Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.1. Do you have trouble seeing far away or up close without an optical aid? Up close (reading) Far away (TV, Driving) Intermediate (computers) 2. What optical aid do you use for correcting your vision currently ?NoneGlassesSoft contact lensesToric soft contact lensesGas permeable lensesOrtho-K lenses3. What is your age? *Under 1818-2021-3940-4950-5455+4. Are you interested in seeing well up close (reading) without glasses? *It’s very important to me NOT to wear reading glasses.It’s not important to me. I do not mind wearing reading glasses to see things up close.5. To understand your visual needs, could you please tell us your occupation *6. Do you know your approximate visual prescription? *YesNoThird Choice7. Do you have astigmatism? *YesNo8. Has your prescription been stable over the last two years? *YesNo9. Do your eyes hurt after prolonged eyewear use? *YesNo10. Medical conditions, medications & commentsName *FirstLastEmail *Contact Number *Submit