Sample of Optometry Eye Screening Report

 
 Optometry Eye Screening

Date	:
Name	:
IC	:
Sex	:
Age	:

   

		Right Eye	Left Eye
Dominant Eye	:	Right
Eye Pressure (<21 mmhg)	:	15	12
Glasses Prescription	:	-5.75/-0.50x170 6/9.6-	-6.25/-0.50x18 6/7.5-
Uncorrected Visual Acuity	:	6/120	6/120
Manual Refraction	:	-6.50/-1.00x165 6/6	-6.75/-0.50x20 6/6
Add: (Reading)	:	+1.50	+1.50
Additional Remarks	:	Needs progressive lenses