Defusing the Confusion of the Jackson Cross Cylinder

Clinical Report: Defusing the Confusion of the Jackson Cross Cylinder

Overview

At the 2026 American Academy of Ophthalmology meeting, presenters reviewed how to use the Jackson cross cylinder (JCC) to refine cylinder axis and power. They emphasized following the JCC’s indicated changes, understanding its red- and white-dot construction, and using feedback between technicians and ophthalmologists to support consistent refraction.

Background

The JCC is used during subjective refraction to refine astigmatic cylinder axis and power. The article describes axis refinement as a frequent source of confusion for technicians, particularly when learners encounter different refraction methods or adjust instrument dials manually rather than following the JCC. The lens has +0.25 D and −0.25 D settings with axes 90 degrees apart, producing choices that represent changes in axis and cylinder power. The related EyeWiki source also describes cross-cylinder technique for subjective refraction.

Data Highlights

Topic	Source detail
JCC construction	One side is +0.25 D and the other is −0.25 D; the axes are 90 degrees apart.
Axis refinement	Begin with the cylinder axis from the patient’s glasses, autorefractor, or retinoscopy. Offer three choices: one, two, or the same. If the patient prefers one, turn the axis knob 10° toward that choice; if returning, turn it 5° in that direction. Continue until the patient reports the views appear the same.
Plus-cylinder rules	Axis: dots straddle the axis; follow the white. Power: dots are on axis; white adds and red subtracts. The power rule is opposite for minus cylinder.
Related 2026 study protocol	The supplied web research summary reports use of ±0.25 D JCC lenses and axis adjustments in 5° steps, reduced to 2.5° when cylinder is at least 1.50 D.

Key Findings

Presenters at the 2026 AAO meeting discussed common difficulties in using the JCC to determine cylinder axis and power.
Jane T. Shuman identified manual dial turning instead of using the JCC as a common technician error.
For axis refinement, Shuman advised starting from the existing cylinder axis, offering the patient three choices, and moving the axis knob toward the preferred choice.
The article describes the JCC as having +0.25 D and −0.25 D settings with axes 90 degrees apart.
Richard J. Kolker’s plus-cylinder rules are: for axis, dots straddle the axis and follow the white; for power, dots are on axis and white adds while red subtracts. He noted that the power rule is reversed for minus cylinder.
Shuman and the Kolker presenters emphasized technician rechecks, ophthalmologist feedback, and two-way communication as parts of collaborative refraction practice.

Clinical Implications

The article’s presenters advise clinicians and technicians to use the JCC indications rather than manually turning axis or power controls without first following the lens response. They also describe senior-technician rechecks and two-way feedback between technicians and ophthalmologists as ways to support accurate and consistent refraction.

Conclusion

The article presents the JCC as a tool for refining both cylinder axis and power and explains practical rules for interpreting its red and white dots. Its presenters also emphasize shared training and feedback in the refraction process.