Scleral Lens Fitting Template

Scleral Lens Record "Patient Details" Name: John Doe DOB: 03/15/1985 Phone: 555-123-4567 Occupation: Software Engineer Subjective "I've been experiencing discomfort with my current contact lenses and am interested in trying scleral lenses for better comfort and vision." Ocular History: Previous LASIK surgery in 2010, history of dry eyes Medications: Artificial tears (Systane Ultra) 4 times daily "Initial Assessment" "Visual Acuity (Unaided)" Right Eye: 20/200 (6/60) (logMAR 1.0) PH: 20/40 (6/12) (logMAR 0.3) Left Eye: 20/200 (6/60) (logMAR 1.0) PH: 20/40 (6/12) (logMAR 0.3) "Refraction" Right Eye: -3.00 -1.25 x 180 VA: 20/20 (6/6) (logMAR 0.0) Left Eye: -3.25 -1.50 x 170 VA: 20/20 (6/6) (logMAR 0.0) "Keratometry" Right Eye: 44.00 @ 180 / 46.50 @ 090 (Radius: 7.67 mm / 7.25 mm) Left Eye: 44.50 @ 180 / 47.00 @ 090 (Radius: 7.58 mm / 7.18 mm) "Ocular Surface Health" Bulbar Conjunctiva: Mild injection Palpebral Conjunctiva: Smooth Cornea: Clear with mild punctate staining inferiorly "Trial Lens Fitting - Right Eye" Sagittal Depth: 4200 microns BOZD: 8.5 mm Power: -4.00 VA with Trial Lens: 20/25 (6/7.5) (logMAR 0.1) Over-Refraction: -0.50 VA: 20/20 (6/6) (logMAR 0.0) "Trial Lens Fitting - Left Eye" Sagittal Depth: 4300 microns BOZD: 8.5 mm Power: -4.25 VA with Trial Lens: 20/25 (6/7.5) (logMAR 0.1) Over-Refraction: -0.25 VA: 20/20 (6/6) (logMAR 0.0) "Lens Fit Evaluation (After 2 Hours)" Right Eye: Debris/Bubbles Under Lens: None Central Corneal Clearance: ~250 microns Limbal Clearance: Adequate Lens Rotation/Stability: Stable Conjunctival Blanching: None Conjunctival Hyperemia: Mild Limbal Hyperemia: Trace Conjunctival Impingement: None Corneal Staining: None Conjunctival Staining: Mild staining at the lens edge Left Eye: Debris/Bubbles Under Lens: None Central Corneal Clearance: ~250 microns Limbal Clearance: Adequate Lens Rotation/Stability: Stable Conjunctival Blanching: None Conjunctival Hyperemia: Mild Limbal Hyperemia: Trace Conjunctival Impingement: None Corneal Staining: None Conjunctival Staining: Mild staining at the lens edge "Solutions and Care Regimen" Filling Solution: LacriPure Storage Solution: Clear Care Cleaning: Boston Simplus Progent: Yes Frequency: Monthly Insertion/Removal Device: DMV Scleral Cup "Observations and Adjustments" Increased R lens sagittal depth by 100 microns to improve central clearance. Instructed patient to use preservative-free artificial tears more frequently. "Follow-Up Schedule" 1 week, 1 month, 3 months, then every 6 months, as needed "Scleral Lens Order - Right Eye" Sagittal Depth: 4300 microns BOZD: 8.5 mm Power: -4.00 Other Parameters: Toric haptics Expected VA: 20/20 (6/6) (logMAR 0.0) "Scleral Lens Order - Left Eye" Sagittal Depth: 4400 microns BOZD: 8.5 mm Power: -4.25 Other Parameters: Toric haptics Expected VA: 20/20 (6/6) (logMAR 0.0) "Additional Notes from Practitioner" Discussed importance of compliance with wearing schedule and follow-up visits. Patient successfully demonstrated insertion and removal techniques. Will monitor for any signs of corneal neovascularization. "Provider Signature:" "Dr. Iain Mellis" "Date:" "11/01/2024"