Iol Self Test
Name
(Required)
First Name
Last Name
Phone
(Required)
Email
1. How interested are you in seeing at a distance, driving or playing golf without glasses after your cataract surgery?
Select Your Answer
It's very important to me NOT to wear glasses for distance vision.
It's not important to me. I do not mind wearing glasses.
2. Are you interested in seeing well up close (reading) without glasses after your cataract surgery?
Select Your Answer
It's very important to me NOT to wear reading glasses.
It's not important to me. I do not mind wearing reading glasses to see things up close.
3. If you had to wear glasses after your vision treatment for one of the following activities, which one would you to most be willing to wear glasses for?
Select Your Answer
Reading fine print
Using a computer or cooking
Driving a car
4. 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?
Select Your Answer
Yes
No
5. If you could have good distance vision day and night, and good vision for computer work, without glasses, would you be willing to wear glasses for reading fine print and small type?
Select Your Answer
Yes
No
6. In our daily lives there are different things we do that require us to SEE at different distances. We have grouped some of these vision activities into 5 lifestyle zones. 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?
Select Your Answer
Newsprint, books, reading maps or sewing.
Computer screens, menus, price tags or headlines.
Watching TV, cooking, cleaning or indoor activities.
Driving, playing golf, seeing road signs.
Night driving, watching movies.
7. Consider your personality. Based on the options scale below how would you rank your personality?
Select Your Answer
Easy Going
In the middle
Perfectionist
CAPTCHA
