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April 1940


Arch Ophthalmol. 1940;23(4):720-726. doi:10.1001/archopht.1940.00860130812004

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I have often noted, and no doubt a similar observation lies within the experience of every oculist, that after determining at retinoscopic examination that the patient needs a weak cylinder with its axis horizontal, the patient decidedly prefers the cylinder at an angle exactly opposite; however, with the addition of more spherical correction, he promptly reverses his choice to the correct meridian. This reversal phenomenon does not occur when the true axis is in the vertical or oblique meridians.

I do not refer to cases of astigmatism in which a weak plus cylinder becomes converted into an equivalent minus cylinder at the opposite axis as the result of an accommodative effort on the part of the ciliary muscle. I refer to instances in which cyclopegia is well effected by homatropine or atropine and in which the question of accommodation does not enter and the sign of the cylinder remains unchanged.

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