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OPT 2083

Subject Name CLINICAL STUDIES I

Lab Record Sheet 10

MONOCULAR SUBJECTIVE REFRACTION III


Topic
− The Fan & Block Test and Second Monocular MPMVA

Name : ……….…………………….……………….. ID No : ...............................

Patient/Subject : …………………..………….…..………...…. Date: ….....…………......

STEPS PROCEDURE OD OS

1. Patient/Subject’s IPD

3. Vision/Unaided VA

Estimated Spherical Rx

5. Net Retinoscopy

VA

Residual Rx

6. Initial MPMVA/BVS

VA

Technique Used

8. Clear Meridian(s)

Gross Axis

9. Fogging Lens Used 1

10. Final Axis

11. Fogging Lens Used 2

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OPT 2083

12. Cylinder Power

13. Second Monocular


MPMVA (fog/unfog)
VA

14. Monocular Spherical


Endpoint
VA

Technique used

15. Patient’s Rx & VA

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