Axone

Last Name

First Name

Gender

Date of Birth

Email

Password

Are you affected by any of the following eye conditions?

Cataract – Conjunctivitis – Retinal Tear – AMD (Age-related Macular Degeneration) – Glaucoma – Keratoconus – Diabetic Maculopathy – Optic Neuritis – Diabetic Retinopathy

No

Yes

Do you have a reffractive error ?

Myopia – Hyperopia – Astigmatism – Presbyopia

No

Yes

Do you wear glasses or contact lenses to correct your vision?

No

Yes

Do you have a significant difference in visual acuity between your two eyes (More than 4 diopters)?

No

Yes

Registration Information