Prevent Blindness Ohio: Survey - Ohio Adult Vision Risk Assessment

Ohio Adult Vision Risk Assessment

Ohio's Aging Eye Public Private Partnership

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 of black heritage and over age 40?

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.

If you would like to receive more information from Ohio's Aging Eye Public Private Partnership about growing older with good vision or other eye health and safety issues, please provide the following information:


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