BE Virtual
BE F2F
URC
Post Inj
MOCT
RETINA
Cataract
BE F2F
Diagnosis
Eye(s):
Both Eyes
Right Eye
Left Eye
Systemic
Diagnosis:
Select Diagnosis
POAG
OHT
NTG
Glaucoma Suspect
Dry Eye
PC IOL
PACS
PAC
PACG
CACG
PXF
Secondary Glaucoma
NVG
Steroid Response
Mixed Glaucoma
Trabeculectomy
Cyclodiode Laser
SLT
Failed Trabeculectomy
MicroPulse Diode Laser
YAG PI
Phaco + MIGS
Dry ARMD
Wet ARMD
DMO
BRVO
CRVO
Add Diagnosis
Treatment
Eye(s):
Both Eyes
Right Eye
Left Eye
Oral
Treatment Option:
Select Treatment Option
Monopost
Cosopt
Fixapost
Trusopt BD
Trusopt TDS
Alphagan BD
Alphagan TDS
Acetazolamide BD
Acetazolamide 250mg TDS
Acetazolamide QDS
G CPL
DEXA 2 hourly
DEXA PF 2 hourly
DEXA QDS
DEXA PF QDS
OC CPL
Hyloforte
Thealoz duo
Cationorm
VisuXL
Evolve Revive
VisuXL Gel
Hylo Night
Acular
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Visual Fields
Eye(s):
Both Eyes
Right Eye
Left Eye
Assessment:
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Normal Full
WNL
Stable
ONL
No Recent VF
Unreliable
Superior Arcuate
Inferior Arcuate
Double Arcuate
Central
Centrocecal
Temporal Wedge
Nasal Step
Bjerrum's
Sup Altitudinal
Inf Altitudinal
R Hemianopia
L Hemianopia
R Heteronymous
L Heteronymous
R Sup Quad
R Inf Quad
L Sup Quad
L Inf Quad
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Disc OCT
Eye(s):
Both Eyes
Right Eye
Left Eye
Evaluation:
Select Option
Healthy NFL
WNL
ONL
Borderline
No Recent DOCT
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Findings
Vision
Right Eye: 6/
Left Eye: 6/
Intraocular Pressure
Right Eye:
Left Eye:
Central Corneal Thickness
Right Eye:
Left Eye:
Mean Deviation
Right Eye:
Left Eye:
Impression
NTG Suspect-PACS
OHT
Stable NTG-POAG-PACG-Periperimetric
PAC-OHT-NTG suspect--> On Treatment
Normal IOP but progression on VF
Suboptimal IOP but stable VF
Creeping up IOP + VF Loss
Patent PI
Post Trabe-Formed bleb
Post Trabe-Flat Bleb
SLT Success
SLT Failure
DNA
Plan
Monitor
Continue Treatment
Treatment revised for better IOP
Treatment revised for ocular Surface
SLT Laser
Cyclodiode
Papilloedema
Papilloedema
Papilloedema
Papilloedema
Referral:
FU POAG
FU NTG
FU OHT
Glaucoma Suspect
VF loss
Post Trabe
Post SLT
GP
Optician
Ward
A/E
Self Referral
Title:
Mr
Mrs
Ms
Miss
Gender:
Gentleman
Lady
Patient's Name:
Stable Eye:
BE
RE
LE
Worsening Eye:
BE
RE
LE
Follow up duration:
1/12
2/12
3/12
4/12
6/12
9/12
12/12
1/52
2/52
Follow up Clinic:
VGC 1
VGC 2
VGC 3
VGC FU
F2F Clinic + Diag
F2F Clinic
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Letter: