Lions Laser Vision Centre - A part of the Lions Eye Institute

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Take the Test

See the world through your own eyes.

Take the online test

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Take the Test

The first step to a new you.

Before we can change the way you see the world, we need to know if you’re an eligible candidate. The questions below will help us determine whether you, and your eyes, are in the right condition for laser treatment.

If you’re unsure about any of the questions, request a call back and one of our specialists will get in touch with you as soon as possible.

Contact Details

Your First Name:

Your Surname:

Your Email: (Test results will be sent here)

Contact Phone:

Preferred method of contact
Email Phone

About You

Your Age:
years

Gender
Male Female

Are you pregnant?:
Yes No

Are you breast feeding?:
Yes No

Questions

1) Do you have trouble seeing:

Up close
Far Away
Both

2) Do you wear:

Spectacles
Contact Lenses
Both

Do you know your spectacle prescription?
(Optional - but useful for this test)

Yes
No

Your Prescription (Left Eye):

Your Prescription (Right Eye):

Spectacle prescriptions are written like this:
-2.00/-1.00 x 90

What sort of contacts do you wear?

Disposable (Soft)
Daily Disposable
Fortnightly Disposable
Monthly Disposable
Rigid gas permeable (Hard)

Do you sleep in your contact lenses overnight?

Yes
No

3) What age did you start wearing glasses or contact lenses?
years

4) Has your spectacle prescription changed in the last 2 years?
Yes No

5) Do you wear spectacles or contact lenses when doing the following:

Playing Sport:
Spectacles Contacts None

Reading:
Spectacles Contacts None

Driving:
Spectacles Contacts None

Working:
Spectacles Contacts None

6) Do you have any of the following conditions:

Diabetes
Autoimmune disease (eg. AIDS, lupus, rheumatoid arthritis, multiple sclerosis)
Immunocompromised for any reason
Collagen vascular disease
Keloid scarring
None of the above

7) Do you have any of the following eye conditions:

Keratoconus or other corneal thinning disorder
Corneal scarring
Glaucoma
Cataracts
Ocular herpes diagnosed in the past year
None of the above

8) What are your main reasons for seeking LASIK?

Lifestyle - I want to be able to do everything I want without worrying about spectacles or contact lenses

Cosmetic - I want people to be able to see my eyes without spectacles in the way

Freedom - I want to reduce my dependence on spectacles and contact lenses

Discomfort - My contact lenses are becoming less comfortable

Cost - Contact lenses and spectacles cost too much

Career - I need to be able to see without spectacles or contact lenses for work

9) How did you hear about us?

Internet Search
Nova
Friend
Family
Work colleague

"The results of LASIK are generally excellent. More than 96 per cent of people no longer require glasses or contact lenses."

Lions Laser Vision Centre Team.

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