Intraocular Pressure
ODRight Eye
IOP — Goldmann Applanation Normal
mmHg
Normal: 10–21 mmHg
OSLeft Eye
IOP — Goldmann Applanation Normal
mmHg
Normal: 10–21 mmHg
Optic Nerve Head
ODRight Eye
Vertical C/D Ratio Normal
ratio
Concern ≥ 0.65
Disc Diameter (vertical)
mm
Avg 1.5–2.0 mm
Findings — click to mark present
OSLeft Eye
Vertical C/D Ratio Normal
ratio
Concern ≥ 0.65
Disc Diameter (vertical)
mm
Avg 1.5–2.0 mm
Findings — click to mark present
C/D Asymmetry > 0.2 between eyes — click to mark present
OCT — RNFL & Ganglion Cell
Visual Field — Humphrey SITA Standard
Angle & Anterior Segment — Gonioscopy
Angle Configuration
Angle Pathology — select all present
Central Corneal Thickness (Pachymetry)
Risk Factors — click to select all that apply
Approximate Age Range
Lens Status
Treatment History
Current / Prior Treatment Status
Failed / Discontinued Medications
Click once = unable to tolerate (amber) · Click twice = ineffective (red) · Click again to reset
Failed / Prior Surgical Interventions
Click once = complication / intolerance (amber) · Click twice = inadequate IOP control (red) · Click again to reset