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Magnum One (Mid-American Digital) (Disc Manufacturing).iso
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EXCPOST.FRM
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1990-01-25
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POSTOPERATIVE EXAM Operative eye: OD OS EXCIMER LASER STUDY ╔════════════════════════════════╤═════════════════════════════════════════╗ ║Date ___/___/___ Chart #________│Eye Meds: Y N Y x/d N ║ ║ m d y │ Pressure patch ■ ■ Dec ■ __ ■ ║ ║ │ Collagen shield ■ ■ Gent ■ __ ■ ║ ║Pt. _______________ _______ ____│Pain (Dr's score:0-10)__ Tyl #3 ■ __ ■ ║ ║ Last First M.I.│Other (list)______________________ __x/d ║ ╠════════════════════════════════╧══════════════════╤══════════════════════╣ ║Visual Acuity: Correction with: Not │Tension: None:OD■ OS■ ║ ║ Uncorr. Specs. CLS CLS+PH done │ OD:_____ OS:_____ ║ ║ │ Not║ ║ OD: _______ _______ _______ _______ ■ │Mod.Trans.f(x): done║ ║ │ OD:_____ ■ ║ ║ OS: _______ _______ _______ _______ ■ │ OS:_____ ■ ║ ╠═══════════════════════════════════════════════════╡ Obs ║ ║Objective Refraction: Not done: OD ■ OS ■ │Pach: init ║ ║ Obs. Vertex with CLS │ 1st.___mm ___ ■ ║ ║ Sph. Cyl. Ax. init (mm) Sph. Cyl. Ax. │ 2nd.___mm ___ ■ ║ ║ │ ║ ║ OD: │Axial Length: ║ ║ │ OD:_____ mm ■ ║ ║ OS: │ OS:_____ mm ■ ║ ║ │ Obs. ║ ║Manifest Refraction: Not done: OD ■ OS ■ │Ks: init. ║ ║ │1. __ ■ ║ ║ OD: │2. __ ║ ║ │ ║ ║ OS: │Mires: ■Not done ║ ║ │ ■Good ■Distorted ║ ╠═══════════════════════════════════════════════════╧══════════════════════╣ ║SLE: Not done ■ Epi defect?? (Y / N). If Y, % of ablated zone __ ║ ║ Is ablation apparent?? (Y / N), edge?? (Y / N) ║ ║ Amount of edge ___ - ___o'c & ___ - ___o'c, or ║ ║ 360 degrees___. DM folds?? 0 1 2 3 4. ║ ║ ║ ║ CLARITY: ║ ║ Epithelium Stromal ║ ║ Super. Deep Ant. Post. Endo ║ ║Clear, possibly with faint spots . . . . . 0 ____ ____ ____ ____ ____ ║ ║Mild reticulated haze, not effecting Rfx . 1 ____ ____ ____ ____ ____ ║ ║Moderate haze, Rfx possible but difficult. 2 ____ ____ ____ ____ ____ ║ ║Opacity prevents Rfx, AC easily viewed . . 3 ____ ____ ____ ____ ____ ║ ║Opacity impairs view of AC . . . . . . . . 4 ____ ____ ____ ____ ____ ║ ║Unable to see AC . . . . . . . . . . . . . 5 ____ ____ ____ ____ ____ ║ ╠═══════════════════════════════════════╤══════════════════════════════════╣ ║ Unc. Worse??(describe) No data│Notes: ║ ║Lens: ■ _______________________ ■ │ ║ ║O.N.: ■ _______________________ ■ │ ║ ║Ret: ■ _______________________ ■ │ ║ ║Ves: ■ _______________________ ■ │ ║ ║Mac: ■ _______________________ ■ │ ║ ╠═══════════════════════════════════════╡ ║ ║Tests: Y N Why not?? │ ║ ║ Sl photo ■ ■ _____________________│ ║ ║ Endo cell ct ■ ■ _____________________│ Investigator's signature ║ ║ CMS ■ ■ _____________________│ _____________________________ ║ ╚═══════════════════════════════════════╧══════════════════════════════════╝
