TO TAKE THE TEST {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

1. Is your DISTANCE vision blurred and NOT clear, even with contacts or glasses? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

2. Is your NEAR vision blurred and NOT clear, even with contacts or glasses? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

3. Does your clarity of vision change or fluctuate during the day? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

4. Do you have poor night vision or can’t see well to drive at night? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

5. Do you have eye discomfort, sore eyes, or eyestrain? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

6. Do you have eye fatigue or are you very tired after using your eyes all day? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

7. Do you feel “pulling” around your eyes? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

8. Do you see double vision, especially when you are tired? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

IMPORTANT NOTE: Frequent double vision HIGHLY suggests a binocular vision problem. If you or your child experience double vision often, we strongly recommend a Vision Rehabilitation Evaluation even if your test score does not suggest a vision problem.

9. Do you have to close or cover one eye to see clearly? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

10. Does print move in and out of focus when reading? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

11. Do your eyes ever feel sore when reading or doing close work? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

12. Is normal indoor lighting uncomfortable or too much glare? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

13. Is outdoor light too bright or do you always have to use sunglasses? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

14. Is indoor fluorescent lighting bothersome or annoying? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

15. Do your eyes feel “dry” and sting? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

16. Do you “stare” into space without blinking? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

17. Do you have to rub your eyes a lot? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

18. Are you clumsy or misjudge where objects really are? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

19. Do you have a lack of confidence for walking, missing steps, or stumbling? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

20. Do you have poor handwriting (spacing, size, legibility)? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

21. Is your side vision distorted, do objects move or change position? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

22. What looks straight ahead, isn’t always straight ahead. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

23. Do you avoid crowds or “visually-busy” places? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

24. Do you have short attention span or are you easily distracted when reading? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

25. Do you have difficulty or slowness with reading and writing? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

26. Do you have poor reading comprehension or can’t remember what was read? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

27. Do you confuse words or skip words while reading? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

28. Do you lose your place or have to use finger to keep your place while reading? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}