Right Eye Contact Lens Prescription Be sure to include plus (+) and minus (-) signs as they are on the
prescription or on the lens case or box.(Click here to see some examples of
contact lens prescriptions )
Enter the Sphere (Sph) Power
Enter any cylinder, axis, or add powers if
present: Cylinder (cyl): Axis: Add (bifocal):
Left Eye Contact Lens Prescription Be sure to include plus (+) and minus (-) signs as they are on the
prescription or on the lens case or box.(Click here to see some examples of
contact lens prescriptions )
Enter the Sphere (Sph) Power
Enter any cylinder, axis, or add powers if
present: Cylinder (cyl): Axis: Add (bifocal):
Which of the following best
describes how you correct your near vision, such as reading the newspaper,
doing close hand work, or using a computer?
I can see at near with or without contact lenses, and my contact lenses are
neither bifocal lenses nor monovision (one eye for reading, one for distance.)
I use bifocals, trifocals, or separate reading glasses over my contact
lenses to read.
I can read with my contact lenses in, and without reading glasses, because
the contact lenses are monovision (one eye set for reading and the other for
distance vision) or they are bifocal contact lenses.
I cannot see at near without removing my contact lenses.
Click Here to Proceed to the Next Page: Medical Information
Click Here to Cancel the Screening and Start Over
