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OPTO-K
IS16 / IS19
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Account Name
Account Number
Date of order
Order required by
Order Number
Patient Reference
Order Reference
Person placing this order
Name
Email
This order is for
Pair
Right lens only
Left lens only
OD / Right Eye
Design
IS16
IS19
Select the trail lens used
K1 (Toric 150)
K2 (Toric 150)
K3 (Toric 150)
K4 (Toric 150)
K5 (Toric 150)
K6 (Toric 150)
K7 (Toric 150)
K8 (Toric 150)
K9 (Toric 150)
K10 (Toric 150)
K11 (Toric 150)
K12 (Toric 150)
K13 (Toric 150)
Adjustments required in each quadrant
Limbal Clearance
Each step = 25 microns
0
90
180
270
Scleral alignment
Each step = 25 microns
Limbal Clearance
Each 0.2 = 30 microns
0
90
180
270
Sag at landing diam.
Each 0.2 = 30 microns
Scleral alignment
Each 0.2 = 30 microns
Power
Over-refraction
Spherical
Sphero-cylindrical
Over-refraction
Spherical
Sphero-cylindrical
Sphere
Back vertex distance
mm
Sphere
/
Cylinder
x
Axis
Back vertex distance
mm
R0 locates at
degrees
Positive value = Counter-Clockwise, Negative value = Clockwise
Notes
OS / Left Eye
Design
IS16
IS19
Select the trail lens used
K1 (Toric 150)
K2 (Toric 150)
K3 (Toric 150)
K4 (Toric 150)
K5 (Toric 150)
K6 (Toric 150)
K7 (Toric 150)
K8 (Toric 150)
K9 (Toric 150)
K10 (Toric 150)
K11 (Toric 150)
K12 (Toric 150)
K13 (Toric 150)
Adjustments required in each quadrant
Limbal Clearance
Each step = 25 microns
0
90
180
270
Scleral alignment
Each step = 25 microns
Limbal Clearance
Each 0.2 = 30 microns
0
90
180
270
Sag at landing diam.
Each 0.2 = 30 microns
Scleral alignment
Each 0.2 = 30 microns
Power
Over-refraction
Spherical
Sphero-cylindrical
Over-refraction
Spherical
Sphero-cylindrical
Sphere
Back vertex distance
mm
Sphere
/
Cylinder
x
Axis
Back vertex distance
mm
R0 locates at
degrees
Positive value = Counter-Clockwise, Negative value = Clockwise
Notes
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