Refractive lens exchange self-evaluation

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Refractive lens exchange self-evaluation

Complete the following questionnaire to help us assist reccomending a lens option.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
How interested are you in seeing at distance, driving or playing golf without glasses after your cataract surgery?*

It's very important to me NOT to wear glasses for distance visionIt's not important to me, I do not mind wearing glasses
Are you interested in seeing well up close (reading) without glasses after having cataract surgery?*

It's very important to me NOT to wear reading glassesIt's not important to me, I do not mind wearing glasses
If you had to wear glasses after your vision treatment for one of the following activities, which one would you most be willing to wear glasses for?*

Reading fine printUsing a computer or cookingDriving a car
If you could have good vision for driving during the day without glasses, and good near vision without glasses in most situations, would you be able to tolerate some halos and glare around lights at night?*

YesNo
Think about the things in life you want to do the most without depending on glasses after cataract surgery. Which group is the most important?*

Newsprint, books, reading maps, sewingComputer screens, menus, price tags, headlinesWatching TV, cooking, cleaning, indoor activitiesDriving, playing golf, seeing road signsNight driving, watching movies
Should be Empty: