Premium Cataract Cataract Self-Test Step 1 of 9 11% AgeWhat is your age group?(Required) Under 18 19-39 40-59 60+ Your VisionWithout my glasses and contacts... (check all that apply)(Required) Farsightedness: I have trouble reading and seeing things up close Nearsightedness: I have trouble driving and seeing things far away Astigmatism: I have distorted vision and cannot see very well EyewearWhat do you usually wear? (check all that apply)(Required) Glasses Contacts Reading Glasses None of Them ConditionsDo you have any of the following? (check all that apply)(Required) Clouded, blurred or dim vision. Increasing difficulty with vision at night. Sensitivity to light and glare. Need for brighter light for reading and other activities. Seeing "halos" around lights. Frequent changes in eyeglass or contact lens prescription. Fading or yellowing of colors. None of the Above. SurgeryHave you been told you have cataracts and require surgery?(Required) Yes No LifestyleAre the following statements important to you?I would like to see well at a distance without relying on glasses and contact lenses.(Required) Yes No I'm not sure I would like to see well up close without relying on glasses and contact lenses.(Required) Yes No I'm not sure It is important to me to see well at night after cataract surgery.(Required) Yes No I'm not sure ImportanceThink about the things in life you want to do without depending on glasses after cataract surgery. Which group is the most important? (check all that apply)(Required) Seeing Far Away (TV, night driving, golfing) Seeing Intermediate Distances (Computer, cooking, iPad) Seeing Close Up (Newsprint, maps, books) Seeing Very Close (Embroidery, sewing and other crafting, puzzles) Speak to Our TeamWould your like to speak with our Laser Vision Correction Team?(Required) I'm ready to book my consultation! Yes, please call me to discuss my options. I'm not ready yet. Basic Information(Required) First Last Phone(Required)Email(Required) Δ
