Welcome to your EyeQ Assessment. We are going to evaluate your situation based on a couple of questions. Please click next to start your EyeQ Assessment. Full Name Phone Number 1. What is your age? Less than 20 years old 20 - 29 years old 30 - 39 years old 40 - 49 years old 50 - 59 years old 60 - 69 years old More than 70 years old 2. Do you use more than 1 device simultaneously? No Yes, I use 2 devices simultaneously Yes, I use more than 2 devices simultaneously 3. How far do you view your reading material(s)? (e.g. books, handphones, tablets) Less than 30 cm 30-50 cm 51-70 cm 71-90 cm 4. What feature(s) are in your spectacles? UV multi coat Blue-light filter Transitions None of the above 5. How many hours do you spend on digital devices (e.g. computer, laptop, tablet, handphone) per day? less than 3 hours 3 - 5 hours 6 -7 hours 8 - 10 hours More than 10 hours 6. Do you use your device(s) in the dark before you sleep? Never Seldom (2-3 times per week) Sometimes (4-5 times per week) Always 7. When was your last eye health check with an eye doctor? Never had one Within the last 6 months Within the last 1 year Within the last 2 years More than 2 years 8. Do you experience dry eyes? (e.g. teary eyes, stinging/scratchy/burning sensation, periodic blurring of vision) Yes No 9. How frequent do you take visual breaks? Never Every half an hour Every hour Every two hours Every three hours 10. In the last 3 months, have you had any of the following: Periodic blurring of vision Having trouble with refocusing between distance and near Eye strain Dryness Sensitivity to bright lights Headaches None of the above 11. How often do you rub your eyes due to irritation or itchiness? Never Sometimes Daily 12. Do you wear soft contact lenses? Yes No 13. NOTE: Please answer only the next 4 questions, if you replied YES to the previous question: Do you wear soft contact lenses?What modality of contact lenses are you using? Daily lenses Biweekly lenses Monthly lenses Others (3 monthly/6 monthly/Yearly lenses) 14. How often do you wear your contact lenses? Special occasions only 1 - 3 times per week 4 -5 times per week Everyday 15. Do you do any of the following: Sleep/Nap with contact lenses Swim with contact lenses Bathe with contact lenses Wash contact lenses with tap water None of the above 16. Do you experience any of the following while wearing contact lenses: Dryness Discomfort Pain Decrease tolerance to contact lenses wear Blurred vision Itchiness None of the Above Time's up
