814-616-3067
311 W. 24TH ST. SUITE 401, ERIE, PA 16502
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814.455.7591
814.455.7591
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Cataract Self Test
Take our cataract self test to see if cataract surgery is right for you.
Name
*
First
Last
Phone
Email
Do you experience blurred vision that cannot be corrected with a change your vision prescription?
*
Yes
No
Do colors appear faded and less vibrant?
*
Yes
No
Do you experience glare from sunlight or artificial light, including oncoming headlights when driving at night?
*
Yes
No
Would you be interested in seeing well without glasses in the following situations?
*
Select All
Distance Vision (Driving, golf, tennis, other sports, watching tv)
Mid-ranged vision (computer, menus, price-tags, cooking, board games, items on shelves)
Near Vision(Reading various items, detailed handiwork)
If you had to wear glasses after surgery for one activity, which activity would you be most willing to use glasses?
*
Distance Vision
Mid-Ranged Vision
Near Vision
Please check the statement that best describes you in terms of night vision:
*
Extremely Important
Moderately Important
Not Important
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