The Jackson cross cylinder (JCC) is an instrument used by

ophthalmologist Ophthalmology (, ) is the branch of medicine that deals with the diagnosis, treatment, and surgery of eye diseases and disorders. An ophthalmologist is a physician who undergoes subspecialty training in medical and surgical eye care. Following a ...

orthoptist Orthoptics is a profession allied to the eye care profession. Orthoptists are the experts in diagnosing and treating defects in eye movements and problems with how the eyes work together, called binocular vision. These can be caused by issues with ...

s and

optometrist Optometry is the healthcare practice concerned with examining the eyes for visual defects, prescribing corrective lenses, and detecting eye abnormalities. In the United States and Canada, optometrists are those that hold a post-baccalaureate f ...

s in their routine eye examination, particularly in determination of

corrective lens A corrective lens is a transmissive optical device that is worn on the eye to improve visual perception. The most common use is to treat refractive errors: myopia, hypermetropia, astigmatism, and presbyopia. Glasses or "spectacles" are w ...

power in patients with

astigmatism Astigmatism is a type of refractive error due to rotational asymmetry in the eye's refractive power. The lens and cornea of an eye without astigmatism are nearly spherical, with only a single radius of curvature, and any refractive errors ...

. It is also used for testing

near point In visual perception, the near point is the closest point at which an object can be placed and still form a focused image on the retina, within the eye's accommodation range. The other limit to the eye's accommodation range is the far point. A n ...

of the eye.

Instrument

Jackson cross cylinder is a single low power lens, which is a combination of a plus cylinder and a minus cylinder of equal power with axis perpendicular to each other, with a handle placed between the two axes at 45 degrees. Therefore JCC is a spherocylindrical lens in which the power of the cylinder is double the power of the sphere and of opposite sign e.g. +0.5DS/-1.0DC or +0.25DS/-0.5DC. JCC are available in different powers including +/-1.00, most commonly used are of +/- 0.25 and +/- 0.50. There are dots or lines to indicate axis of minus and plus powers.

Indications

The Jackson cross cylinder is used to determine

power and its axis in patients with

. It is also used for testing

of the eye.

Procedure

Best corrected vision with a spherical lens should be identified before using a Jackson cross cylinder. In case of astigmatism the best vision with a

spherical lens A lens is a transmissive optical device that focuses or disperses a light beam by means of refraction. A simple lens consists of a single piece of transparent material, while a compound lens consists of several simple lenses (''elements''), u ...

is obtained when the

circle of confusion In optics, a circle of confusion (CoC) is an optical spot caused by a cone of light ray (optics), rays from a lens (optics), lens not coming to a perfect focus (optics), focus when imaging a Point source#Light, point source. It is also known ...

is on the

retina The retina (; or retinas) is the innermost, photosensitivity, light-sensitive layer of tissue (biology), tissue of the eye of most vertebrates and some Mollusca, molluscs. The optics of the eye create a focus (optics), focused two-dimensional ...

Detecting astigmatism

Best corrected vision with a spherical lens should be identified first. The JCC lens is then placed over spherical lens first with the minus-cylinder axis at 180°, and then with the axis at 90°. If there is no difference in vision, repeat the test with JCC lens axis 45° and 135°. If the patient again reports no difference in vision, there is no astigmatism and if there is improvement in either positions cylindrical lens should be tried to correct astigmatism.

Refinement of axis

Refinement of axis of cylindrical lens in astigmatism correction is done by placing JCC along with corrective lens with the handle parallel to the axis of corrective lens in the

trial frame A trial frame is a tool used by ophthalmic professionals like ophthalmologists and optometrists. It is basically an adjustable spectacle frame with multiple cells, used to hold corrective lenses, and other accessories in subjective refraction (f ...

. Handle is rotated so that the minus and plus lens in cross cylinder interchanges. If there is no difference in vision in either position, the axis of corrective lens is correct and if there is difference in vision, axis should be rotated to get a clear vision. Axis should be rotated by 5 degree on better side.

Refinement of power

Refinement of power of cylindrical lens in astigmatism correction is done by placing JCC along with corrective lens with the axis of JCC power parallel to the axis of corrective lens in the trial frame. Handle is rotated so that the minus and plus lens in cross cylinder interchanges and if there is no difference in vision in either position, the power of corrective lens is correct and if there is difference in vision, power should be adjusted.

Near point of accommodation

The uniocular and binocular cross cylinder findings at 40 cm give information about near point of accommodation and near addition needed to correct

presbyopia Presbyopia is a physiological insufficiency of optical Accommodation (vertebrate eye), accommodation associated with the aging of the human eye, eye; it results in progressively worsening ability to focus clearly on close objects. Also known as ...

History

In 1837, English mathematician and astronomer

George Biddell Airy Sir George Biddell Airy (; 27 July 18012 January 1892) was an English mathematician and astronomer, as well as the Lucasian Professor of Mathematics from 1826 to 1828 and the seventh Astronomer Royal from 1835 to 1881. His many achievements inc ...

invented the cylindrical lens and used it to correct astigmatism. In 1849, Irish English physicist and mathematician George Stokes invented

Stokes lens Stokes lens also known as variable power cross cylinder lens is a lens used to diagnose a type of refractive error known as astigmatism. Lens design The Stokes lens also known as variable power cross cylinder lens, in its standard version, is a l ...

to diagnose astigmatism. This lens consisted of two cylindrical lenses, one plano-convex and one plano-concave, which be rotated in opposite directions. In 1887 Edward Jackson described the use of modified Stokes' lens in detecting astigmatism, and in 1907 he described the determination of the axis of a correcting cylinder in astigmatism using a cross cylinder. The modified cross cylinder lens with a handle, which he used was later known as Jackson cross cylinder.

References

{{reflist Ophthalmic equipment Diagnostic ophthalmology Optometry