Cataract Candidacy Quiz

do or do not , there is no try

What is your age?

18-44

45-64

65+

What type of eyewear are you currently using?(please check all that apply)

Eyeglasses

Reading Glasses

Bifocals/Progressive Glasses

Contact Lenses

None of the above

Without glasses and/or contacts: (please check all that apply)

I have trouble reading and seeing things up close

I have trouble driving and seeing things that are far away

I have trouble seeing both far and near

Do you currently experience any of the following symptoms? (please check all that apply)

Blurry and/or cloudy vision

Glare and/or halos around lights

Poor night vision

Sensitivity to light

Double vision in one eye only

None of the above

Have you had any previous eye operations? (please check all that apply)

Refractive surgery (LASIK, PRK, RK)

Eye muscle surgery

Retina surgery

Glaucoma surgery

None of the above

Have you ever been told you have cataracts and need surgery?

Yes

What would be your goal outcome after cataract surgery?

I am fine with needing glasses all the time

I would like to limit my need for glasses only to reading

I would like to eliminate the need for glasses all together

Are you interested in scheduling a cataract consultation?

Yes

No, not right now

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Troy, OH 45373

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