HOW THE KERATOMETER WORKS To measure the image size, which is directly related to the corneal radius, the prisms that form the left and top images can be moved forward and back. As the prisms move they increase or decrease the separation of the deviated image from the central image. The examiner moves the prisms by rotating the power drums. When they are moved to the point where the sides of the images touch (plus signs or minus signs overlap) the size of the image is know and is converted to a dioptric power by the markings on the drum.