eyeForm: Myopia tracking for school-aged children
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Patient ID
Case No.
Institution
Neurobit
TTT
HHH
Eastbay
Date of visit
Date of birth
Age
Height (cm)
Preterm week
Week
Day
Gender
Male
Female
Fetal status
Single
Multiple
Father:degree of myopia ≦ -5D
Mother:degree of myopia ≦ -5D
OD BCVA
( with glasses
) :
OS BCVA
( with glasses
) :
OS VABC
OD VABC
OD SPH (D) :
OS SPH (D) :
OD CYL (D) :
OS CYL (D) :
OD Axis(°)
0
90
180
10
170
20
160
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75
80
85
90
95
100
105
110
115
120
125
130
135
140
145
150
155
160
165
170
175
OS Axis(°)
0
90
180
10
170
20
160
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75
80
85
90
95
100
105
110
115
120
125
130
135
140
145
150
155
160
165
170
175
OD AL(mm)
< 20
20
21
22
23
24
25
26
27
28
29
30
> 30
.00
.01
.02
.03
.04
.05
.06
.07
.08
.09
.10
.11
.12
.13
.14
.15
.16
.17
.18
.19
.20
.21
.22
.23
.24
.25
.26
.27
.28
.29
.30
.31
.32
.33
.34
.35
.36
.37
.38
.39
.40
.41
.42
.43
.44
.45
.46
.47
.48
.49
.50
.51
.52
.53
.54
.55
.56
.57
.58
.59
.60
.61
.62
.63
.64
.65
.66
.67
.68
.69
.70
.71
.72
.73
.74
.75
.76
.77
.78
.79
.80
.81
.82
.83
.84
.85
.86
.87
.88
.89
.90
.91
.92
.93
.94
.95
.96
.97
.98
.99
OS AL(mm)
< 20
20
21
22
23
24
25
26
27
28
29
30
> 30
.00
.01
.02
.03
.04
.05
.06
.07
.08
.09
.10
.11
.12
.13
.14
.15
.16
.17
.18
.19
.20
.21
.22
.23
.24
.25
.26
.27
.28
.29
.30
.31
.32
.33
.34
.35
.36
.37
.38
.39
.40
.41
.42
.43
.44
.45
.46
.47
.48
.49
.50
.51
.52
.53
.54
.55
.56
.57
.58
.59
.60
.61
.62
.63
.64
.65
.66
.67
.68
.69
.70
.71
.72
.73
.74
.75
.76
.77
.78
.79
.80
.81
.82
.83
.84
.85
.86
.87
.88
.89
.90
.91
.92
.93
.94
.95
.96
.97
.98
.99
Untreated/Under observation
Treatment procedure
Glasses
Regular_glasses
Myopia_control_glasses_Zeiss_MyoVision
Myopia_control_glasses_Hoya_MiyoSmart
Myopia_control_glasses_Essilor_Stellest
Myopia_control_glasses_CooperVision_MiSight
Mydriatic agent
Use Mydriaticst.
Low-concentration Mydriaticst.
Medium-concentration Mydriatics
Hight-concentration Mydriatics.
Ortho-K lenses
Ortho_K_lenses
true
Reminder: Please update the automatically filled recent visit date👆
Treatment recommendations
Axial length risk assessment
Spherical diopter risk assessment
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