• Have you expericenced and of the following in the past week?

    4 = All the time | 3 = Most of the time | 2 = Half of the time | 1 = Some of the time | 0 = None of the time
  • Have problems with your eyes limited you in performing any of the following during the last week?

    4 = All the time | 3 = Most of the time | 2 = Half of the time | 1 = Some of the time | 0 = None of the time | Blank = N/A
  • Have your eyes felt uncomfortable in any of the following situations during the last week?

    4 = All the time | 3 = Most of the time | 2 = Half of the time | 1 = Some of the time | 0 = None of the time | Blank = N/A
  • Total