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Accepted file types: pdf, jpg, jpeg, png, heic, pdf, jpg, jpeg, heic, png, Max. file size: 100 MB.
Name
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Street Address
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Select Prescription type
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Prescription
Readers
Prescription with Readers
RIGHT (OD)
SPHERE (SPH)
NONE
-5-5
-4.75
-4.5
-4.25
-4
-3.75
-3.5
-3.25
-3
-2.75
-2.5
-2.25
-2
-1.75
-1.5
-1.25
-1
-0.75
-0.50
-0.25
0.00
+0.25
+0.5
+0.75
+1
+1.25
+1.5
+1.75
+2
+2.25
+2.50
+2.75
+3.00
CYLINDER (CYL)
NONE
-3
-2.75
-2.5
-2.25
-2
-1.75
-1.5
-1.25
-1
-0.75
-0.50
-0.25
0.00
+0.25
+0.5
+0.75
+1
+1.25
+1.5
+1.75
+2
+2.25
+2.50
+2.75
+3
AXIS (AXI)
NONE
1
2
3
4
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159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
ADD
NONE
+0.25
+0.5
+0.75
+1
+1.25
+1.5
+1.75
+2
+2.25
+2.50
+2.75
+3
+3.25
+3.5
LEFT (OS)
SPHERE (SPH)
NONE
-5-5
-4.75
-4.5
-4.25
-4
-3.75
-3.5
-3.25
-3
-2.75
-2.5
-2.25
-2
-1.75
-1.5
-1.25
-1
-0.75
-0.50
-0.25
0.00
+0.25
+0.5
+0.75
+1
+1.25
+1.5
+1.75
+2
+2.25
+2.50
+2.75
+3.00
CYLINDER (CYL)
NONE
-3
-2.75
-2.5
-2.25
-2
-1.75
-1.5
-1.25
-1
-0.75
-0.50
-0.25
0.00
+0.25
+0.5
+0.75
+1
+1.25
+1.5
+1.75
+2
+2.25
+2.50
+2.75
+3
AXIS (AXI)
NONE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
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111
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113
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115
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121
122
123
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129
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131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
ADD
NONE
+0.25
+0.5
+0.75
+1
+1.25
+1.5
+1.75
+2
+2.25
+2.50
+2.75
+3
+3.25
+3.5
PD
PD
NONE
40
40.5
41
41.5
42
42.5
43
43.5
44
44.5
45
45.5
46
46.5
47
47.5
48
48.5
49
49.5
50
50.5
51
51.5
52
52.5
53
53.5
54
54.5
55
55.5
56
56.5
57
57.5
58
58.5
59
59.5
60
60.5
61
61.5
62
62.5
63
63.5
64
64.5
65
65.5
66
66.5
67
67.5
68
68.5
69
69.5
70
70.5
71
71.5
72
72.5
73
73.5
74
74.5
75
75.5
76
76.5
77
77.5
78
78.5
79
79.5
80
I have 2 numbers for my PD
Add one more
PD
NONE
40
40.5
41
41.5
42
42.5
43
43.5
44
44.5
45
45.5
46
46.5
47
47.5
48
48.5
49
49.5
50
50.5
51
51.5
52
52.5
53
53.5
54
54.5
55
55.5
56
56.5
57
57.5
58
58.5
59
59.5
60
60.5
61
61.5
62
62.5
63
63.5
64
64.5
65
65.5
66
66.5
67
67.5
68
68.5
69
69.5
70
70.5
71
71.5
72
72.5
73
73.5
74
74.5
75
75.5
76
76.5
77
77.5
78
78.5
79
79.5
80
Readers
ADD POWER
NONE
+0.25
+0.5
+0.75
+1
+1.25
+1.5
+1.75
+2
+2.25
+2.50
+2.75
+3
+3.25
+3.5
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