Vision Quiz

COVD Quality of Life Checklist

To take the vision quiz, check the column which best represents the occurrence of each symptom.

Category

Symptom

Never

Seldom

Occas.

Freq.

Always
A Blur when looking at near
A Headaches with near work
A Sees worse at end of the day
A Difficulty copying from the Chalkboard
A Avoids near work/reading
A Holds head too close to the page
B Has double vision
B Words run together while reading
B Eyes burn, itch, or seem watery
B Falls asleep while reading
B Closes one eye or tilts head while reading
OR Dizzy or nauseous with near work
OR Writes up or down hill
OR Poor/inconsistent in sports
OR Avoids sports/games
OR Poor hand-eye coordination/poor handwriting
OR Clumsy/knocks things over
OR Car/motion sickness
OM Skips or repeats lines when reading
OM Misaligns digits/columns of numbers
P Reading comprehension is poor
P Trouble keeping attention on reading
P Says “I can’t” before trying
P Does not use his/her time well
P Does not make change well with money
P Loses belongings/things
P Forgetful/poor memory
ALL Difficulty completing assignments on time
ALL Does not judge distance accurately

Your Final Score:

Score >20 — There is a high risk of having a vision problem that makes it difficult to read, to learn, to comprehend and even to pay attention. Further evaluation with a Comprehensive Vision Examination is recommended.

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Call 206.624.0737

Our office is pleased to serve; Seattle, Bellevue, Kirkland, Redmond, Issaquah, Bainbridge Island, Vashon, Mercer Island, Shoreline, Lynnwood, Totem Lake, Sammamish, Bothel, Renton, Burien, Tukwilla, Sea Tac, Kent, and other surrounding communities in Washington. Call us at 206.624.0737 .