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Other documents randomly have
different content
in place. Concave cylinders are then employed in quarters until the
final results of +1.D. spherical, combined with -1.D. cylinder axis
180° is secured. This necessitates the change of but four cylindrical
lenses as shown in routine “A” as follows:
ROUTINE “A” ROUTINE “B”
(Made with minus cylinder) (Made with plus cylinder)
Sph. +1.D. Cyl. Axis Sph. +1.D. Cyl. Axis
Step 1 +1.D. = -.25 ax. 180° equal to +.75 = +.25 ax. 90°
Step 2 +1.D. = -.50 ax. 180° equal to +.50 = +.50 ax. 90°
Step 3 +1.D. = -.75 ax. 180° equal to +.25 = +.75 ax. 90°
Step 4 +1.D. = -1 ax. 180° equal to 0 +1 ax. 90°

In brief the method of using minus cylinders exclusively in an

examination, as explained in routine “A”, necessitates the change of
the cylinder lenses only after the strongest plus sphere is secured.
On the other hand, notwithstanding innumerable other methods
where plus cylinders are used, routine “B” shows that the best
spherical lens strength the patient will accept, is also first
determined. Then both spheres and cylinders are changed in their
regular order by gradually building up in routine, by increasing plus
cylinder and next decreasing sphere, a quarter diopter each time,
until the final result is secured.
While it is conceded that both routine “A” and “B” are of
themselves simplified methods, by comparing routine “A” where
minus cylinders are used with routine “B” where plus cylinders are
used in their corresponding steps, the refractionist will note by
comparison that one is the exact equivalent and transposition of the
other. Where plus cylinders are employed, eight lens changes are
made before final results are secured; while but four lens changes
are necessary where minus cylinders are used.
The refractionist should also note by comparison that the use of
minus cylinders reduces focus of the plus sphere, but only in the
meridian of the axis. It has not made the patient myopic.
Furthermore, a plus cylinder will bring the focal rays forward, while
minus cylinders throw them backward toward the retina.
 This is but another reason for the exclusive use of minus
cylinders in refraction.
The method of using minus cylinders exclusively in an
examination, necessitates the change of the cylinder lenses only. On
the other hand, the method of using plus cylinders makes it
necessary to change spheres and cylinders in routine.
In brief, since using the minus cylinder is merely a matter of
mathematical optics, their use even in a trial-case examination is
strongly urged.
The maximum value of the Ski-optometer is fully realized only
when the advantages of using minus cylinders exclusively in every
examination is clearly understood.

Constant Attention Not Required

With the Ski-optometer, when the examination is completed, the
sum-total of final results—whether spherical, cylinder, axis, or all
combined—are automatically indicated or registered ready to write
the prescription. Until then, the foci of the various lenses that may be
employed are of no importance.
In short, in using the Ski-optometer, it is not necessary to
constantly watch the registrations during examinations. The
automatic operation of the instrument is an exclusive feature, so that
the refractionist should unhesitatingly employ it. Hence, by
eliminating the perpetual watch on the lenses in use, the refractionist
is enabled to give his undivided attention to the patient rather than to
the trial lenses.
Where a special dark-room is used for skioscopic work, an
additional wall bracket or floor stand will necessitate only the
removal of the instrument itself. This enables the refractionist to use
the Ski-optometer for subjective or objective work, without disturbing
the patient’s correction.
 Chapter IV
IMPORTANT POINTS IN CONNECTION WITH
THE USE OF THE SKI-OPTOMETER

T he Ski-optometer is equipped with an adjustable head-rest,

permitting its lenses to be brought as close as possible to the
eye without touching the patient’s lashes, a matter of importance
in every examination.

Fig. 11—The nasal lines of the Ski-

optometer fit the contour of face with
mask-like perfection, patient remaining in
comfortable position.
 Elimination of Trial-Frame Discomfort
Where the Ski-optometer is correctly fitted to the face, the patient
invariably remains in a comfortable position (Fig. 11). The instrument
is shaped to fit the face like a mask, so that even with a pupillary
distance of but 50 m/m (that of a child) there still remains, without
pinching, ample room for the widest nose of an adult.
Before making an examination, the correct pupillary distance
should always be obtained by drawing an imaginary vertical line
downward through the center of each eye from the 90° point on the
Ski-optometer axis scale. The pupillary distance will then register in
millimeters on the scale of measurements for each eye separately. If
the Ski-optometer is correctly adjusted, the patient is securely held in
position, the cumbersome trial-frame being entirely eliminated.

Rigidity of Construction
Illustration on following page (Fig. 11a) shows the reinforced
double bearing arms which hold the Ski-optometer lens batteries at
two points. This eliminates possibility of the instrument getting out of
alignment, and prevents wabbling or loose working parts.
The broad horizontal slides shown in the cut, move in and out
independently so that the pupillary distance is obtained for each eye
separately by turning the pinioned handle on either side of the
instrument. The scale denotes in millimeters the P.D. from the
median line of the nose outward, the total of both scales being the
patient’s pupillary distance.
Fig. 11a also serves to show the staunch construction of the base
of the Ski-optometer.
 Fig. 11a—Showing staunch construction
of Ski-optometer base.

How to Place the Ski-optometer in Position

The patient should be placed in a comfortable position with “chin
up,” as though looking at a distant object. The instrument should
then be raised or lowered by the adjustable ratchet wheel of the
bracket. The wall bracket gives best results when suspended from
the wall, back of the patient, as shown on page 135. This bracket
should be placed about ten inches above the head of the average
patient. When the Ski-optometer is placed in position for use, its
lower edge will barely touch the patient’s cheeks. It is sometimes
advisable to request the patient to lightly press toward the face the
horizontal bar supporting the instrument. Particularly good results
are secured where a chair with a head-rest is employed in
conjunction with the Ski-optometer. (See illustration of Model
Refraction Room, Page 112).
 Cleaning the Lenses
The time-waste of perpetually cleaning lenses is overcome where
the Ski-optometer is employed. For the convenience of the operator
and protection of Ski-optometer lenses, the latter are concealed in a
dust-proof cell, overcoming all dust and finger-print annoyances.
When not in use, the instrument should be covered with the
standardized hood forming part of the equipment.
The instrument should not be taken apart under any
circumstances. To clean its lenses, not a single screw need be
removed, as the lenses of each disk may be cleaned individually
through the opening of the other disks. These openings are
conveniently indicated by the white zeros (Fig. 2). The Ski-optometer
contains but eleven spherical and eight cylindrical lenses on each
side, so that the actual work of cleaning should not require over ten
minutes at the most, cleaning the lenses every other week proving
quite sufficient.

Accuracy Assured in Every Test

Loss of refraction is completely eliminated through the use of the
Ski-optometer. The most casual examination of the trial-frame or any
other instrument shows that the construction necessitates the
placing of the spherical lens next to the eye with the cylinder lens
outermost—a serious fault wholly overcome in the Ski-optometer.
Not only do the cylindrical lenses of the Ski-optometer set directly
next to the patient’s eye, thus overcoming any possible loss of
refraction, but the strong spherical lenses of the supplementary disk
are set directly next to the cylinder. There is apparently but a hair’s
distance between these lenses; the two disks containing the
spherical lenses of the Ski-optometer likewise setting close together.
In a word, the Ski-optometer’s cylinder lenses set directly next to
the patient’s eye, followed by the stronger sphericals, so that the
weakest spherical or +.25 (the lens of least importance) sets farthest
away. This is 3½ m/m closer than any trial-frame manufactured,
however, and at least 10 m/m closer than any other instrument—
another reason for implicitly relying on the Ski-optometer for
uniformly accurate results.

Built to Last a Lifetime

Fig. 12—(A. and B.)—This unique,

patented split-spring device of screwless
construction, securely holds all movable
parts. In case of repair, they may be
removed with the blade of a knife.
The Ski-optometer is built on the plan of ¹/₁₀₀₀″, insuring absolute
rigidity and accuracy and a lifetime of endurance. Particular and
detailed attention has been given to the novel means of eliminating
screws which either bind, create friction or continually work loose,
causing false indications of findings on scales of measurements;
hence correct and accurate indications are insured in the Ski-
optometer by means of a split-spring washer construction similar to
that of an automobile tire’s detachable rim (Fig. 12).
This patented spring washer construction securely holds the
phorometer lenses, the rotary prism and the revolving cylinder lens
cells.
Whenever necessary, or in case of repair, these parts may be
readily removed with the blade of a knife.
 Chapter V
CONDENSED PROCEDURE FOR MAKING
SPHERE AND CYLINDER TEST
WITH THE SKI-OPTOMETER

N otwithstanding various methods employed, for both

subjective and objective refraction, the following synopsis of the
previous chapters will unquestionably prove most valuable to
the busy refractionist, enabling him to make error-proof examinations
in practically every case without resorting to the transference of trial-
case sphere or cylinder lenses. A careful reading of chapters one
and two should be made however, so that one may gain an
understanding as to how spheres and cylinders are obtained with the
Ski-optometer.

