Take this survey to learn which vision correction treatment(s) may be best for your specific needs.
1. Are you over 40? Yes No
2. Have you had good vision prior to turning 40? Yes No
3. Describe your vision. Which of the following problems do you experience? Check all that apply
Seeing things far away Seeing things close up Reading a newspaper or book Driving at night
4. Have you previously undergone vision correction surgery? Yes No if yes, which one:
LASIK PRK RK Lens Implant Other
5. Have you been diagnosed with any of the following?
Cataracts Dry eye Glaucoma Retinopathy Other None
6. Are you pregnant or nursing? Yes No
7. Do you suffer from any chronic illness or disease? Yes No
