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Doctor Of Optometry
10-15 minutes

Template for Fitting Soft Contact Lenses Template

The Soft Contact Lens Fitting Template by s10.ai is a vital resource for optometrists aiming to meticulously document the soft contact lens fitting process. This all-encompassing template features sections for patient information, current vision status, prescription details, ocular measurements, trial lens specifications, and lens evaluation. It also includes training for insertion and removal, care guidelines, patient education, and follow-up strategies. Utilizing this template allows optometrists to maintain a comprehensive and uniform approach to contact lens fittings, thereby boosting patient care and satisfaction. This template is perfect for optometrists looking to optimize their documentation workflow and enhance patient outcomes.

1,732 uses
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Dr. Emily Carter
Template Structure

Organized sections for comprehensive clinical documentation

Soft Contact Lens Fitting Documentation
"Patient Information"
Name: [Patient name] (Complete name)
Date of Birth: [DOB] (MM/DD/YYYY)
Patient ID: [ID] (Unique identifier)
Date of Visit: [Visit date] (MM/DD/YYYY)
Subjective
Reason for Visit: [Describe the patient’s primary reason for seeking contact lenses, e.g., visual correction, convenience over glasses, cosmetic, sports, special events, etc.] (In patient's own words, if available)
Ocular History: [Mention personal ocular history, including previous lens wear, surgeries, or eye conditions] (Only include if explicitly mentioned, otherwise leave blank)
Medications: [List all medications with dosage and frequency] (Only include if explicitly mentioned, otherwise leave blank)
Allergies: [Note any allergies, particularly to contact lens solutions or materials] (Only include if explicitly mentioned, otherwise leave blank)
"Current Vision and Prescription"
Uncorrected Visual Acuity (UCVA):
OD: [VA] (e.g., 20/20, 20/400, CF, HM) (6/[UK Snellen]) (logMAR [logMAR value])
OS: [VA] (e.g., 20/20, 20/400, CF, HM) (6/[UK Snellen]) (logMAR [logMAR value])
Current Spectacle Prescription:
OD: [Sph] (e.g., -2.50, +1.75) [Cyl] (e.g., -1.25, -0.50) x [Axis] (e.g., 180, 090)
OS: [Sph] (e.g., -2.50, +1.75) [Cyl] (e.g., -1.25, -0.50) x [Axis] (e.g., 180, 090)
Best Corrected Visual Acuity (BCVA) with spectacles:
OD: [VA] (e.g., 20/20, 20/25) (6/[UK Snellen]) (logMAR [logMAR value])
OS: [VA] (e.g., 20/20, 20/25) (6/[UK Snellen]) (logMAR [logMAR value])
"Ocular Measurements"
Keratometry:
OD: [Flat K in diopters] (e.g., 45.00) @ [Axis] (e.g., 180) / [Steep K in diopters] (e.g., 46.00) @ [Axis] (e.g., 090) (Radius: [radius in mm] / [radius in mm])
OS: [Flat K in diopters] (e.g., 45.00) @ [Axis] (e.g., 180) / [Steep K in diopters] (e.g., 46.00) @ [Axis] (e.g., 090) (Radius: [radius in mm] / [radius in mm])
Horizontal Visible Iris Diameter (HVID): [Measurement in mm] (e.g., 11.8 mm) (OU or OD/OS if different)
