Self Test for Cataracts

Select your age group*Under 1819-3940-5960+

Were your first glasses more for reading or distance?*ReadingDistance

Have you noticed any deterioration of your vision in the past 5 years?*YesNo

Without my glasses and contacts (Select all that apply)*I have trouble reading and seeing things up closeI have trouble driving and seeing things that are far awayI've been told that I have astigmatism

What do you usually wear? (Select all that apply)*GlassesContactsReading GlassesBifocals/Trifocals

Describe your vision*Blurry or cloudyNot as colorful or vibrant as it used to beHalos around lights and/or over-sensitivity to lightPoor at nightDouble or multiple images in one eyeNone of the above

First name*

Last name*

Your Email*

Phone*

• WHAT’S A GOOD TIME TO CALL YOU?*

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