Cataract Candidate Survey

This online self test is not a substitute for a comprehensive eye health examination, and patients should consult an optometrist or ophthalmologist for a complete vision screening or comprehensive eye examination.

A

CATARACT SURGERY
CANDIDACY TEST

START YOUR TEST

B

CATARACT SURGERY
CANDIDACY TEST

1 / 8

Are you having trouble with your vision?

Yes
No

C

CATARACT SURGERY
CANDIDACY TEST

2 / 8

Have you had any previous eye operations (Refractive surgery/LASIK, or lasers)?

Yes
No

D

CATARACT SURGERY
CANDIDACY TEST

3 / 8

Do you currently wear anything to correct your vision?
check all that apply

Reading glasses only
Glasses (Distance, bi-focals, tri-focals or progressive)
Contact Lenses
No correction

E

CATARACT SURGERY
CANDIDACY TEST

4 / 8

Have you been told you have cataracts and require surgery?

Yes
No

F

CATARACT SURGERY
CANDIDACY TEST

5 / 8

Think about your vision when looking in the distance (driving, playing golf). How important is it for you to do these tasks without glasses after surgery?

I am very interested in not wearing glasses for distance vision
I am moderately interested in not wearing glasses for distance vision
I don't mind wearing glasses, so it is not important to me

G

CATARACT SURGERY
CANDIDACY TEST

6 / 8

Think about your near vision (reading, cell phone). How important is it for you to do these tasks without glasses after cataract surgery?

I am very interested in not wearing reading glasses
I am moderately interested in not wearing reading glasses
I don't mind wearing glasses, so it is not important to me

H

CATARACT SURGERY
CANDIDACY TEST

7 / 8

How important is clear night vision for you after cataract surgery?

Very Important
Moderately Important Not Important

I

CATARACT SURGERY
CANDIDACY TEST

8 / 8

Below are 4 zones of vision. Consider things in life you want to do without dependence on glasses, which group is most important to your lifestyle?
Click here to check all

Far

(T.V., night driving, road signs, golf)

Intermediate

(computer, cooking, grocery shelf items, iPad)

Near

(newsprint, phone book, maps, sewing)

Very Near

(tying a fly, embroidery, knitting, setting jewelry stones)

2 1

CATARACT SURGERY
CANDIDACY TEST

HIGHLY LIKELY

Congratulations, you have been ranked a Highly Likely Candidate for Laser Vision Correction. We would like to confirm the accuracy of these results and discuss which treatment is right for you. One of our LASIK coordinators will be in touch with you soon. Or, if you prefer you are welcome to call at 1111111 our office to start the conversation today!

Schedule a Cataract Screening