Cataract Self-Test Step 1 of 5 20% 1. What is your age group?(Required) Under 18 19-39 40-59 60+ 2. Without my glasses and contacts... (check all that apply)(Required) Farsightedness: I have trouble reading and seeing things up close Nearsightedness: I have trouble driving and seeing things far away Astigmatism: I have distorted vision and cannot see very well 3. What do you usually wear? (check all that apply) Glasses Contacts Reading Glasses None of Them 4. Do you have any of the following? (check all that apply)(Required) Rheumatoid Arthritis Multiple Sclerosis Lupus Cataracts Keratoconus Diabetic Retinopathy Prior Eye Surgery Prior serious eye injury None of the above 5. Have you been told you have cataracts and require surgery?(Required) Yes No Are the following statements important to you?6. I would like to see well at a distance without relying on glasses and contact lenses.(Required) Yes No I'm not sure 7. I would like to see well up close without relying on glasses and contact lenses(Required) Yes No I'm not sure 8. It is important to me to see well at night after cataract surgery.(Required) Yes No I'm not sure 10. Think about the things in life you want to do without depending on glasses after cataract surgery. Which group is the most important? (check all that apply) Seeing Far Away (TV, night driving, golfing) Seeing Intermediate Distances (Computer, cooking, iPad) Seeing Close Up (Newsprint, maps, books) Seeing Very Close (Embroidery, sewing and other crafting, puzzles) 11. Would you like to speak with one of our specialists? I'm ready to book my consultation! Yes, please call me to discuss my options. I'm not ready yet. First NameLast NamePhoneEmail Δ
