Cataract self-evaluation
Are you a candidate?
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Select each answer that applies
*
You have trouble driving at night
You have trouble seeing distant objects
Your vision seems blurred or dim
Your eyes are sensitive to light and glare
You see a halo around lights
Colors appear "dull"
You have to change eyeglass prescriptions frequently
You need a brighter light for reading
You see "ghost" images
You experience double vision in one eye only
Submit
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