VOL. 68, NO.
5 NOTES, CASES, INSTRUMENTS
METHOD OF EXTENDING THE
RANGE OF THE KERATOMETER
DAVID MILLER, M.D.
ADOLPH HOLMBERG
JOAN EXFORD, O.D.
AND
MIRIAM BOYD, O.D.
Boston, Massachusetts
In patients with keratoconus, the 52-
dioptric limit of the keratometer often falls
short of the patient's corneal refractive
power.
Use of a +2.25 lens over the sighting ap­
erture of the instrument and the use of a
correction factor increase the range of the
instrument to 68D.2 However, this method
measures the curvature over a relatively
small central area in steep corneas.
The device to be described extends the
range of the keratometer in a different man-
From the Cornea Service, Massachusetts Eye and
Ear Infirmary. This work was supported by
USPHS Grant NB-05691 from the National Insti­
tute of Neurological Diseases and Blindness.
Reprint requests to David Miller, M.D., Massa­
chusetts Eye and Ear Infirmary, 243 Charles
Street, Boston, Massachusetts 02114.
Fig. 1 (Miller, Holmberg, Exford and Boyd). (A) Front of conventional keratometer, showing the
fires. (B) Auxiliary mires, attached to the front of the keratometer.
931
ner, and yields a figure for corneal curvature
which represents a larger area for steeper
corneas than the auxiliary lens method.
METHOD
This device essentially decreases the dis­
tance between the mires and the subject's
cornea by attaching a self-illuminated mire
to the front of the keratometer. The new
mires, which are the same size as those of
the keratometer (64 mm), are attached to a
plastic cylinder (19.5 mm thick) by a re­
tainer ring. The back of the cylinder is shaped
so that it fits into the recess covering the ex­
isting mires.
The new mire, a transparent positive of
the actual mire (somewhat like a photo­
graphic slide), is illuminated by four G.E.
No. 2157D bulbs placed inside the plastic
cylinder (figs. 1-A, 1-B and 2 ) . In one ex­
periment, the plastic cylinder (with the new
mire) was fitted over the front of the kera­
tometer and readings were taken on five cali­
brated steel balls.
A factor was developed so that a reading
from the keratometer drum could be con­
verted to the true curvature of a steep cor­
nea.
932 AMERICAN JOURNAL OF OPHTHALMOLOGY NOVEMBER, 1969

in diopters by 4/3, would thus give the true

corneal reading with the auxiliary mire in
place.
The present modification gives a new
range to the keratometer of from 48D to
68D.
The keratometer with auxiliary mire has
been used on human corneas and found to be
easily readable in a darkened room.

TABLE 1
CALIBRATION OF KERATOMETER EXTENSION
USING PRECISION STEEL BALLS
Fig. 2 (Miller, Holmberg, Exford and Boyd).
Auxiliary mires, with wires leading from the light Keratometer Reading Ratio
bulbs enclosed in the mire to a fuse box and switch. with New Mire Keratom­
Radius of eter
Steel Reading
RESULTS Ball Diopters Radius to Real
Radius
The mean ratio of keratometer reading to
real radius was 1.332 (table 1). The stan­ 5.15 49.00 6.89 1.338
5.55 45.50 7.42 1.337
dard deviation was 0.00054. 5.95 42.75 7.90 1.328
Multiplying the radius of curvature by 6.35 39.87 8.46 1.331
6.75 37.75 8.94 1.324
3/4, or multiplying the keratometer reading

ORIGINAL NEW
MIRE MIRE

CORNEA
CORNEAL AREA
64 mm INCLUDED WITH
ORIGINAL MIRE

Fig. 3 (Miller, Holmberg, Exford and Boyd). Optical ray diagram, illustrating the area of cornea
yielding the reflected image from the original keratometer mires (situated 75 mm from the cornea) as
compared to the area encompassed with the new mires (situated 55.5 mm from the cornea).
VOL. 68, NO. 5 NOTES, CASES, INSTRUMENTS
DISCUSSION
The principle of the keratometer assumes
that the cornea is a convex mirror. The rela­
tionship between the image, object and radius
of a mirror is h' = — hr J /2d — r when
h = size of object (mire) = 64 mm in
B & L keratometer
h' = size of image (determined by dou­
bling device in keratometer)
r = radius of curvature of cornea
d = distance between object and image
(75 mm in keratometer)
The conventional keratometer holds h
(mire size) and d (distance between object
and image) constant. By determining h'
(image size), the operator finds r (corneal
radius of curvature). In the case of most
ophthalmometers, h' is determined by using
a doubling device. Since we wanted to use
the same doubling device for the present
modification, we determined its limits. For a
cornea with a refractive power of 38D, the
image size was 4.26 mm and for a cornea of
52D, the image size was 2.88 mm. Knowing
the range of the image sizes for the instru­
ment tells us the range of the doubling de­
vice. Any change in d (such as in our modi­
fication) had to keep within the range of the
doubling device.
The present device changes from 75 mm
to 55.5 mm, yet keeps h 64 mm, and stays
within the set range of h' (that is, 2.88 mm
to 4.26 mm). Under these conditions the
new range of the keratometer becomes 48D
to68D.
An added feature of this keratometer ex­
tension in contrast to the use of auxiliary
lenses is the enlarged area of corneal surface
represented by the measurement (fig. 3 ) .
Using the conventional keratometer, a read­
ing of 44D represents the curvature of a
3.27-mm corneal zone. If one measured a
steep cornea of 68D using an auxiliary
+2.25 lens, a corneal zone of only 2.32 mm
in diameter would be represented. However,
using the modification already described, a
933
68D cornea would have a 3-mm zone repre­
sented.
SUMMARY
The range of the keratometer has been
extended to 68D by attaching a device which
moves the mires closer to the patient and re­
cords the curvature from a larger portion of
the cornea than does the conventional kera­
tometer.
REFERENCES
1. Linksz, A. : Physiology of the Eye. New
York, Grune and Stratton, 1950, v. 1, p. 118.
2. Gordon, S. : Extended Range Keratometry.
Rochester, Contact Lens Guild, Inc., 1967, p. 1.
AUTODISLOCATION OF A LENS
IN CONGENITAL RUBELLA
ALBERT HORNBLASS, M.D.
AND
NED REINSTEIN, M.D.
Brooklyn, New York
The oculodigital phenomenon 1 · 2 is that act
whereby a person elicits a retinal phosphene
by exerting pressure on the globe with his
finger. We have studied an eight-year-old
boy with the rubella syndrome who caused
the rupture and dislocation of his catarac-
tous lens by the oculodigital phenomenon.
We believe that this is the first reported case
of autodislocation of the lens resulting from
this action. In addition, this child demon­
strated gestures previously unreported in
visually deprived individuals.
CASE REPORT
T. G, an eight-year-old Negro boy, weighed four
pounds, six ounces at birth after a 40-week gesta-
From the Division of Ophthalmology, Depart­
ment of Surgery, Downstate Medical Center, State
University of New York. This study was supported
by USPHS Grant 5T1NBS11S-12 from the Na­
tional Institute of Neurological Diseases and Blind­
ness.
Reprint requests to Albert Hornblass, M.D., Di­
vision of Ophthalmology, Downstate Medical Cen­
ter, State University of New York, 450 Clarkson
Avenue, Brooklyn, New York 11203.