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SOFT CONTACT LENS EXAM
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CC:
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SUBJECTIVE REFRACTION OD
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SUBJECTIVE REFRACTION OS
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CURRENT CL BRAND
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B.C / DIAM
• • •
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CURRENT CL RX OD
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Distance Visual Acuity OD
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CURRENT CL RX OS
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Distance Visual Acuity OS
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TRIAL #1
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CONTACT LENS BRAND OD
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B.C/Diam
• • •
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CONTACT LENS RX OD:
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Distance Visual Acuity OD
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CONTACT LENS BRAND OS
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B.C. / DIAM
• • •
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CONTACT LENS RX OS
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Distance Visual Acuity OS
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Over refraction OD
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Over refraction OS
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Rotation
• • •
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Fit
• • •
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Adequate Movement
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Comfort
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RELEASE CL SAMPLE OF TRIAL #1 TO PATIENT
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TRIAL #2
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CONTACT LENS BRAND:
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BC / DIAM
• • •
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CONTACT LENS RX OD:
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Distance Visual Acuity OD
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CONTACT LENS RX OS
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Distance Visual Acuity OS
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Over refraction OD
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Over refraction OS
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Rotation
• • •
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Fit
• • •
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Adequate Movement
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Comfort
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RELEASE CL SAMPLE OF TRIAL #2 TO PATIENT
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Assessment
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Plan
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Other
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