Order Nocturnal Lenses

ACCOUNT INFORMATION

Account Name *

Prescriber Name *

Account Number *

Email Address *

PLEASE SUPPLY NOCTURNAL DESIGN LENS FOR PATIENT DATA BELOW:

PX Reference *

Payment Option *

SE RX D Right

HVID (mm) Right *

Optic Diameter Right *

Material & Tint Right *

SE RX D Left

HVID (mm) Left *

Optic Diameter Left *

Material & Tint Left *

SE Rx Input SE Rx (Best Vision Sphere).

HVID Lens diameter 11.0 for HVID >11.20, 10.5 if below

Optic Diameter Standard optic diameters will provide optimum vision quality. Smaller diameters can be used to increase spherical aberration desirable in myopia management or presbyopia. Specify Standard or desired diameter in 0.5mm

RX	Standard	Minimum
< -5.00	6.50	4.50
-5.00 to -6.00	6.00	4.50
>6.00	5.50	4.50

Topography File

Choose File

IF YOU CANNOT UPLOAD A TOPOGRAPHY FILE PLEASE FILL IN THE FIELDS BELOW

K Flat mm Right

K Steep mm Right

e (Average) Right

e Flat Right

e Steep Right

K Flat mm Left

K Steep mm Left

e (Average) Left

e Flat Left

e Steep Left

Attach Topography Attach exported file from Medmont, Keratron, Oculus, Topcon, CSO topographer. If topographer not listed input Ks and e data.

K Flat K Steep* (needed if NO topography attached) Input Ks from topographer.

Eccentricity (if e>0.45) Input the average e value from the flat and steep axis from topography or use 0.45 which is population average. To design meridian specific lenses with eccentricity input e in e Flat and e Steep boxes

Additional Comments

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