CST 20429 | edow.com -MDP-5228-

0% Completion

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1

What is your age group?

What is your age group?

Under 40 40-55 55-70 70+

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2

Without my glasses and contacts I experience...

Without my glasses and contacts

Farsightedness‎ Nearsightedness‎ Astigmatism‎

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3

What do you usually wear?

What do you usually wear?

Glasses‎ Contacts‎ Reading Glasses‎ None of Them‎

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4

Do you have any of the following?

Do any apply to you?

Rheumatoid arthritis‎ Multiple Sclerosis‎ Cataracts‎ Keratoconus‎ Diabetic Retinopathy‎ Prior eye Surgery‎ Prior eye injury‎ LASIK, PRK or RK‎ Eyelid surgery‎ Retinal detachment‎ Dry eye disease‎ None of the above‎

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5

Have you been told you have cataracts?

Been told you have cataracts?

Yes No

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6

Are you ready to schedule an appointment?

Are you ready to schedule an appointment?

Yes, I'm ready I've already booked No, I'm not ready I'd like more info

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7

I want to see far away without glasses or contacts

I want to see far away

Yes No Not Sure

8

I want to see up close without glasses or contacts

I want to see up close without glasses or contacts

Yes No Not Sure

9

It is important to me to see well at night.

It's important I can see well at night

Yes No Not Sure

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10

Which of the following is most important?

Which is most important?

Seeing Far Away‎ Seeing Medium Distances‎ Seeing Close Up‎ Seeing Very Close‎

If > 0 patient is a candidate