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Contact lens fit
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Subjective
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Comfort
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Distance Visual AcuityOD
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Distance Visual AcuityOS
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Distance Visual AcuityOU
|
Near Visual Acuity
|
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Brand
|
B.C.
|
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Diameter
|
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Brand OD
|
B.C. OD
|
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Diameter OD
|
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Brand OS
|
B.C. OS
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Diameter OS
|
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OD Sph
|
OD Cyl
|
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OD axis
|
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OD Add
|
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OS Sph
|
OS Cyl
|
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OS axis
|
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OS Add
|
|
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Rotation OD
• • •
|
Rotation OS
• • •
|
|
Fit
• • •
|
Fit Evaluation
• • •
|
|
Over refraction OD
|
Over ref VA OD
|
|
Over refraction OS
|
Over ref VA OS
|
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RGP material
|
RGP material comment
|
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O.D B.C/Diam
|
OD Power
|
|
O.S B.C/Diam
|
OS Power
|
|
RGP fit
• • •
|
Add
• • •
|
|
Duette
• • •
|
Duette skirt curve
• • •
|
|
|
|
|
Good Handling?
|
Rx same contacts
|
|
Care instructions
|
s/sx CTL probs disc?
|
|
Dist RX?
|
Monovision
|
|
Adjust Over MR
|
|
|
RTC
|
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