1.1.1
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Right eye 
Left eye 

General Data

Eye status Phakic   Pseudophakic
Target refraction D
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General questions medical history (anamnesis)

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Biometry data and implanted IOL

Stable subjective refraction
Date of examination:
UCVA:
Cylinder Notation:  
Sphere: D D
Cylinder: D D
Axis: ° °
BCVA:
Cornea-
vertex distance:
mm
Pseudophakic biometry
Date of measurement:
Diagnostic system
Axial length: mm
Anterior Chamber Depth: mm
mm D °
K1: at
K2: at
CBAK
Implanted IOL
Date of implantation:
spheric toric
multifokal toric multifocal
IOL Power (SEQ): D
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Result

Spheric AddOn
Toric AddOn
Progressive AddOn
Toric Progressive AddOn
AddOn proposal
Lens SEQ ZYL
D  D
D  D
D  D
Residual refraction
SEQ SPH ZYL AXIS
D D D °
D D D °
D D D °

Quality of calculation

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