Knowing how to use a phoropter comes down to running its controls in a fixed order, every time: level the head, set the PD and convergence, set the vertex distance, then work the sphere, cylinder, cross-cylinder, prism and auxiliary controls as the exam calls for them. This guide walks through that sequence control by control, using the published instructions for manual refractors (including the Ezer ERF-5200 and Luxvision R-2500 we supply) and showing where a digital refractor changes the workflow.
It is written for technicians, new associates and anyone setting up an exam lane. It covers how the instrument is operated, not how to interpret a refraction or write a prescription; that stays with the examining doctor. If you are still choosing an instrument, start with our manual phoropter guide, which covers anatomy, spec sheets and the buying checklist. This page is the operating procedure.
Shopping for manual refractors? US Ophthalmic is a direct provider of manual refractors to eye care practices across the US. Tell us how your lane is set up and we will come back with the configurations that fit, plus current availability and lead times.
Before the patient sits down
Start with a clean instrument and nothing left in the apertures. Reichert's Phoroptor Instructions for Use asks owners to "make it a habit to always keep your Phoroptor covered when it is not in use," and its cleaning procedure begins with rotating the turret "so no loupes are in front of viewing apertures." Two habits from the same manual are worth posting at every lane:
- Dust off the lenses with air, not fingers. The manual suggests a common rubber ear syringe for blowing dust from lens surfaces, and warns against checking for an open aperture by putting a finger in it, because the lens surfaces get soiled.
- Know what your cleaner is allowed to touch. Reichert says not to use alcohol or acetone on the instrument exterior. The face shields are different: they can be washed with mild soap or wiped with alcohol, but should not be soaked.
On a digital refractor the routine is similar. Topcon's CV-5000 manual tells the operator to wipe the forehead rest, examination window and face shield before seating the patient, using the accessory silicone cloth.
Step 1: Level the refractor head
Leveling comes first because every other alignment depends on it. On a manual refractor, turn the leveling knob until the spirit level's bubble is centered. Reichert's manual puts it plainly: "Turn the Leveling Knob until the instrument is level as shown on the Spirit Level." The ERF-5200 uses the same one-knob approach, a leveling knob read against a built-in level.
The check that leveling worked is visual. According to the Reichert manual, if the patient's head is held level in the headrest and the bubble is centered, both eyes should appear on the same horizontal level in the apertures. If they do not, look at the patient's head position before you touch the knob again.
Step 2: Set the PD and the convergence levers
With the patient looking straight ahead, turn either PD adjustment knob until each pupil is centered behind its aperture. That is the instruction in Reichert's manual, and it applies to the side-mounted PD knobs on the ERF-5200 and R-2500 as well. Ranges differ by model:
- Ezer ERF-5200: 1.88 in to 2.95 in, read on a scale in 0.04 in graduations.
- Luxvision R-2500: 48 mm to 80 mm in 1 mm steps.
Next, set the convergence levers for the test distance. Reichert's manual notes that distance tests "are generally made with the Vergence Levers in the extreme outward position." For near work, both levers move inward. On the Reichert unit, starting from a 64 mm distance PD, that converges the apertures for a 16 inch near test and reduces aperture separation by 4 mm. Reichert also cautions: "Do not attempt to fully converge the instrument below 55mm distance PD." The ERF-5200 works the same way, with the convergence lever closed inward for near and opened outward for distance.
Step 3: Set the vertex distance
Vertex distance is the gap between the back lens and the front of the cornea. You set it with the forehead rest knob and confirm it in the corneal aligning device. Wikipedia's vertex distance entry notes that most refractions are performed at 12 to 14 mm, but the zero mark on the scale depends on the instrument, so read your own manual:
| Instrument | What the reference mark means | Source |
|---|---|---|
| Ezer ERF-5200 | Sets the cornea at 12 mm from the lenses; measure at the "0" position of the scale | ERF-5200 product page |
| Reichert Phoroptor (manual) | Pointers aligned on the solid black line = 13.75 mm from the corneal apex; three hash marks, each 2 mm additional | Reichert Instructions for Use |
| Topcon CV-5000 (digital) | Long line = 12 mm; short lines in 2 mm steps; dotted line = 13.75 mm | Topcon CV-5000 user manual |
The procedure is the same on all three. While watching the alignment scale, turn the forehead rest knob until the corneal apex sits on the reference line. Reichert's manual includes a correction table for refractions taken at other distances and states that "the correction factor is always added to the Phoroptor reading as a plus quantity." If your lane uses a correction table, keep it with the instrument it was written for.
