[Reprinted from The Post-Graduate, Vol. VII., No. 18, 1892.] 
THE VALUE OF JAVAL’S OPHTHALMOMETER FOR 
THE CORRECTION OF ASTIGMATISM WHERE 
MARKED AMBLYOPIA IS PRESENT. 
BY 
A. BRITTON DEYNARD, M.D., 
Instructor in the Refraction of the Eye ; Assistant Surgeon Manhattan Eye and Ear 
Hospital; Fellow of the Academy of Medicine, etc. 
A description of this instrument would be out of place at this 
late date in its history, and, for those familiar with its use in a 
general way, any words of mine in its praise would be as unneces- 
sary as would be a plea for the value of Helmholtz’s ophthalmo- 
scope. I wish to call attention to its value in a class of cases where 
there are amblyopic conditions. Such patients have not clearly 
defined images on their retinae, and it is not possible for them to 
determine, with any degree of accuracy, with which of the many 
lenses of different focal force they see best. We may call to our 
aid such valuable witnesses for the truth as the ophthalmoscope, 
skiascope, trial case, with or without atropia, but in the ophthal- 
mometer of Javal we have a witness without whose aid our deci- 
sions would be in some cases very defective, as the following cases 
show. 
Case I.—John Gr., set. twenty-five, gardener and a reader; albi- 
no with a horizontal nystagmus. Was in November, 1886, or- 
dered lenses 
0. D. + 8 D. cy. ax. 90° 
0. S. + 8 D. cy. ax. 90° 
by a competent oculist, after the use of atropia. These glasses did 
not relieve his asthenopia, but gave vision : 
0- D. -gW 
0. S. 
In November, 1891, vision was : 
0* D. -jfu- W. + 4 Ds 
0. S. W. + 4 D8 
Ophthalmoscopic findings : 
K. 
L. + 7 D. 
Javal : 
0. D. 5 D. 90°—180° 
0. S. 5 D. 90° —180° 
Under homatropine, vision : 
O D 6_ . ijs 
"STTTT ' ¥00 
0 S • J-8- 
¥o o ' ¥o o 
with any combination ranging between 6 D. and 8 D., with or 
without cylinders. 
Falling back on the ophthalmometer markings as a basis for the 
correction of the astigmatism,!- 4 Ds3 + 3 D. cy. ax. 90° : both 2 
eyes were ordered, which relieved the asthenopia and rendered to 
the patient, in his own words, “ services in valuable. ” 
Case II.—Mary H., set. sixteen, waiter in a cloak establishment, 
suffered from granular lids and keratitis, both eyes, leaving cica- 
tricial tissue on palpebral conjunctivse and opacities on corneae. 
The patient has suffered from blepharitis marginalis from time to 
time. 
January, 1892 : 
T? V 2 0- 4. 
-U. * . -g 0 0 -t 
' T, V 2 0_ i 
-U. v . 5T() 
Javal : 
0. D. 3 D. 110° - 20° 
0. S. 2.50 D, 90° - 180° 
Ophthalmoscopic findings •: 
R. + 3 D. 
L. + 3 D. 
Vision : 
O. D. f-Q- — w + 2.50, cy. ax. 110° 
0. S. §#■ — w + 1.50, cy. ax. 90° 
These were ordered and found very beneficial. They enabled the 
patient to see what could be seen, without the strain of accom- 
modation incident to the regular astigmatic condition. 
I was told yesterday, by a friend of this Mary H., that the young 
woman was keeping from “red eyes” (blepharitis) ; that she was 
sewing on tickets in the cloak shop ; that she had worked at learn- 
ing dressmaking during the summer, and that she was so proud of 
her glasses that it was a part of “her worship. ” 
Case III.—J. R. M., get. eighteen years, bookkeeper, applied 
at the Out-door Department of Bellevue Hospital for relief from eye 
strain. There were opacities on both corneae. Atropia was used, 
but as lenses did not improve vision to any marked degree, and 
patient was uncertain which glasses gave the best vision, a change 
of occupation was advised. 
February, 1892, the patient again applied for relief. 
R. V. xJcr + 
L. V. ffr + 
Javaks ophthalmometer was then used, with the following results ; 
0. D. 3 D. 120°— 30° 
0. S. 2.50 D. 90°—180° 
R. V. -fo- — w — 2.50, cy. ax. 30° 
L. V. -f-g- — w — 2, cy. ax. 180° 
These were ordered and reported very beneficial, enabling the pa- 
tient to do his work with comfort. 