Pupil Size: [Measurement in mm] (e.g., 3.5 mm) (Typically measured under normal room illumination, specify if measured in dim/bright conditions, and note if OU or OD/OS)
Tear Break-Up Time (TBUT): [Seconds] (e.g., 12 seconds) (OU or OD/OS if different)
"Trial Lens Parameters"
Brand/Material: [Specify lens brand and material, e.g., Acuvue Oasys/Senofilcon A, Biofinity/Comfilcon A]
Base Curve (BC): [Measurement in mm] (e.g., 8.4 mm, 8.6 mm)
Diameter (DIA): [Measurement in mm] (e.g., 14.0 mm, 14.2 mm)
Power:
OD: [Power] (e.g., -3.00, +2.50)
OS: [Power] (e.g., -3.50, +2.00)
"Lens Assessment"
Lens Centration: [Well-centered/Decentered (specify direction - e.g., decentered temporally)] (Note if OU or OD/OS)
Lens Movement: [Minimal (e.g., 0.25mm), Optimal (e.g., 0.5 - 1.0 mm), Excessive (e.g., >1.5mm)] (Note if OU or OD/OS)
Comfort: [Patient-reported comfort level] (e.g., on a scale of 1-10, with 10 being the most comfortable) (Note if OU or OD/OS)
Vision Quality: [Clear/Blurred/Fluctuating] (Note if OU or OD/OS)
"Over-Refraction"
OD: [Sphere] (e.g., -0.50, +0.25) [Cylinder] [Axis] (if applicable)
OS: [Sphere] (e.g., -0.50, +0.25) [Cylinder] [Axis] (if applicable)
"Final Visual Acuity with Trial Lenses"
OD: [VA] (e.g., 20/20, 20/25) (6/[UK Snellen]) (logMAR [logMAR value])
OS: [VA] (e.g., 20/20, 20/25) (6/[UK Snellen]) (logMAR [logMAR value])
"Insertion and Removal Training"
Training Completed: ☐ Yes ☐ No
Patient Proficiency: [Good/Average/Poor] (Describe patient's ability to insert and remove lenses independently)
Additional Comments: [Include specific notes about patient handling or concerns, e.g., difficulty with insertion, lens awareness, etc.]
"Care Instructions Provided"
Lens Care Solutions: [Brand/Type, e.g., Biotrue Multi-Purpose Solution, Clear Care Hydrogen Peroxide System]
Cleaning Instructions: [Include cleaning regimen, e.g., rub and rinse with multi-purpose solution daily, use enzymatic cleaner weekly if applicable]
Wearing Schedule: [Hours/day, e.g., 8-10 hours/day, build-up schedule if applicable]
Day 1: [Number] Hours
Day 2: [Number] Hours
Day 3: [Number] Hours
Continue to increase by [Number] hours daily.
Replacement Frequency: [Daily/Two-Weekly/Monthly]
Advised to Avoid Tap Water: ☐ Yes ☐ No
Advised to Avoid Showering in Lenses: ☐ Yes ☐ No
Advised to Avoid Swimming in Lenses: ☐ Yes ☐ No
"Patient Education"
Advised on Symptoms of Complications (Redness, Pain, Blurry Vision, Discharge): ☐ Yes ☐ No
Emergency Removal Instructions Provided: ☐ Yes ☐ No
Handling Tips Provided: ☐ Yes ☐ No (e.g. always wash hands before handling lenses)
"Follow-Up"
Scheduled Follow-Up: [Date/Time] (e.g., in 1 week on MM/DD/YYYY at HH:MM)
Follow-Up Notes: [Include any specific issues to address at follow-up, e.g., check lens fit, assess comfort and vision, reinforce proper care and handling]
"Additional Notes"
[Include any observations, patient questions, or unique considerations, e.g., patient has dry eyes and was advised to use rewetting drops, patient is a first-time wearer and needs extra encouragement]
"Practitioner Signature:" [Signature]
"Date:" [Date] (MM/DD/YYYY)
Sample Clinical Note

