Cataract Test

Please rate your ability to do each of the following activities wearing up-to-date eyeglasses on a scale of 1 thru 5 (1=no limitation; 5=cannot do the activity). This test assumes you otherwise could do the activity except for visual difficulties.

1. Do you have any difficulty reading small print, such as labels on medicine bottles, a telephone book or food labels?
   No Difficulty 0 1 2 3 4 Extreme Difficulty
   
   
2. Do you have any difficulty reading a newspaper or a book?
   No Difficulty 0 1 2 3 4 Extreme Difficulty
   
   
3. Do you have any difficulty reading a large-print book or large-print newspaper or numbers on a telephone?
   No Difficulty 0 1 2 3 4 Extreme Difficulty
   
   
4. Do you have any difficulty recognizing people when they are close to you (within 10 ft)?
   No Difficulty 0 1 2 3 4 Extreme Difficulty
   
   
5. Do you have any difficulty seeing steps, stairs or curbs?
   No Difficulty 0 1 2 3 4 Extreme Difficulty
   
   
6. Do you have any difficulty reading traffic signs, street signs or store signs?
   No Difficulty 0 1 2 3 4 Extreme Difficulty
   
   
7. Do you have any difficulty doing fine handwork like sewing, knitting, crocheting or carpentry?
   No Difficulty 0 1 2 3 4 Extreme Difficulty
   
   
8. Do you have any difficulty writing checks or filling out forms?
   No Difficulty 0 1 2 3 4 Extreme Difficulty
   
   
9. Do you have any difficulty playing games such as bingo, dominos, card games or mahjong?
   No Difficulty 0 1 2 3 4 Extreme Difficulty
   
   
10. Do you have any difficulty taking part in sports like bowling, handball, tennis or golf?
    No Difficulty 0 1 2 3 4 Extreme Difficulty
    
    
11. Do you have any difficulty cooking?
    No Difficulty 0 1 2 3 4 Extreme Difficulty
    
    
12. Do you have any difficulty watching television?
    No Difficulty 0 1 2 3 4 Extreme Difficulty
    
    
13. Do you currently have any difficulty driving a car?
    No Difficulty 0 1 2 3 4 Extreme Difficulty
    
    
14. How much difficulty do you have driving a car during the day because of your vision?
    No Difficulty 0 1 2 3 4 Extreme Difficulty
    
    
15. How much difficulty do you have driving a car at night because of your vision?
    No Difficulty 0 1 2 3 4 Extreme Difficulty