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 FEMALE QUESTIONNAIRE - PAGE 4(a) 

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This section deals with specific eye/vision problems.
410.  Do you have Cataracts?
No / don't know
In the past only, now resolved
Minor (juvenile, immature, early)
Moderate
Advanced, serious
411.  Do you suffer from Glaucoma?
Never had it / don't know
Probably/minor episode now resolved
Major episode now resolved
Current minor problem
Current major problem
412.  Are you suffering from Macular Degeneration?
No / don't know
I suspect I might have it
Moderately
Seriously
Severely
413.  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
414.  Do you have any form of discharge coming from from one or both eyes? It may be colored (for example white, yellow, green) or clear; it may be thick or watery.
No / don't know
Mild - barely anything
Moderate - needs regular cleaning
Serious - impairs vision
Severe - difficult to open eyes in the morning
415.  Vision disturbances. Ignoring any long/short-sightedness, does your vision sometimes become blurry or otherwise distorted, for example double vision?
No / don't know
Occasionally / moderately
Often / severely
416.  Vision. Do you have general difficulty seeing, especially when the lights are dim?
Don't know
No
Some difficulty
Significant difficulty
I am blind or very nearly blind
417.  Within the past few years, have you suffered any loss of vision in one or both eyes?
It occurred a long time ago / don't know
No
Slight / barely noticeable
Significant
Severe/complete loss of vision
418.  Within the past few years, if you have suffered loss of vision, how would you describe it?
Not applicable / long time ago / don't know
General vison loss
Mainly central (foveal) vision loss
Mainly outer (peripheral) vision loss

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GLOSSARY

Cataract (Cataracts)
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.

Discharge (Discharges)
A secretion, of pus for example, from a wound or bodily orifice.

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.

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





























 
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