Gender

Patient ID LINA JATI HARDIMAN

Surgeon Operator

OD right IOL Calculation left OS

Eye Status
Lens Status Phakic VS --- Lens Status Phakic VS ---
LVC untreated LVC Mode untreated LVC untreated LVC Mode untreated
Target Refraction 0.00 D SIA +0.25 D Target Refraction 0.00 D SIA +0.25 D
Inc. @ 180° Inc. @ 0°

Biometry
Date of Measurement --- Date of Measurement ---
AL 25.81 mm AL 24.18 mm
ACD 2.95 mm From Epithelium ACD 2.87 mm From Epithelium
LT --- LT ---
WTW --- n 1.3375 WTW --- n 1.3375
K1 --- @ --- Cyl --- @ --- K1 --- @ --- Cyl --- @ ---
K2 --- @ --- SE --- K2 --- @ --- SE ---
TK1 44.01 D @ 159° Cyl TK --- @ --- TK1 43.68 D @ 10° Cyl TK --- @ ---
TK2 47.03 D @ 69° TSE --- TK2 46.87 D @ 100° TSE ---
ZEISS AT LISA® tri toric 939 | M ZEISS AT LISA® tri toric 939 | M
Z CALC | Total Keratometry Z CALC | Total Keratometry
IOL Predicted Outcome IOL Predicted Outcome
SE Sph Cyl Axis SE Sph Cyl Axis SE Sph Cyl Axis SE Sph Cyl Axis
[D] [D] [D] [°] [D] [D] [D] [°] [D] [D] [D] [°] [D] [D] [D] [°]
+11.75 +9.50 +4.50 70 -0.75 -0.80 +0.11 160 +17.25 +15.00 +4.50 99 -0.83 -0.81 -0.04 9
+11.25 +9.00 +4.50 70 -0.39 -0.44 +0.10 160 +16.75 +14.50 +4.50 99 -0.46 -0.44 -0.05 9
+10.75 +8.50 +4.50 70 -0.03 -0.08 +0.09 160 +16.25 +14.00 +4.50 99 -0.10 -0.07 -0.06 9
+10.25 +8.00 +4.50 70 +0.32 +0.28 +0.08 160 +15.75 +13.50 +4.50 99 +0.26 +0.29 -0.06 9
+9.75 +7.50 +4.50 70 +0.67 +0.63 +0.07 160 +15.25 +13.00 +4.50 99 +0.61 +0.65 -0.07 9

Incision Orientation: 180° Incision Orientation: 0°

Implant Axis: 70° Implant Axis: 99°

180° 70° 0° 180° 99° 0°

T N N T

Comment: Signature:

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    Gender

Patient ID LINA JATI HARDIMAN

Surgeon

IOL Order Form OD OS

IOL ZEISS AT LISA® tri toric 939 | M ZEISS AT LISA® tri toric 939 | M

IOL (SE / Sph / Cyl / Axis) +10.75 D / +8.50 D / +4.50 D / 70° +16.25 D / +14.00 D / +4.50 D / 99°

Order Quantity 1 1

Surgery Date

Target Refraction (SE) 0.00 D 0.00 D

Axial Length 25.81 mm 24.18 mm

Anterior Chamber Depth (from Epithelium) 2.95 mm (from Epithelium) 2.87 mm

Refractive Index (n) 1.3375 1.3375

K1 --- @ --- --- @ ---

K2 --- @ --- --- @ ---

Cyl --- @ --- --- @ ---

TK1 44.01 D @ 159° 43.68 D @ 10°

TK2 47.03 D @ 69° 46.87 D @ 100°

Cyl TK --- @ --- --- @ ---

Incision Orientation 180° 0°

SIA +0.25 D +0.25 D

Predicted Outcome (SE / Sph / Cyl / Axis) -0.03 D / -0.08 D / +0.09 D / 160° -0.10 D / -0.07 D / -0.06 D / 9°

Order Reusable STACY:

Disclaimer:

The order request follows a non-binding recommendation. I have accepted the Terms and Conditions of use of the ZEISS product that generated this order request. The recommendation is
merely an approximate value on the basis of general experience and a calculation algorithm and I have verified it on the basis of my specialist expertise. The order request and a resulting
order are based on the General Terms and Conditions of Carl Zeiss Meditec AG that I was able to access online at https://www.zeiss.com/meditec/us/imprint/terms-and-conditions.html.

Comment: Signature:

Zeiss Calculation Web Services - Version 1.3 Printed on 2020-12-11 08:20 (UTC) by prod, isaac Page 1 of 1
Carl Zeiss Meditec AG | Template Version 1.3 [04/2020] | © Copyright 2020 All rights reserved.