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Computer Vision Syndrome Survey

by City Eye Care
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Name
Profession
Time Spent doing near tasks (Screen Time, Hard Print Reading)
Do you have any of the following
Do you Smoke?
Do you have any eyewear? (Glasses, Contact Lens etc)
Do you know who is an OPTOMETRIST?
Have you ever heard the term "Computer Vision Syndrome"?

CVS Questions

Question

Frequency

0 - Never | 1 - Sometimes | 2 - Always

Intensity

1 - Moderate | 2 - Intense

Neck Pain

012
0
1
2
12
1
2

Burning Eyes

012
0
1
2
12
1
2

Itching Eyes

012
0
1
2
12
1
2

Feeling of Foreign Body in Eye

012
0
1
2
12
1
2

Tearing Eyes

012
0
1
2
12
1
2

Eye Redness

012
0
1
2
12
1
2

Eye Pain

012
0
1
2
12
1
2

Heavy Eyelids

012
0
1
2
12
1
2

Dryness in the Eye

012
0
1
2
12
1
2

Blurred Vision

012
0
1
2
12
1
2

Double Vision

012
0
1
2
12
1
2

Difficulty in focusing for near vision

012
0
1
2
12
1
2

Increased sensitivity to light

012
0
1
2
12
1
2

Colored Halos around objects

012
0
1
2
12
1
2

Feeling that sight is worsening

012
0
1
2
12
1
2

Headache

012
0
1
2
12
1
2

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