Cataract - Vision assessment

Date of Birth

Has someone alerted you that you have cataracts?*

Do you experience blurry or cloudy vision?*

Do you have difficulty seeing in bright light or glare?*

Do you struggle with night vision or see halos around lights?*

Has your vision impacted daily activities like reading, driving, or watching TV? *

Have you ever undergone eye surgery before? *

Do you frequently change your glasses prescription with little improvement?*

How important is it to you to be able to drive at night following cataract surgery?*

Do you believe your vision needs to be better? *

Think about the activities you would like to engage in without your glasses based on their importance in your way of life? *