Step 4: Work the sphere controls
A manual refractor gives you two ways to change sphere power:
- Weak sphere dial. The large wheel on the side of the head, in 0.25 D steps. On the Reichert unit, rotating the weak sphere dial downward (clockwise for the left eye, counterclockwise for the right) adds plus power or reduces minus. On that model the weak dial alone covers the full +16.75 D to -19.00 D range.
- Strong sphere control. A faster control on the top knob that changes sphere in 3.00 D steps, which Reichert's manual calls "a time saver." The Luxvision R-2500 has the same idea in its Rapid Feed Dial, which moves sphere in 3.00 D steps.
Read the window color as well as the number. On the Reichert unit, plus powers show in black numbers and minus powers in red. Both the ERF-5200 and R-2500 also carry 0.12 D auxiliary lenses for finer steps. The R-2500 spec sheet lists 0.12 D sphere readings with its 0.12 D auxiliary lens or the optional ±0.12 D lens, and a range of +26.75 D to -29.00 D with the optional +10.00 D lens.
Step 5: Set cylinder power and axis
Cylinder is set with two concentric knobs. On the Reichert unit, the inner lower dial is cylinder power and the outer lower dial is axis. Turning the power knob clockwise increases power. The axis is read on a protractor scale from 0° to 180° in 5° steps. That matches the ERF-5200 and R-2500, which both read the axis from 0 to 180° in 5° steps.
Check which cylinder form the head was ordered in before you start. Reichert's manual lists 0.00 to -6.00 D for minus-cylinder instruments and 0.00 to +6.00 D for plus-cylinder instruments. Our two manual refractors are minus cylinder, 0 to -6.00 D in 0.25 D steps, and both reach -8.00 D with the -2.00 D auxiliary cylinder lens in place.
Step 6: Use the Jackson cross-cylinder (JCC)
The JCC sits on a turret that also carries the rotary prisms. Rotate the turret to bring the cross-cylinder loupe in front of the eye being tested. From there, operation follows a fixed pattern:
- Axis-check position. In Reichert's description, the unit is in the axis-check position when the finger roll knob handles line up with the correcting cylinder axis and the red and white dots sit 45° from it.
- Flip. A thumb-operated roll knob flips the lens so the patient can compare the two positions. Red dots mark the minus axis and white dots the plus axis.
- Move to power check. To reach the power-check position from axis check, Reichert's manual says the practitioner "merely rotates the unit clockwise to the next detent position."
- Let axis tracking follow you. On instruments with a synchronized mechanism, changing the cylinder axis automatically changes the cross-cylinder axis. Both the ERF-5200 and R-2500 have their cross-cylinder synchronized with the cylinder axis knob.
- Reset at the end. Reichert's manual says the cross-cylinder unit should be rotated 45° counterclockwise to the detent at the end of each refraction.
Check which JCC value is in the loupe. The R-2500's synchronized loupe is ±0.25 D and its auxiliary dial carries a ±0.50 D cross cylinder. For the ERF-5200, ±0.37 D and ±0.50 D cross-cylinder lenses are available. Wikipedia's Jackson cross cylinder entry notes that ±0.25 and ±0.50 are the most commonly used powers.
Step 7: Swing in the rotary prisms
The rotary (Risley) prisms sit on the same turret as the JCC, so rotate the turret to bring a prism loupe in front of the eye. The ERF-5200 and R-2500 both read 0 to 20Δ in 1Δ steps. Reichert's unit also has a 20Δ range, with the scale in one-prism-diopter divisions.
Base direction depends on where the finger roll knob sits. Reichert's manual explains that when the knob is at the top or bottom of the prism unit, turning it changes the prism base in or out, and the arrowhead positioned nasally from 0 denotes base in. Turn back to 0 and rotate the turret clear when the test is done, so no prism carries into the next step.
Step 8: Turn the auxiliary lens dial
The auxiliary lens knob indexes extra lenses into the line of sight, one position at a time. The abbreviations are close but not identical between makers, so read the markings on your own head. This is the Reichert Phoroptor layout, which lists 10 auxiliary lenses plus two open apertures:
| Marking | What it puts in front of the eye (Reichert manual) |
|---|---|
| O | Open aperture |
| R | +1.50 D retinoscopy lens, low-reflection coated; compensates for a 26 inch working distance |
| P | Polarizing lens for binocular techniques (axis 45° left eye, 135° right eye) |
| WMV / RMV, WMH / RMH | Maddox rod, vertical or horizontal: white for the left eye, red for the right eye |
| RL / GL | Red lens and green lens for binocular vision tests |
| PH | Pinhole: an opaque disk with a small hole |
| +0.12 | +0.12 D sphere, refines sphere to 1/8 D steps |
| 10I / 6U | Dissociating prisms: base-in left eye, base-up right eye |
| ±0.50 | Fixed cross cylinder with preset axis for dynamic and dissociated CC tests |
| OC | Occluder: covers one eye during refraction |
Two practical notes. First, the retinoscopy lens power varies: Reichert's is +1.50 D, while the R-2500's built-in retinoscope lens is +2.00 D, and the ERF-5200 offers a +2.50 D retinoscope lens as an option. Match the lens to your working distance. Second, the dial is not symmetrical. On the Reichert unit, the side over the patient's left eye holds the white Maddox lenses and the green lens.
Step 9: Set up for near
For near testing, move the convergence levers inward (Step 2), then lower the near-point rod and mount the reading card. Reichert's rod is 28 inches (71 cm) long, graduated in inches, centimeters and diopters, and its Nearpoint Rotochart guide says the card notations apply to a test at 16 inches. Slide the card to the distance printed for your card, and return the levers to the outward position before going back to distance tests.
Quick reference: the controls in order
| Step | Control | What to set | Typical increment (model-dependent) |
|---|---|---|---|
| 1 | Leveling knob + spirit level | Bubble centered | — |
| 2 | PD knobs; convergence levers | Pupils centered; levers out for distance, in for near | 1 mm (R-2500), 0.04 in (ERF-5200) |
| 3 | Forehead rest knob; corneal aligning device | Corneal apex on the reference line | 2 mm marks (Reichert, Topcon) |
| 4 | Weak sphere dial; strong sphere / rapid feed | Sphere power | 0.25 D; 3.00 D |
| 5 | Cylinder power and axis knobs | Cylinder power and axis | 0.25 D; 5° |
| 6 | Turret + JCC roll knob | Axis check, flip, power check, reset | ±0.25 D standard loupe |
| 7 | Turret + rotary prism knob | Prism amount and base direction | 1Δ, 0–20Δ |
| 8 | Auxiliary lens dial | Open, retinoscopy, pinhole, Maddox, filters, occluder | — |
| 9 | Near-point rod + card | Card at its printed distance | 16 in for Reichert's Rotochart |
Shutting the lane down
- Return the JCC to its rest detent and rotate the turret so no loupe is in front of the apertures.
- Set the auxiliary dial to O and the prisms to 0.
- Raise the near-point rod and open the convergence levers.
- Wipe the face shields, blow dust off the lenses and cover the head.
A lane that is reset the same way every night starts the next morning at Step 1 instead of with a search for whichever lens was left in place.
How a digital refractor changes the workflow
A digital refractor runs the same sequence, but the knobs move to a control panel. On the Topcon CV-5000, the measuring head still has a leveling knob and level indicator, PD is set by turning a dial until the pupil center lines up with a cross, and vertex is set with the forehead rest knob against a corneal alignment scale. The lens changes are what move: the CV-5000 manual describes a controller dial that "is used to adjust the sphere, cylinder and axis values," and a switch that advances a programmed exam sequence by one step.
