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Cataract Self-Test
Discover if Cataract Surgery is right for you by taking our 60-second self-test.
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Have you had any previous eye procedures, such as Refractive Surgery or LASIK?
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Yes
No
Have you been diagnosed with cataracts by an eye doctor?
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Yes
No
What do you currently use to correct your vision?
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👓 Reading Glasses only
👓 Glasses
⚪ Contacts
Nothing
How often do you currently rely on readers, glasses or contacts to correct your vision?
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Frequently
Occasionally
Rarely
Never
Considering your personal and professional life, please check the one activity you do most often.
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Computer Work
Reading
Driving
Physical Activity
Think about your DISTANCE vision: How important is it for you to perform tasks such as driving and playing golf without glasses after surgery?
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Very interested in not wearing glasses for distance vision
It would be nice to not wear glasses for distance vision
I don't mind wearing glasses
Think about your NEAR vision: How important is it for you to perform tasks such as reading and texting without glasses after surgery?
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Very interested in not wearing glasses for near vision
It would be nice to not wear glasses for near vision
I don't mind wearing reading glasses
What is your age range?
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18-29
30-39
40-54
55-64
65+
May we have your first name?
*
Thanks! And your last name?
*
Where should we text your results?
*
I agree to receive communications from American Eye Associates and understand that I can opt out at any time.
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