BE Virtual
BE F2F
URC
Post Inj
MOCT
RETINA
Cataract

BE VIRTUAL

Diagnosis

Eye(s):
Diagnosis:

Treatment

Eye(s):
Treatment Option:

Visual Fields

Eye(s):
Assessment:

Disc OCT

Eye(s):
Evaluation:

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:

Cup to Disc Ratio

Right Eye:
Left Eye:

Impression

NTG Suspect-PACS VF+DOCT
OHT VF+DOCT
Stable NTG-POAG-PACG-Periperimetric VF+DOCT
PAC-OHT-NTG suspect- On Treatment VF+DOCT
All Normal
Normal IOP -VF Progression VF+DOCT
Suboptimum IOP - stable VF VF+DOCT
Creeping up IOP + VF Loss
Only IOP - Normal
Only VF Done
Only DOCT Done
DNA
SLT Success
SLT Failure
Cyclodiode Success
Cyclodiode Failure
Test

Plan

Monitor
Continue Treatment- Stable
Treatment revised for better IOP
Treatment revised for ocular Surface
Close monitoring with Borderline IOP
Early Rev F2F
Dry eye with glaucoma
Dry eye- No glaucoma
Papilloedema
Not Suitable for VGC

Referral:
Reason:
Title:
Gender:
Patient's Name:
Stable Eye:
Worsening Eye:
Follow up duration:
Follow up Clinic:

Letter: