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.