Self Evaluation Test

First Name*

Last Name*

Email*

Phone

Is being able to see at a distance, driving or playing golf without needing glasses after your cataract surgery important to you?
Yes. It is very important that I don’t have to wear glasses for distance vision.Not really. I don’t mind wearing glasses.

Is being able to see (read) up close without glasses after you’ve had cataract surgery important to you?
Yes. It is important that I not have to wear glasses while I read or need to view something up close.No it isn’t. I don’t mind having to wear reading glasses.

After your vision treatment, if you had to wear glasses for one of the following activities, which would you be the most willing?
Reading a Computer monitorReading fine printWhile driving

If you are able to drive during the day without glasses and are usually able to read without glasses, would you be okay with driving at night if you see glares around lights at night?
YesNo

If you have good distance vision both day and night, as well as good near vision without using glasses, are you willing to wear reading glasses to read fine print?

YesNo

There are many different things we do each day that require us to see at different distances. After cataract surgery, which of the following would you like to do without having to depend on glasses?
Looking at menus, computer monitors, price tags or newspaper headlines.Reading newspapers, books or sewing.Cooking, cleaning, watching TVDriving, see road signs or playing golfWatching movies or driving at night

Based on the scale below, which would you consider best describes your personality?
Laid-backIn the middlePerfectionist

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HIGH-TECH MULTIFOCAL LENS SELF EVALUATION TEST

HIGH-TECH MULTIFOCAL LENS
SELF EVALUATION TEST