Cataract Self-Assessment

2-minute quiz to assess your cataract symptoms

Cataract Self Test Quiz

2-minute quiz to assess your cataract symptoms

Step 1 of 8

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Email Address(Required)

Phone Number(Required)

Name(Required)

First Name Last Name

Preferred Location (Optional)

Your Vision Assessment

Please answer these questions honestly based on your current vision.

Vision Clarity & Quality

How would you describe your overall vision right now?(Required)

Clear and sharp

Slightly cloudy or blurry

Noticeably cloudy or dim

Very cloudy, difficult to see clearly

Has your vision gotten progressively worse over the past few months or years?(Required)

No change

Slightly worse

Moderately worse

Significantly worse

Do you have difficulty seeing at night or in low light?(Required)

No difficulty

Some difficulty occasionally

Yes, regularly have trouble

Yes, I avoid driving at night because of it

Light Sensitivity & Glare

Do you see halos or glare around lights (especially at night)?(Required)

Occasionally

Frequently

All the time, very bothersome

Are you more sensitive to bright lights than you used to be?(Required)

No change

Slightly more sensitive

Moderately sensitive, need sunglasses often

Very sensitive, bright light bothers me significantly

Color & Contrast

Do colors seem faded, dull, or yellowish?(Required)

No, colors look normal

Slightly less vibrant

Noticeably faded or yellowish

Yes, significant yellowing or dulling

Do you have trouble distinguishing between similar colors?(Required)

No difficulty

Occasionally

Often

Yes, very difficult

Reading & Close-Up Work

Has reading become more difficult?(Required)

No change

Need brighter light to read

Words appear blurry even with good light

Reading has become very challenging

Do you find yourself holding reading material farther away or closer than before?(Required)

Yes, farther away

Yes, closer

I've had to stop reading small print

Prescription Changes

How often have you needed to change your eyeglass prescription in the past 2 years?(Required)

No changes needed

Once

Twice

Three or more times

Does your vision seem blurry even with updated glasses or contacts?(Required)

No, glasses/contacts work well

Sometimes blurry despite new prescription

Often blurry

Yes, new prescriptions don't seem to help anymore

Daily Activity Impact

Which activities have become more difficult due to your vision? (Select all that apply)

Driving (especially at night)

Reading books/newspapers

Watching TV

Using computer/tablet

Recognizing faces

Reading street signs

Cooking/detailed tasks

Hobbies

None of the above

Do your vision problems interfere with your daily life or independence?(Required)

Not at all

Slightly, minor inconvenience

Moderately, I've had to adjust some activities

Significantly, I've stopped doing things I enjoy

Medical History & Risk Factors

What is your age?(Required)

Under 50

50-59

60-69

70 or older

How long have you been experiencing vision changes?(Required)

No significant changes

Less than 6 months

6 months to 1 year

1-2 years

More than 2 years

Do any of these apply to you? (Check all that apply)

Diabetes

Current or former smoker

High blood pressure

Previous eye injury or surgery

Prolonged sun exposure without sunglasses

Family history of cataracts

Long-term steroid use

None of the above

Ideal Eye Surgery is your trusted partner for LASIK vision correction and refractive eye care, offering trusted, state-of-the-art treatments and compassionate, patient-centered care to help you achieve optimal vision.

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