Example of completed documentation using this template

Soft Contact Lens Fitting Record
"Patient Details"
Name: John Doe  
Date of Birth: 01/15/1985  
Patient ID: 123456  
Date of Visit: 11/01/2024  
Subjective
Reason for Visit: "I am seeking contact lenses for improved vision and convenience compared to glasses."  
Ocular History: Previously wore lenses, no surgeries or major eye conditions.  
Medications: None  
Allergies: Allergic to specific contact lens solutions.  
"Current Vision and Prescription"
Uncorrected Visual Acuity (UCVA):  
OD: 20/200 (6/60) (logMAR 1.0)  
OS: 20/200 (6/60) (logMAR 1.0)  
Current Spectacle Prescription:  
OD: -3.00 -1.00 x 180  
OS: -3.25 -0.75 x 170  
Best Corrected Visual Acuity (BCVA) with spectacles:  
OD: 20/20 (6/6) (logMAR 0.0)  
OS: 20/20 (6/6) (logMAR 0.0)  
"Ocular Measurements"
Keratometry:  
OD: 44.00 @ 180 / 45.00 @ 090 (Radius: 7.67 mm / 7.50 mm)  
OS: 44.50 @ 180 / 45.50 @ 090 (Radius: 7.57 mm / 7.41 mm)  
Horizontal Visible Iris Diameter (HVID): 11.8 mm OU  
Pupil Size: 3.5 mm (normal room illumination, OU)  
Tear Break-Up Time (TBUT): 10 seconds OU  
"Trial Lens Parameters"
Brand/Material: Acuvue Oasys/Senofilcon A  
Base Curve (BC): 8.4 mm  
Diameter (DIA): 14.0 mm  
Power:  
OD: -3.00  
OS: -3.25  
"Lens Assessment"
Lens Centration: Well-centered OU  
Lens Movement: Optimal (0.5 - 1.0 mm) OU  
Comfort: 8/10 OU  
Vision Quality: Clear OU  
"Over-Refraction"
OD: -0.25  
OS: -0.25  
"Final Visual Acuity with Trial Lenses"
OD: 20/20 (6/6) (logMAR 0.0)  
OS: 20/20 (6/6) (logMAR 0.0)  
"Insertion and Removal Training"
Training Completed: ☑ Yes  
Patient Proficiency: Good  
Additional Comments: Patient initially had difficulty with insertion but improved with practice.  
"Care Instructions Provided"
Lens Care Solutions: Biotrue Multi-Purpose Solution  
Cleaning Instructions: Rub and rinse with multi-purpose solution daily.  
Wearing Schedule: 8-10 hours/day  
Day 1: 4 Hours  
Day 2: 6 Hours  
Day 3: 8 Hours  
Continue to increase by 2 hours daily.  
Replacement Frequency: Two-Weekly  
Advised to Avoid Tap Water: ☑ Yes  
Advised to Avoid Showering in Lenses: ☑ Yes  
Advised to Avoid Swimming in Lenses: ☑ Yes  
"Patient Education"
Advised on Symptoms of Complications (Redness, Pain, Blurry Vision, Discharge): ☑ Yes  
Emergency Removal Instructions Provided: ☑ Yes  
Handling Tips Provided: ☑ Yes  
"Follow-Up"
Scheduled Follow-Up: 11/08/2024 at 10:00  
Follow-Up Notes: Check lens fit, assess comfort and vision, reinforce proper care and handling.  
"Additional Notes"
Patient has dry eyes and was advised to use rewetting drops. First-time wearer and needs extra encouragement.  
"Practitioner Signature:" Dr. Iain Mellis  
"Date:" 11/01/2024
Clinical Benefits

Key advantages of using this template in clinical practice

  • The Soft Contact Lens Fitting Record template is an essential tool for eye care professionals seeking to streamline the contact lens fitting process. This comprehensive template captures critical patient details, including ocular history, current vision and prescription, and ocular measurements, ensuring a personalized approach to contact lens fitting. With sections dedicated to trial lens parameters, lens assessment, and over-refraction, practitioners can meticulously document each step of the fitting process. The template also includes detailed instructions for insertion and removal training, care instructions, and patient education, promoting optimal lens care and patient compliance. By adopting this template, clinicians can enhance patient outcomes, improve workflow efficiency, and ensure thorough documentation, making it an invaluable resource for any practice focused on delivering high-quality eye care.
Frequently Asked Questions

Common questions about this template and its usage

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Template for Fitting Soft Contact Lenses | Medical Chart Template