Cataract Self-Evaluation

Interested in Cataract Surgery?

Not sure if you are a good candidate? Start by filling out our self-evaluation to help you decide if cataract surgery might be a good option for you.

Cataract Self-Evaluations





Start

What is your occupation?

Have you had prior eye surgery

Yes


No


What is your age group

Under 18


18-40


40-65


Over 65

When did you start wearing glasses?

Under 40


40-55


Over 55

Have you noticed any deterioration of your vision in the last 5 years

Yes


No

Is your vision...(check all that apply)

Blurry or cloudy


Halos and lights and/or over-sensitivity to light


Poor at night


Double or multiple images in one eye


Not as colorful or vibrant as it used to be


None of the above

Are you...(check all that apply)

Nearsighted (trouble seeing far way)


Farsighted (trouble seeing close up)


Astigmatism (double images)


Wear bifocals or over the counter reading glasses

Is it most important to you to have...(check all that apply)

Good distance vision (driving, golfing, watching TV)


Good intermediate vision (computer work)


Good close up vision (reading)


All of the above

If you have cataract surgery, how important is it to you to be free of glasses and contacts afterwards?

Very important


Not important


Not sure

If you could enjoy good distance vision during the day for most activities without glasses, would you be able to tolerate some halos or glare at night?

Yes


No

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