Digital systems also tie in the rest of the lane. The CV-5000 manual describes controlling the distance acuity chart from the controller and importing data from a Topcon autorefractor, autorefractor-keratometer and lensmeter. Reichert's Phoroptor VRx page describes up to four user-programmable sequences, a keypad grouped by color (gray for data, blue for refraction, black for acuity), and one-touch switching between final, subjective, unaided, autorefractor and lensmeter data.
Our Ezer EDR-H digital refractor follows the same pattern. It has a dual cross-cylinder function that shows a split image of the target, a dioptric range of -29 D to +26.75 D, and built-in System Programs plus Custom Programs, so a practice can set its own exam order. The EDR-H deep dive covers its controller and lane setup in detail.
The practical difference for staff training: on a manual head, the technician learns where each knob is; on a digital head, they learn the program. The steps above still apply. Leveling, PD and vertex are physical adjustments on both.
The manual refractors we supply
US Ophthalmic supplies two manual refractors, both minus cylinder with synchronized cross-cylinder axis tracking. You can see them side by side in our manual refractors collection:
- Ezer ERF-5200: our house-brand manual refractor, with one-touch leveling, a corneal alignment device referenced to 12 mm, 0–20Δ rotary prisms in 1Δ steps, and optional ±0.37 D / ±0.50 D cross-cylinder lenses.
- Luxvision R-2500: -19.00 D to +16.75 D sphere in 0.25 D steps with a 3.00 D Rapid Feed Dial, 48–80 mm PD, a ±0.25 D synchronized JCC, and built-in ±0.50 D cross-cylinder, +0.12 D and +2.00 D retinoscope auxiliary lenses.
A refractor is only half the lane. If you are building one from scratch, our trial lens set and trial frame guide covers the backup refraction kit most practices keep next to the phoropter.
Ready to spec your manual refractors?
Send us your requirements and our equipment specialists will come back with a configuration built around how your practice actually works — including availability and lead time. US Ophthalmic is a direct provider to eye care practices nationwide.
Frequently asked questions
How do you level a phoropter?
Turn the leveling knob until the bubble in the spirit level is centered. On a manual refractor such as the Reichert Phoroptor or Ezer ERF-5200, that is a single knob. A quick check: with the patient's head level in the headrest, both eyes should appear at the same height in the apertures.
What does the R on a phoropter's auxiliary dial mean?
R is the retinoscopy lens, a plus sphere that compensates for the examiner's working distance. Its power varies by instrument: Reichert's is +1.50 D (for a 26 inch working distance), the Luxvision R-2500's is +2.00 D, and the Ezer ERF-5200 offers a +2.50 D retinoscope lens as an option.
What vertex distance does a phoropter's corneal aligning device show?
It depends on the instrument. The Ezer ERF-5200 references 12 mm. Reichert's manual Phoroptor uses 13.75 mm on the solid line with 2 mm hash marks. Topcon's CV-5000 uses a long line at 12 mm and a dotted line at 13.75 mm. Set the forehead rest so the corneal apex sits on the line your instrument specifies.
How do you flip the Jackson cross cylinder on a phoropter?
Swing the JCC loupe in front of the eye using the turret, then turn the thumb-operated roll knob to flip between the two positions. Red dots mark the minus axis and white dots the plus axis. On Reichert's manual unit, rotating the loupe clockwise to the next detent moves it from axis check to power check.
Which way do you turn the sphere dial for more plus?
On the Reichert Phoroptor, rotating the weak sphere dial downward (clockwise for the left eye, counterclockwise for the right) adds plus power or reduces minus. Plus values show in black and minus in red. Confirm the direction on your own head before training staff, because layouts differ between makers.
Is a digital refractor operated the same way as a manual phoropter?
Leveling, PD and vertex are set physically on both. On a digital refractor, sphere, cylinder and axis move from knobs to a controller dial or keypad, and the exam can follow a programmed sequence that links the acuity chart and imports autorefractor and lensmeter data.
Equip your refraction lane
Whether you are replacing a worn manual head or moving a lane to digital refraction, we can help you compare the Ezer ERF-5200, Luxvision R-2500 and Ezer EDR-H for your space and workflow. Request a quote and our team will follow up with configuration options and lead times.
