OD/Right Sphere *
OD/Right Cylinder *
OD/Right Axis *
OS/Left Sphere *
OS/Left Cylinder *
OS/Left Axis *
Bifocal/Right
Bifocal/Left
Pupil Distance Binocular – if one number is shown on your Rx *
PD/Right (Optional. If two numbers are shown on your Rx)
PD/Left (Optional. If two numbers are shown on your Rx)
Laser Name Labeling – Enter your name or message. in the box below
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