Subjective Distance Test

1st—Place Ski-optometer in position, employing spirit level, thus
maintaining instrument’s horizontal balance.
2nd—Adjust the pupillary distance for each eye individually, by
drawing an imaginary vertical line downward through the center of
each eye from the 90° point on the Ski-optometer’s axis scale. The
opaque disk should be placed before the patient’s left eye by setting
the supplementary disk handle at “shut.”
3rd—The Ski-optometer lens battery before the patient’s right eye
should be set at “open” (figure 2), whereupon the first turn of
spherical lens battery toward the nasal side places a +6.D sphere in
position. This should blur vision of average patient.
 4th—It is now only necessary to remember that an outward turn
toward temporal side of the instrument increases plus sphere power,
while a nasal turn decreases it. Therefore continue to reduce convex
spherical lens power until the large letter “E” on the distant test card
is clear. Then request patient to read as far down as possible,—a
rapid turn of a quarter diopter being readily accomplished with the
Ski-optometer (Fig. 4).
5th—In the event of working down to “zero” with spheres, the
supplementary disk handle or indicator should next be set at -6.D
sphere, while the spherical reel should be turned toward the nasal
side—thus building up on minus spheres (Fig. 6). In short, the
strongest plus sphere or weakest minus sphere should always be
determined before employing cylinders.
6th—With the best spherical lens that the patient will accept left
in place, direct attention to the letter E or F in the lowest line of type
the patient can see on the distant test letter chart. Then set axis
indicator at 180° (Fig. 7).
7th—Next increase concave cylinder power until vision is
improved. If vision is not improved after increasing cylinder strength
to -.50 axis 180°, merely reverse the axis to 90°. If vision is
improved, cylinder lens strength should be increased. If not, it should
be decreased (Fig. 8).
8th—Slowly move axis indicator through entire arc of axis, thus
locating best possible axis (Fig. 7).
9th—After sphere and cylinder test of right eye has been made,
place supplementary disk handle at “shut.” Then repeat procedure in
testing left eye.
10th—After completing examination for each eye separately,
then, with both of the patient’s eyes open, direct attention to lowest
line of type he can see, concentrating on the E or F, simultaneously
increasing or decreasing spherical power before both eyes. The
refractionist merely recalls that by turning the Ski-optometer’s single
reel toward the temporal side, convex spherical power is increased,
by turning toward the nasal side for either eye, spherical power is
decreased. Cylinder lens strength may be changed in a like manner
before both eyes simultaneously.
11th—After making the distance test, then only is it necessary to
copy the result of the examination as recorded by the Ski-optometer.

Subjective Reading Test

Tilt Ski-optometer forward in making reading test. The wide
groove in the horizontal bar supporting the instrument, permits it to
be slightly tilted.
12th—Place Ski-optometer reading rod in position with card at
about 14 inches. Close off one eye. Direct patient’s attention to the
name “Benjamin” printed at top of card.
13th—Leave cylinder lens in place. Proceed as in distance test
with +6.D sphere, fogging down until the first word “laugh” on the
reading card, in line 75M, is perfectly clear, this being slightly smaller
than the average newspaper type.
14th—After completion of examination for each eye separately,
then with both eyes direct patient’s attention to word “laugh.” Move
reading card in or out a few inches either side of 14 inch mark. This
will determine any possibility of an over-correction. Then record
prescription just as Ski-optometer indicates. For a detailed
description of above, as well as for objective testing with the Ski-
optometer, read chapter three.
 Chapter VI
MUSCULAR IMBALANCE

T he purpose of the present chapter is to acquaint the refractionist

with the operation of the Ski-optometer as “a scientific instrument
for muscle testing”—the subject being treated as briefly and
comprehensively as is practicable.
As the reader progresses in the subject of muscular anomalies,
he may carry his work to as high a plane as desired, increasing his
professional usefulness to an enviable degree.
Through the use of the Ski-optometer, muscle testing may be
accurately accomplished in less time than a description of the
operation requires. Furthermore, tedious examinations may be
wholly overcome through the discontinuance of the consecutive
transference of the various degrees of prisms from the trial-case. In
fact, the latter method has long been quite obsolete, owing to the
possibility of inaccuracy. The muscle action of the eye is usually
quicker than the result sought through the use of trial-case prisms;
hence muscle testing with the Ski-optometer is accomplished with far
greater rapidity and accuracy, thus making the instrument an
invaluable appliance in every examination.

The Action of Prisms

Students in refraction—and one may still be a student after years
of refracting—are sometimes puzzled as to just what a prism does
when placed before an eye. They refer to every available volume
and are often confused between ductions and phorias, finally
dropping the subject as an unsolvable problem. In view of this fact, it
is suggested that the refractionist should read the present volume
with the actual instrument before him.
 Before proceeding, one should first understand the effect of a
prism and what it accomplishes. To determine this, close one eye,
looking at some small, fixed object; at the same time, hold a ten
degree prism base in before the open eye, noting displacement of
the object. This will clearly show that the eye behind the prism turns
toward the prism apex.
To carry the experiment further, the following test may be
employed on a patient. Covering one eye, direct his attention to a
fixed object, placing the ten degree prism before the eye, but far
enough away to see the patient’s eye behind it. As the prism is
brought in to the line of vision, it will be seen that the eye turns
towards the apex of the prism. When the prism is removed, the eye
returns to its normal position.
Similar experiments enable the refractionist to make the most
practical use of treating phorias and ductions, as well as to
comprehend all other technical work.
 Fig. 13—An important part of the
equipment for muscular work.

