Presenting Complaint
Ocular History
Medical History
External Examination
Findings For Both Eyes
Anterior Segment
Posterior Segment
Tests Advised
VA
R: L:
IOP
R: L:
BCVA
R: L:
C/D Ratio
R: L:
Diagnosis
Old Spectacle Correction
Right Eye (OD) | Left Eye (OS) | ||||||
---|---|---|---|---|---|---|---|
SPH | CYL | AXIS | VA | SPH | CYL | AXIS | VA |
ADD: | ADD: | ||||||
Far PD: mm | Near PD: mm |
℞ Medication
Advised
New Glasses
Right Eye (OD) | Left Eye (OS) | ||||||
---|---|---|---|---|---|---|---|
SPH | CYL | AXIS | VA | SPH | CYL | AXIS | VA |
ADD: | ADD: | ||||||
Far PD: mm | Near PD: mm |