Technique
 Cross Cylinder Technique
• The cross cylinder is a lens
with the same power but
opposite signs in the two
principal meridians, e.g.
+0.25DCx045/-0.25DCx135.
• Usually the axis negative
powered meridian is
marked with red letters, the
axis of the positive power
meridian with white.
AAO 2010-2011, Section 3
Ledford J, Daniels K. Optics, Retinoscopy and Refractometry. 2006
 Cross Cylinder (CC) Technique
1. Adjust sphere that gives best visual acuity
2. Use chart 1 or 2 lines larger
3. Testing astigmatism with CC lens at axes 90-
180 . If (-) testing at 45 -135 .
4. Placing the cylinder lens according to CC
5. Refine axis
a) Flip the CC, asked the patient preferences

AAO 2010-2011, Section 3

Ledford J, Daniels K. Optics, Retinoscopy and Refractometry. 2006
 Cross Cylinder (CC) Technique
b) Rotate the cylinder axis toward the patient’s favor (-
cylinder toward – cylinder)
c) Repeat until report no change when the lens is flipped
4. Refine Power
a) Align the cylinder axis to the principle meridian
b) Determine the preferred flip choice
c) Add or subtract the cylinder power
5. Refine Sphere (addjust final sphere)
AAO 2010-2011, Section 3
Ledford J, Daniels K. Optics, Retinoscopy and Refractometry. 2006
 Stenopaic Slit
• Stenopaic slits are found in most trial lens sets
and consist simply of a piece of cardboard
from which a slit shaped aperture has been
cut out

Ledford J, Daniels K. Optics, Retinoscopy and Refractometry. 2006

 Stenopaic Slit
1. Adjust sphere that gives best visual acuity
2. Fogged the eye
3. Rotates the slit to the position of clearest vision.
4. The slit is now alligned along principle meridian.
5. Refract the two principal meridians separately
with the stenopaic slit
(double spherical method).

Ledford J, Daniels K. Optics, Retinoscopy and Refractometry. 2006

 Stenopaic Slit
-12.00 D
• R/ : S -3.50 D C -8.50 D x
180 

Ledford J, Daniels K. Optics, Retinoscopy

and Refractometry. 2006

-3.50 D
 Cylinder Lens Rotation
1. Simple way of determining cylinder axis is to
rotate the cylinder lens until best prefers is
found.
2. This works best for high astigmatism where
cross cylinder and fan dial often work poorly.

Lung A, Refractive Technique, 1992.

 Cylinder Lens Prescription
1. Gives cylinder minus correction
2. Children accept the full astigmatic correction
3. In Older patient :
a) Changing the lens axis will cause some distortion
b) Rotate the cylinder lens to vertical or horizontal
principle meridian
c) Keep the spherical equivalent constant when
reducing cylinder power

AAO 2010-2011, Section 3