Which of the following age groups do you fall into?
Under 20
20-30 years old
30-40 years old
40-50 years old
50-60 years old
Over 60
Prefer not to answer
Have you experience LIGHT SENSITIVITY over the last week?
Never
Sometimes
Half of the time
All the time
Have you experienced GRITTY EYES over the last week?
Never
Sometimes
Half of the time
All the time
How often do you find yourself BLINKING to clear your vision?
Never
Sometimes
Half of the time
All the time
Have you eyes ever felt WATERY or UNCOMFORTABLE in windy or air conditioned environments?
Never
Sometimes
Half of the time
All the time
Do you eyes feel uncomfortable when READING on the computer, IPAD or cell phone screens?
Never
Sometimes
Half of the time
All the time
Did you have problems with your eyes when DRIVING AT NIGHT over the last week?
Never
Sometimes
Half of the time
All the time
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