Post-Op Form "*" indicates required fields Patient DetailsTitleMrMrsMissMsDrProfName* First Last Tel homeMobileEmail Address Street Address Address Line 2 City Postcode D.O.B DD slash MM slash YYYY Date of Surgery: R DD slash MM slash YYYY Date of Surgery: L DD slash MM slash YYYY Additional InformationAdditional InformationRefraction and Vision :Right EyeUnaided Dist VisionUnaided Near Vision&WDSphereCylinderAxisAddBCVABCVA (N)PHLeft EyeUnaided Dist VisionUnaided Near Vision&WDSphereCylinderAxisAddBCVAPHBCVA (N)BEUnaided Dist VisionUnaided Near Vision&WDSphereCylinderAxisAddBCVAPHBCVA (N)EXAMINATION FINDINGSRightLeftTBUT (s)TBUT (s) - RightTBUT (s) - LeftCorneaCornea - Right- Please Select -NormalAbnormalCornea - Left- Please Select -NormalAbnormalACAC - Right- Please Select -NormalAbnormalAC - Left- Please Select -NormalAbnormalLensLens - Right- Please Select -NormalAbnormal*Lens - Left- Please Select -NormalAbnormal*VitreousVitreous - Right- Please Select -NormalAbnormalVitreous - Left- Please Select -NormalAbnormalMaculaMacula - Right- Please Select -NormalAbnormal**Macula - Left- Please Select -NormalAbnormal**P.RetinaP.Retina - Right- Please Select -NormalAbnormalP.Retina - Left- Please Select -NormalAbnormalIop (mmHg)AT NCTIop (mmHg)AT NCT - RightIop (mmHg)AT NCT - Left*Check for PCO **Check for CMOCommentsPLEASE TICK IF FURTHER ASSESSMENT IS REQUIRED CommentsThis field is for validation purposes and should be left unchanged.
