Estimating the error of refraction involves problems which are not commonly thought of during a routine examination but the recognition and the proper solution of which may be of extreme importance to the patient who presents the variation from the average. The purpose of this paper is to call attention to a rare condition which might easily escape detection, viz. a considerable difference in the axis of a moderate amount of astigmatism when the eyes are adjusted to the reading distance and when they are adjusted for distance fixation.
Since the first case was observed I have recognized 3 more and several other oculists have each recognized a similar one, their cases being included in the present report. This would indicate that the condition is not extremely rare, and one should be on the alert in cases in which the near vision is not as good as one would expect
HUGHES WL. CHANGE OF AXIS OF ASTIGMATISM ON ACCOMMODATION. Arch Ophthalmol. 1941;26(5):742–749. doi:10.1001/archopht.1941.00870170032002
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