Adult's Symptom Survey

Adult's Symptom Survey

Any of the following symptoms may indicate a functional vision problem. Please mark the symptoms that occur and use the scoring criteria which will automatically calculate at the bottom of the page to determine if a functional vision evaluation is recommended.

If you would like to request an evaluation, please make note of your score as you will need this when making an appointment.

Please count which apply to you from this list:

Skip lines while reading or copying
Lose your place while reading or copying
Substitute words while reading or copying
Read very slowly
Have difficulty remembering what has been read
Hold you head to close when reading/writing (7-8")\Squint, close or cover one eye while reading
Have unusual posture/head tilt when reading/writing
Have headaches following intense reading/computer work
Have eyes that hurt or feel tired after close work
Feel unusually tired after completing a visual task
Have double vision
Notice vision blurs at distance when looking up from near work
Notice that print seems to move or go in and out of focus
Notice that letters or lines "run together" or words "jump" when reading
Misalign letters or numbers
Make errors copying
Have difficulty tracking moving objects
Notice unusual clumsiness, poor concentration
Have difficulty with sports involving good eye-hand coordination
Have an eye that turns in or out
Feel sleepy while reading
Avoid near tasks such as reading
Become restless when working at a desk
Experience unusual blinking
Experience unusual eye rubbing
Experience dry eyes
Experience watery eyes
Experience red eyes
Have eyes that are bothered by light

Total Score

Print this survey

Sometimes we do not realise that our struggles in the workplace or with reading in general are in no way linked to intelligence or how hard we are trying, instead we find it more difficult to visually process the information put before us. These types of vision problems are called Functional Vision Disorders or Visual Dysfunction.

If you have scored 3 or more on the survey above then we recommend a comprehensive eye examination with our Behavioural Optometrist.

Contact us for more information or to request an appointment