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Type of lenses used Std. Spectacle Aphakic Contact Lenses Telescopic Lenses Extent of entire horizontal form field either binocular or monocular as determined with a III4e or V4e Goldmann test target or equivalent such as the SSA Kinetic V4e isopter test on Humphrey Field Analyzers. Visual acuity using telescopic lens Right Eye 20/ Both c. Visual acuity through carrier lens Right Left d. MUST BE COMPLETED STATEMENT OF VISION NOT VALID AFTER 90 DAYS FROM EXAMINATION DATE. Additional Comments...
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