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CATARACT POST OP VISIT
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Post-Op Visit / Eye
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Right Eye Surgery Date
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Left Eye Surgery Date
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Surgeon
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PO Medications used
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Drops Comments
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Symptoms
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Symptom Comments
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VA at Distance uncorrected OD
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VA at Distance Uncorrected OS
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VA with Pinhole OD
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VA with Pinhole OS:
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Refraction OD
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VAcc @ Dist OD
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Refraction OS
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VAcc@Distance OS
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Add OU
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Corrected NVA
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IOP OD/OS Goldmann
/
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Pupils
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Pupil Comments
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SLE OD
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SLE OD Comments
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SLE OS
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SLE OS Comments
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Dilation Drops Used
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Fundus Eval OD
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Fundus Comments OD
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Fundus Eval OS
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Fundus Comments OS
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C / D OD
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C / D OS:
/
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Assessment
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Plan
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RTC
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RTC For
• • •
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RTC Comments
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