Vision Symptom Checklist

Quiz Questions

• 1.
  Check all symptoms that apply:

  • A.
    Skip lines while reading or copying
  • B.
    Lose your place while reading or copying
  • C.
    Skip words while reading or copying
  • D.
    Substitute words while reading or copying
  • E.
    Reread words or lines
  • F.
    Reverse letters, numbers or words
  • G.
     Use a finger or marker to keep place while reading or writing
  • H.
    Read very slowly
  • I.
    Poor reading comprehension
  • J.
    Difficulty remembering what you've read
  • K.
    Close (within 7-8 inches) to reading and/or writing material
  • L.
    Squint, close or cover one eye while reading
  • M.
    Tilt head in an unusual posture when reading or writing
  • N.
    Headaches after intense visual activities such as reading or computer work
  • O.
    Eyes hurt or feel tired after close work
  • P.
    Unusually tired after completing a visual task
  • Q.
    Double vision
  • R.
    Vision blurs at a distance when looking up from near work
  • S.
    Crooked or poorly spaced writing
  • T.
    Print moves or goes in and out of focus when reading
  • U.
    Poor spelling skills
  • V.
    Letters or lines “run together” when reading
  • W.
    Words appear to jump on the page when reading
  • X.
    Misalign letters or numbers
  • Y.
    Make errors when copying
  • Z.
    Difficulty tracking moving objects such as balls
  • A.
    Clumsiness or poor coordination
  • B.
    Difficulty with eye‐hand coordination sports such as baseball
  • C.
    An eye that turns in or out
  • D.
    One eye sees more clearly than the other, even with glasses
  • E.
    Feel sleepy while reading
  • F.
    Lose awareness of surroundings when concentrating
  • G.
    Dislike tasks requiring sustained concentration
  • H.
    Confuse right and left directions
  • I.
    Restless when working at a desk
  • J.
    You must feel things to "see" them
  • K.
    Car sickness or motion sickness
  • L.
    Excessive blinking
  • M.
    Excessive eye rubbing
  • N.
    Dry eyes
  • O.
    Watery eyes
  • P.
    Experiencing red eyes
  • Q.
    Sensitivity to light

Quiz Outcomes

• 1.
  What's Next? 

  A score of 20 or more indicates the need for a functional vision evaluation.15-20 = Possible functional vision problem21-30 = Probable functional vision problem31+ = Definite functional vision problemNow that you have taken the Symptom Checklist, if you have a score of 20 or higher, the next step is to set up an evaluation.