Case IV.—Lucy 0. C., set. sixteen, student, came for relief 
from eye troubles September 15th, 1889. Patient had blepharitis 
marginalis, and complained that her eyes grew tired when long used 
at her studies. 3 
Record made at the time : 
on 2(l -l ) 
o’ s' + \ accepts + glasses. 
Ophthalmoscopic findings : Hypermetropic. Atropia ordered. 
September 19th, under atropia : 
0. D. -gi/Tr : — w + 1.25 O + 4, cy. 90°. 
0. S. ¥Vo : t* — " + i-50 - + 3, cy. 125°. 
Ordered : 
R. + .25 Ds O + 4, cy. 90°. 
L. + .50 Ds O + 3, cy. 125°. 
September 26th, 1892, the patient presented herself with ble- 
pharitis marginalis in right eye, stating that she could not get 
along without her glasses at her studies, but that the right eye had 
suffered from time to time with that “redness/’ although the left 
had kept free from it. 
Javal’s ophthalmometer showed : 
R. 3.50, 90° — 180°. 
L. 3.50, 125° — 35°. 
Ordered the right lens changed to + 3, cy. ax. 90°. 
October 10th patient reports the change an improvement; and 
although it is too soon to decide, I have no doubt that this more 
suitable correction will relieve the blepharitis as effectually as it 
did in the other eye. 
Case V.—Grace M., set. ten, was taken to one of the leading 
regular ophthalmic hospitals of this city December 8th, 1888. 
Had convergent squint, more marked in the right eye. From 
“card,” and papers kept with it, I copy the following record : 
“ R. Y. -gVV, accepts + G D. 
L- v- uVo : tVtt with + 6 Ds- 
Atropia ordered one week. 
December 15th : 
B. V. : tVo w + 6, O + 1, ISO0. 
L. V- YTo' : TERT w + DS. 
Ophthalmoscopic findings : 
R. + 7 D. vertical. 
4- 8 D. horizontal. 
L. + 7 D. vertical. 
+ 8 D. horizontal. 
Ordered : 
O. D. + 6 D, C + 1, cy. 90°. 
0. S. +6 D. 0 + 1, cy. 90°. ” 
March 25th, 1890, the patient was brought to see if any better 
glasses could be obtained, as the strabismus had been relieved in 
part only. Patient looked around the glasses, and turned the 
head, at times suggesting one with eccentric fixation. She com- 
plained of a tired feeling in eyes while studying. 4 
Record from my case book : 
R- V* tott : ¥1oV w + 9 D. 
L. V. ,V\r : tVo w + 4.50 D. 
Ophthalmoscopic findings : 
+ 7. 
+ 7. 
Atropia three days : 
V. : TjjQ- w + 8 D. 
L- "V. -gVV : 4o' — w + 8 D. 
Ophthalmoscopic findings : 
+ 10 D. 
+ 10 D. 
Atropia continued three days longer: 
R- V* tut: sinr w + 9. 
L. V. WV: - W+ 8C + .50, cy. 90°. 
Ophthalmoscopic findings : 
R. + 11 D. 
L. + 10 D. 
Ordered : 
+ 9. 
+ 8 D. C + 50, cy. 90°. 
These were thought to be an improvement, but the eccentric 
fixation-look more or less continued, and the patient returned Sep- 
tember 1st, 1892, to see if anything more could be done. Javal's 
ophthalmometer was then used : 
O. D. 4 D. 90° - 180°. 
O. S. 3 D. 90° - 180°. 
Ophthalmoscopic findings : 
R. + 11. 
L. + 11. 
R. V. jforVWr w + 3.50, cy. 90° C + 8 D. 
L. Y. ¥VV: U w + 2.50, cy. 90° C + 8 D. 
These glasses have been used fora month, and the patient states 
that she can see better and that the eyes do not hurt “ half so 
much” as they did with the other glasses. The “ squinting” has 
ceased since using these lenses. 
It may be argued that the fuller correction of the hypermetro- 
pia has made the improvement. This is a matter of opinion, but 
that Javal gave the astigmatism correctly, when the use of atropia 
failed to do so, is a fact. 
It will be seen that in the most of these amblyopic eyes, vision 
was not improved in any marked degree. They were all benefited, 
hewever, and that by the aid of this last, best gift to the refraction 
room, the ophthalmometer. 
24 West 30th street, New York.