The Phorometer
As previously stated, it is practically impossible to accurately
diagnose a case of muscular imbalance with trial-case prisms. For
this reason the phorometer forms an important part of the equipment
for muscle testing in the Ski-optometer, having proven both rapid and
accurate. It consists of two five-degree prisms with bases opposite,
each reflecting an object toward the apex or thin edge. The patient
whose attention is directed to the usual muscle-testing spot of light,
will see two spots.
 Aside from the instrument itself, and in further explanation of the
phorometer’s principle and construction, when two five-degree
prisms are placed together so that their bases are directly opposite,
they naturally neutralize; when their bases are together, their
strength is doubled. Thus while the prisms of the phorometer are
rotating, they give prism values from plano to ten degrees, the same
being indicated by the pointer on the phorometer’s scale of
measurements.
As a guide in dark-room testing, it should be noted that the
handle of the phorometer in a vertical position is an indication that
the vertical muscles are being tested; if horizontal, the horizontal
muscles are undergoing the test.

The Maddox Rod

The Maddox rod (Fig. 14) consists of a number of red or white
rods, which cause a corresponding colored streak to be seen by the
patient. This rod is placed most conveniently on the instrument,
being provided with independent stops for accurately setting the rods
at 90 or 180 degree positions. The Maddox rod has proven of
valuable assistance in detecting muscular defects, particularly when
used in conjunction with the phorometer. Thus employed, it enables
the patient to determine when the streak seen with one eye crosses
through the muscle-testing spot-light observable by the other eye, as
hereafter described.
 Fig. 14—The Maddox Rod,
a valuable aid in making muscular tests.

Procedure for Making the Muscle Test

The Ski-optometer should be equipped with two Maddox rods,
one red and one white. Their combined use is of the utmost
importance since they assist in accurately determining cyclophoria
and its degree of tortion as designated on the degree scale, and fully
described in a later chapter.
When the Maddox rods are placed in a vertical position, it is an
indication that the vertical muscles are being tested; when placed
horizontally, the horizontal muscles are being tested. It should be
particularly noted that the streaks of light observable through the
Maddox rods always appear at right angles to the position in which
they lie.
 The Ski-optometer should be placed in a comfortable position
before the patient’s face with the brow-rest and pupillary distance
adjusted to their respective requirements. The instrument should be
levelled so that the bubble of the spirit level lies evenly between its
two lines, thus insuring horizontal balance. The muscle test light
should be employed at an approximate distance of twenty feet on a
plane with the patient’s head. Best results in muscle testing are
secured through the use of the Woolf ophthalmic bracket, with iris
diaphragm chimney and a specially adapted concentrated filament
electric lamp (Fig. 9). This gives a brilliant illumination which is
particularly essential. The test for error of refraction should be made
in the usual manner, using the spherical and cylindrical lenses
contained in the Ski-optometer, thus obviating the transference of
trial-case lenses and the use of a cumbersome trial-frame. The time-
saving thus effected enables the refractionist to include a muscle test
in every examination and without tiring the patient—a consideration
of the utmost importance.

Binocular and Monocular Test

The test for muscular imbalance may be divided in two parts.
First, binocular test, or combined muscle test of the two eyes;
second, monocular test, or muscle test of each eye separately. The
latter does not signify the shutting out of vision or closing off of either
eye, since muscular imbalance can only be determined when both
eyes are open. These two tests are fully explained in the following
chapter.
 Chapter VII
THE BINOCULAR MUSCLE TEST

Made with the Maddox Rod

and Phorometer

D irecting the patient’s attention to the usual muscle testing spot

of light, the red Maddox rod should be placed in operative
position before the eye, with the single white line or indicator on
red zero (Fig. 15). The rods now lie in a vertical position.
 Fig. 15—The Maddox rods placed
vertically denote test for right or left
hyperphoria, causing a horizontal streak to
be seen by patient.
The pointer of the phorometer should likewise be set on the
neutral line of the red scale, causing the handle to point upward (Fig.
16). A distance point of light and a red streak laying in a horizontal
position should now be seen by the patient.
 Fig. 16—The phorometer handle placed
vertically, denotes vertical muscles are
undergoing test for right or left hyperphoria
—as indicated by “R. H.” or “L. H.”
Instead of memorizing a vast number of rules essential where
trial case prisms are employed for testing ocular muscles, the pointer
of the phorometer indicates not only the degree on the red scale, but
the presence of right hyperphoria (R. H.) or left hyperphoria (L. H.).