ARE MY EYES SUITABLE FOR REFRACTIVE SURGERY?

The above information will help you to know if your refraction error falls within the group where it can be corrected. But, it is only a rough screening. Your eyes will still have to be thoroughly examined by Dr. Maritz before a definite go-ahead can be given. If there is any problems such as keratokonus or a cornea that is too thin you can still be excluded.

 

Your Name:

 

Your Age:

 

E-mail:

 
Telephone:

Gender:

Male:  

Female:  

 

 Current Contact Lens Strength:
 

Sphere:

Cylinder:

Axis:

Right Eye:

 

 

 

Left Eye:

 

 

 

 Current Spectacle Correction:

Right:

 

Left:

 

 My lens strength has been the same for about two (2) years:

Yes:          No: