Female Questionnaire
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This section deals with specific eye/vision problems.


Are your eyes often irritated? This irritation may present itself as a 'sandy-gritty' feeling, the sensation of a foreign object in the eye, or watery eyes (excess tears).
  • No / don't know
  • Occasional mild irritation
  • Frequent mild / some significant irritation
  • Frequent significant / some severe irritation
  • Frequent or constant severe irritation


Are the whites of one or both of your eyes bloodshot (with red/pink veins showing)? Only answer if you have had bloodshot eye(s) for more than 2 days, and it is not from rubbing them.
  • No / for under 2 days / from rubbing / don't know
  • Significant episodes in the past
  • A little - they appear slightly red colored
  • Significantly - numerous individual red veins
  • Seriously - there is a large, very red area


Do the whites of your eyes have a more yellow (jaundiced) color than in previous weeks or months?
  • Don't know
  • No
  • Yes, a little I think
  • Definitely


Have you noticed, or have others commented, that your eyes seem to be bulging out or protruding?
  • No / don't know
  • Yes, due to past hyperthyroidism now resolved
  • Yes, due to current hyperthyroidism
  • Yes, but I don't know why


Do your eyeballs (not eyelids) jerk or move involuntarily?
  • Don't know
  • No
  • Rarely
  • Occasionally
  • Yes, frequently noticeably


Vision - poor dark adaptation. Do you have difficulty seeing things when going from the light into 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


Sensitivity to bright light. Is daylight too strong for your eyes?
  • No / don't know
  • A little - I occasionally have to shield my eyes
  • Regularly - I often need to shield my eyes
  • Usually - I need sunglasses when I go out
  • Always - I can't stand bright sun at all


Have you ever had a serious eye injury, or eye surgery?
  • No / don't know
  • Yes, but I have fully recovered
  • Yes, and I still have eye problems


Do you have Cataracts?
  • No / don't know
  • In the past only, now resolved
  • Minor (juvenile, immature, early)
  • Moderate
  • Advanced, serious


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


Are you suffering from Macular Degeneration?
  • No / don't know
  • I suspect my central vision is starting to blur
  • Moderately - my central vision is starting to blur
  • Seriously - my central vision is blurred
  • Severely - I can not read, drive, recognize faces


If you have been diagnosed with Macular Degeneration, what type is it? The most common form is Age-related Macular Degeneration (AMD).
  • I don't have it / don't know
  • Non-age-related Macular Degeneration
  • 'Dry' AMD
  • 'Wet' AMD
  • 'Dry' AMD in one eye and 'Wet' AMD in the other


Has your vision become worse within the past few years? In other words, do you have greater difficulty seeing with one or both eyes, especially when the lights are dim?
  • Don't know
  • No, my vision has remained about the same
  • Yes, it is slightly worse now (slow decline)
  • Yes, it is a lot worse now (rapid decline)
  • Yes, I have (almost) completely lost my sight


If you have suffered any loss of vision within the past few years, how would you describe it?
  • Not applicable / long time ago / don't know
  • General vision loss
  • Mainly central (foveal) vision loss
  • Mainly outer (peripheral) vision loss


Are you experiencing eye pain that was not caused by an injury? Include any burning, throbbing, aching or stabbing pain.
  • Don't know
  • No
  • In the past only
  • Yes, in one eye only
  • Yes, in both eyes


Do you have any form of constant discharge coming 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


Vision disturbances. Aside from 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