Prevent Blindness America: Survey - Adult Vision Risk Assessment

Adult Vision Risk Assessment

1.

Question - Not Required - Do you have a blood relative with glaucoma?

2.

Question - Not Required - Has a doctor treated you for or said you have glaucoma?

3.

Question - Not Required - Have you ever had an eye injury or eye surgery?

4.

Question - Not Required - Have you noticed a change in your vision over the last 12 months?

5.

Question - Not Required - Do you have persistent pain in or around the eye?

6.

Question - Not Required - Are you Black, Hispanic or Latino and age 40 or older?

7.

Question - Not Required - Are you over age 65?

8.

Question - Not Required - Was your last dilated eye exam more than two years ago?

9.

Question - Not Required - Do you have diabetes?

10.

Question - Not Required - If you are diabetic, was your last dilated eye exam more than a year ago?

If you suspect that you are not seeing correctly or have an eye problem, you should arrange for a professional eye exam, regardless of the results of this risk assessment.

11.

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