Welcome to our Refractive Lens Exchange (RLE) self test

To Start

Please tell us how old you are

Under 18
19-39
40-59
60+
Take Our Self Test Online
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Question 2:

Have you ever been told you have astigmatism?

Yes
No
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Question 3:

Do you have to wear glasses/contacts for?

Driving
Computer
Reading
All of the above
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Question 4:

Have you had any of the following procedures on your eyes (LASIK, PRK, RK, CATARACT SURGERY)?

Yes
No
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Question 5:

Do you suffer from multiple sclerosis, lupus, keratoconus or diabetic retinopathy?

Yes
No

Question 6:

What phone can we use to call/text you?

Next
First Name

Question 7:

What is your first name?

Next
Last Name

Question 8:

What is your last name?

Next
Email

Question 9 (the final one!):

What is your email?

Question 1 of 9

Unfortunately you are not a candidate for RLE due to your age (18 or under). If you entered this age by mistake, refresh the page and select your age again.

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