Lifestyle Lens Questionnaire

  1. How interested are you in seeing at a distance, driving or playing golf without glasses after your cataract surgery?

  2. Are you interested in seeing well up close (reading) without glasses after your cataract surgery?

  3. If you had to wear glasses after your vision treatment for one of the following activities, which one would you most be willing to wear glasses for?

  4. If you could have good vision for driving during the day without glasses, and good near vision without glasses in most situations, would you be able to tolerate some halos and glare around lights at night?

  5. If you could have good distance vision day and night, and good vision for computer work, without glasses, would you be willing to wear glasses for reading fine print and small type?

  6. Consider your personality. Based on the options scale below how would you rank your personality?

  7. We Divide vision into 5 "Zones of Vision"

    Near ------------------------------------------------------------------------------------------------------------ Far

    Zone 1 Zone 2 Zone 3 Zone 4 Zone 5
    (12-20 in) (2-4ft) (6-20ft) (20-100ft) (100ft)
    Newsprint Headlines Indoors Day-Far Night-driving
    Phonebook Computer TV Driving

    Night-far

    Maps Menus Cooking Golf Movies
    Sewing Price tags Cleaning Road Signs Star Gazing
  8. Which group of "Zones of Vision" is the most important to you? Please choose only one of the following options of Group A, B or C.