"With the rule" astigmatism has an axis of about 180 degrees (when Rx
is written in minus cyl form). "Against the rule" astigmatism has
the axis at about 90 degrees.
Both forms are common. Nevertheless, when looking at population
norms, "with the rule is more common in young adults while "against
the rule" is more common in older adults.
Thomas C. Kopan, O.D. - Dana Point, CA