Cataract Self-TestCataract Self-Test Name* First Last Phone*Email* What Is Your Age Group?* Under 18 18-40 40-65 66 and aboveHave you noticed any changes or deterioration in your vision recently?* Yes NoWithout my glasses and/or contact lenses, I have trouble: Reading and seeing up close Driving and seeing things that are far awayWhat type of vision correction do you usually wear? Contact Lenses Reading Glasses Bifocals, Trifocals, or ProgressivesDescribe your uncorrected vision. Check all that apply. Blurry or Cloudy Less Colorful, Colors Less Vibrant Than Before Glare or Haloes Around Light Sources Poor Night Vision Double Vision in One EyeAre you interested In seeing well up close (reading) without glasses?* Yes NoWhat is your preferred method of contact?Phone — A.M.Phone — P.M.EmailText MessageCAPTCHANameThis field is for validation purposes and should be left unchanged.
