Questionnaire - Page 4(a) of 9
(1014 maximum possible questions)		 Last updated: May 12, 2008

THE ANALYST TM
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This section pertains to eye problems.
406.  Are you experiencing eye pain that is not caused by an injury? Include any burning, throbbing, aching or stabbing sensation.
Don't know
No
In the past only
Yes, in one eye only
Yes, in both eyes
407.  Visual acuity: Without corrective lenses, which answer best describes your vision?
Don't know
Nearsighted
Normal
Astigmatic
Farsighted
408.  Do you experience double vision?
Don't know
No, very rarely
Occasionally
Intermittently
Frequently, at least once a day or more
409.  Do you see halos around objects? Please answer 'Don't know' if seeing these halos is a result of laser surgery done on your eye/s.
Don't know
No
Yes, around bright lights
Yes, around objects
Yes, around bright lights and objects
410.  Have you noticed, or have others commented that your eyes seem to be bulging out or protruding?
No / don't know
Yes, but not due to hyperthyroidism
Yes, due to hyperthyroidism now resolved
Yes, but don't know why
Yes, due to current hyperthyroidism
411.  Have you noticed that one or both eyelids are harder to hold open, especially toward the end of the day? This is called ptosis.
Don't know
No, there is no drooping
Possibly
Noticeably with one eyelid
Noticeably with both eyelids
412.  Do your eyeballs (not eyelids) jerk or move involuntarily?
Don't know
No
Rarely
Occasionally
Yes, noticeably
413.  Have you had a problem with styes or chalazia on your eyelids? It may have also been referred to as a hordeolum.
Don't know
No
Isolated case/s in the past only
Recurrent problem
Current problem
414.  Vision - poor dark adaptation. Do you have difficulty seeing things when going from a light to a darkened room?
No / don't know
Mildly - can see well after very brief adjustment
Moderately - I need time to adjust
Seriously - can see only a little after a while
Severely - can see nothing at all
415.  Vision. Do you have general difficulty seeing, especially when the lights are dim?
No / don't know
Mild
Moderate
Serious
Severe - I can see barely anything or nothing
416.  Eye sensitivity to bright light. Do you feel sunlight is too strong for you, or need to wear sunglasses a lot?
No / don't know
Mildly - I occasionally have to shield my eyes
Moderately - I often need to shield my eyes
Seriously - I always need sunglasses
Severely - I can't stand bright sun at all
417.  Do you have any abnormal blind spots in your field of vision?
Don't know
No
The blind spot around optic nerve is enlarged
At least one elsewhere
Several
418.  Have you experienced any retinal detachments?
Don't know
No
Yes, due to a physical injury
Yes
Yes, more than one / once
419.  Have you had a problem with Cataracts?
No / don't know
In the past only, now resolved
Minor (juvenile, immature, early)
Moderate
Advanced, serious
420.  Have you had Glaucoma?
Never had it / don't know
No, but there is a family history
Past problem now resolved
Current possible / minor problem
Current major problem
421.  Have you had iritis?
Don't know
Never had it
In the past only
Current mild case
Current moderate or worse case
422.  Have you had uveitis?
Don't know
Never had it
In the past only
Current mild case
Current moderate or worse case
423.  Are you suffering from Macular Degeneration?
No / don't know
I suspect I might have it
Moderately
Seriously
Severely

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GLOSSARY

Blind Spots:  Blind spots (scotomas) are dark "holes" in the visual field in which nothing can be seen.

Cataract:  A steadily worsening disease of the eye in which the lens becomes cloudy as a result of the precipitation of proteins. Most cataracts are caused by the functions of the body breaking down. Eye trauma, such as from a puncture wound, may also result in cataracts.

Glaucoma:  A disease of the eye characterized by vision loss due to an increase in the pressure of fluid within the eye. This rise in pressure results from a build-up of aqueous fluid and leads to progressive damage to the optic nerve that transmits visual signals to the brain. Over time, glaucoma can lead to a gradual loss in peripheral vision. There are usually no signs that you're developing glaucoma until vision loss occurs.

Hordeolum:  A hordeolum is a bacterial infection of either the meibomian glands or ciliary glands (the glands of Zeis and Moll). If the latter are involved, the hordeolum is considered external and appears focal in nature. If the deeper meibomian glands are involved, the hordeolum is considered internal and is less circumscribed in appearance. Acute and chronic inflammation associated with hordeola, especially if improperly treated, may result in a granulomatous inflammation known as chalazia.

Iritis:  An inflammation of the iris of the eye.

Macular Degeneration:  Increasingly poor eyesight often accompanied by light sensitivity, distorted vision and a blank or dark patch in the center of vision.

Ptosis:  A drooping of the eyelid(s).

Retina:  A 10-layered, frail nervous tissue membrane of the eye, parallel with the optic nerve. It receives images of outer objects and carries sight signals through the optic nerve to the brain.



 


A man gets a telephone call from a doctor. The doctor says: "About this medical test I did on you, I have some good news and some bad news."
The man asks for the good news first: "The good news is that you have 24 hours to live," says the doctor.
Horrified, the man asked: "If that is the good news, then what is the bad news??"
"I couldn't reach you yesterday!"